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COMMUNICABLE DISEASE HEAD START Joyce M. Smith M.D., MPH Slide 2 CHILD CARE / EARLY EDUCATION SETTING Group Setting Increased risk of infectious disease spread Among children Younger than 2 years Rates of Infection tend to Increase for first 6 months Rates decrease after six months of attendance Children are 2 to 18 times more likely to catch an infectious disease than non-group Slide 3 CHILD CARE / EARLY EDUCATION SETTING Adult Care Givers Increased risk of acquiring and spreading infection in the first year Spread depends on environmental and host variables Season, crowding, hygiene practices Immune status of host Virulence of germ or pathogen Slide 4 INCREASE TRANSMISSION (Short List) Otitis Media Ear infections Pneumonia Diarrhea Hepatitis A Streptococcal Infection Rotavirus Chicken pox (Varicella) Slide 5 CONDITIONS FOR TRANSMISSION Pathogen (Germ) must be present Adequate quantity present Susceptible Host Correct portal of entry Slide 6 MODES OF TRANSMISSION Airborne Droplet Direct Contact (Fecal Oral) Fomites (Common Vehicle) Bloodborne Vectorborne Slide 7 RESPIRATORY CONDITIONS COMMON COLD Pathogen Virus (many strains) Symptoms: Runny Nose, Congestion, Headache, Cough, Muscle aches Little or no fever Mode of Transmission Droplets Respiratory Slide 8 RESPIRATORY CONDITIONS COMMON COLD Incubation Period 1 to 3 days Period of Contagiousness 1 day before up to 5 days after start of symptoms Management Supportive Prevention of Spread Cover Cough, Hand Hygiene Only excluded if fever is present Slide 9 RESPIRATORY CONDITIONS PHARYNGITIS VIRAL Pathogen Viruses (Multiple Strains) Symptoms Gradual onset of sore throat, runny nose, cough + diarrhea, + fever Mode of Transmission: Respiratory, droplets, close contacts Management Supportive, pain and fever medication as indicated Slide 10 RESPIRATORY CONDITIONS STREPTOCOCCAL PHARYNGITIS Pathogen Bacteria Streptococcus Strep Throat GABHS Symptoms Rapid onset, painful swallowing, fever, headache, muscle aches, enlarged tonsils, enlarged lymph nodes Mode of Transmission Respiratory, Close Contacts Slide 11 RESPIRATORY CONDITIONS STREPTOCOCCAL PHARYNGITIS Incubation Period 1 3 days May develop scarlet fever Period of Contagiousness Treated 24 to 48 hours Untreated 10 days May lead to Rheumatic Fever Management Antibiotics within 9 days Slide 12 PHARYNGITIS Nonspecific Pharyngitis, can be produced by several pathogens. Physical exam + Lab for final diagnosis Nelsons Textbook of Pediatrics, 19 th edition Slide 13 PHARYNGITIS More erythematous (red) with petechiae on roof of mouth, suggestive of strep infection Slide 14 PHARYNGITIS White exudate on tonsils suggestive of Strep or Mono infection Slide 15 RESPIRATORY CONDITIONS CROUP Upper Respiratory Infection with partial obstruction, causing noisy breathing (stridor) and respiratory distress Causes Bark-like cough Mostly affects children 3 months to 5 years (Video of Croup) Slide 16 RESPIRATORY CONDITIONS CROUP Pathogen Usually a virus Symptoms Starts as mild cold-like illness for 1-3 days then strider and bark-like cough develop Fever can be low grade or high 102.2 104 Can become hypoxic and need hospitalization Mode of Transmission - Respiratory Slide 17 RESPIRATORY CONDITIONS CROUP Management Usually can be managed at home Keep calm, respiratory distress increases with distress and crying To Emergency Room if respiratory distress worsens Medication can be used for severe cases Slide 18 RESPIRATORY CONDITIONS EAR INFECTION (OTITIS MEDIA) Middle Ear Infection 80% of children have at least one episode of Otitis Media Peak incidence in the first 2 years of life Most cases are self-limited Pathogen Virus or Bacteria Symptoms Fever, ear pain, Slide 19 RESPIRATORY CONDITIONS EAR INFECTION (OTITIS MEDIA) Risk factors Age highest rates in 6 to 20 month old Anatomy smaller facial structures allow local spread Smoke Exposure Preventable risk factor Pacifier use Small increase Risk Breast Milk Protective affect Slide 20 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Viral Bacterial Allergic Other conditions Slide 21 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Viral and Bacterial Highly contagious Spread by touching contaminated objects (fomites) Poor hand hygiene Allergic Not contagious Usually bilateral Slide 22 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) Symptoms Redness or Pink eyes with white or yellow discharge May have ild eye pain Mode of Transmission Direct Contact Incubation Period 1 to 3 days Period of Contagiousness until redness resolves or determined to be non- contagious Slide 23 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) VIRAL Usually watery discharge Medicine.net.com Slide 24 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) BACTERIAL HAS THICK GREENISH YELLOW DISCHARGE Slide 25 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) BACTERIAL ASSOCIATED WITH YELLOW CRUSTED DISCHARGE Slide 26 COMMUNICABLE DISEASE CONJUNTIVIS (PINK EYE) MANAGEMENT Hand Hygiene- Prevent spread to other eye, prevent spread to other people Prevent progression of viral or allergic to bacterial Bacterial Antibiotic Eye Drops Viral Self limited Allergic Topical Antihistamines Slide 27 COMMON SKIN PRESENTATIONS **Measles Viral, preventable through vaccination Pathogen Symptoms Mode of Transmission Incubation Period Period of Contagiousness Management Slide 28 ***MEASLES Pathogen Measles Virus Symptoms 2 4 days of prodrome Fever, 103-105, Harsh Cough, Watery Reds Eyes, Then blotchy red rash starts 14 to 21 days post exposure on face and spreads to the body Rash lasts 4 to 7 days Mode of Transmission Highly Contagious Direct Contact with oral and nasal secretions Contaminated clothing (*** Reportable; One case reported in Illinois in 2013) Slide 29 MEASLES Incubation Period 8 to 12 days range 7 to 18 days Period of Contagiousness Slightly before prodrome until 4 days after rash develops Complications may include Pneumonia Meningitis Otitis Media Death Slide 30 MEASLES Hurwitz Clinical Pediatric Dermatology Third Edition Intensely erythematous pathches of the face with spreading inferiorly onto the trunk Slide 31 RUBELLA GERMAN MEASLES Pathogen German Measles Virus Symptoms 3-Day Measles Mild disease, mild fever, swollen glands Rash last 2 to 3 days Mode of Transmission Contact with respiratory droplets Incubation Period 14 to 21 days Period of Contagiousness Management - Immunization Slide 32 RUBELLA GERMAN MEASLES Hurwitz Clinical Pediatric Dermatology Third Edition Nonspecific rose pink macules and papules on the trunk of an adolescent male Slide 33 ***VARICELLA (CHICKEN POX) Pathogen - VZV Varicella-Zoster Virus Incubation Period 10 to 21 days Symptoms Sudden onset, mild fever itchy rash starts as maculopapular and progresses to vesicles, then crust, more develop different stages of healing, Ave about 300 lesions. Much worse in older children and adults Slide 34 ***VARICELLA (CHICKEN POX) Mode of Transmission Direct Contact with respiratory droplets and contaminated items, touching skin vesicles Period of Contagiousness 24 to 48 hours before the rash until lesions are crusted Management / Complications ***Reportable to the city Notification of parents, VZIG within 96 hours of exposure Immunizations Slide 35 ***VARICELLA (CHICKEN POX) UNIMMUNIZED CHILD Slide 36 ***VARICELLA (CHICKEN POX) BREAK THROUGH LESIONS OF IMMUNIZED CHILD Slide 37 FIFTH DISEASE (Erythema Infectiosum) Pathogen Parvovirus B19 Incubation Period 4 to 28 days Symptoms Usually benign, mild fever slapped cheek rash, progress to lacy appearance Mode of Transmission Respiratory nasal droppings Period of Contagiousness right before rash Slide 38 FIFTH DISEASE (Erythema Infectiosum) Erythema of the cheeks giving a slapped cheeks appearance Slide 39 FIFTH DISEASE (Erythema Infectiosum) Reticulate erythema lacy rash on upper arm Slide 40 HAND-FOOT AND MOUTH DISEASE Pathogen Coxsackie Virus A 16 Incubation Period Symptoms Mild Illness with low grade fever, on ulcers on Mouth and blisters Hands and Feet Mode of Transmission Period of Contagiousness Before lesions appear and for several weeks after Slide 41 HAND-FOOT AND MOUTH DISEASE Deep-seated vesicles with erythema involving the palmar surface of the hand Slide 42 HAND-FOOT AND MOUTH DISEASE A painful ulcer on the lateral aspect of the tongue Slide 43 HAND-FOOT AND MOUTH DISEASE Red to purple vesicles involving the knee Slide 44 HAND-FOOT AND MOUTH DISEASE Slide 45 WARTS (VERRUCA) Pathogen HPV Human Papilloma Virus (Multiple strains more than 200) Usually benign in children and adolescents Incidence is highest in children and adolescents Incubation Period Develop lesions one month after inoculation Symptoms Slow developing growth, sometimes painful Usually less than 3 in mm in size Slide 46 WARTS (VERRUCA) Mode of Transmission Direct contact, autoinoculation and fomites Period of Contagiousness, no limits, can be covered to avoid direct contact Management / Complications 65% disappear within 2 years Liquid Nitorgen Salicyclic Acid Compound W podophyllin Slide 47 WARTS (VERRUCA) Multiple Forms Flat Filiform Plantar Common Periungual Slide 48 COMMON WARTS (VERRUCA) A dome-shaped lesion on the nose and filliform wart down below Slide 49 COMMON WART (VERRUCA) Common Wart on the Tongue Slide 50 PLANTAR WARTS (VERRUCA) Slide 51 SUBUNGAL WARTS Verrucous papules under the thumb and index finger with extension under the nail plate Slide 52 MOLLUSCUM CONTAGIOSUM Pathogen Poxvirus Incubation Period Greater than 2 weeks Symptoms Occurs mainly on children and immune compromised adults. Discreet pearly to flesh colored dome shape papules with umbilicated center Anywhere on the body. Ave last 6 to 9 months May persist for years Slide 53 MOLLUSCUM CONTAGIOSUM Mode of Transmission Direct Contact Fomites Autoinoculation Period of Contagiousness May be present for years Management Self limited Curettage (scraping) is the treatment of choice Slide 54 MOLLUSCUM CONTAGIOSUM Solid dome shaped pearly papule Slide 55 MOLLUSCUM CONTAGIOSUM Slide 56 FUNGAL DISEASE OF SKIN TINEA Tinea Capitus (Ring Worm of the Scalp) Corporis (Ring Worm of the body) Pedis (Athletes Foot) Versicolor Intertrigo In skin folds Slide 57 FUNGAL DISEASE OF SKIN TINEA CAPITUS Pathogen Fungus Dermatophytes affect skin Incubation Period Symptoms Hair loss, Black dot hair breaks off near the scalp; Diffuse flakiness with little or no hair loss; Sever inflammatorty reactions produces kerions Mode of Transmission Direct contact with fomites Combs, brushes, chairs, hats Period of Contagiousness Ongoing without treatment Management Oral antifungal medication for 6 to 8 weeks Slide 58 FUNGAL DISEASE OF SKIN TINEA CAPITUS BLACK-DOT RING WORM Slide 59 FUNGAL DISEASE OF SKIN TINEA CAPITUS - KERION Slide 60 FUNGAL DISEASE OF SKIN TINEA CORPORIS (Body) Pathogen Fungal Dermatophyte Incubation Period Symptoms Round reddish, scaly areas that progress to centrally clean can be millimeters or centimeters in size Slide 61 FUNGAL DISEASE OF SKIN TINEA CORPORIS (Body) Mode of Transmission Direct Contact Infected Pet Period of Contagiousness As long as lesions are present Management Topical antifungal medication OTC Small lesions can be covered to decrease spreading Slide 62 FUNGAL DISEASE OF SKIN TINEA VERSICOLOR Hypopigmented minimally scaly macules and patches on trunk Slide 63 FUNGAL DISEASE OF SKIN TINEA VERSICOLOR Tinea Versicolor in dark skinned person Slide 64 BACTERIAL SKIN DISORDERS Scarlet Fever Abcesses Impetigo Slide 65 BACTERIAL SKIN DISORDERS SCARLET FEVER Scarlet fever in a dark-skinned person. The rash resembles gooseflesh. Note the beginning of desquamation Slide 66 BACTERIAL SKIN DISORDERS Post-scarlet fever desquamation. Extensive peeling of the hands following treatment Slide 67 BACTERIAL SKIN DISORDERS ABCESS (CARBUNCLE) Large, tender eythematous swelling on lateral trunk of teenager.. Note small adjacent furnacle Slide 68 BACTERIAL SKIN DISORDERS IMPETIGO (BULLOUS) Multiple tender eythematous patches with a peripheral collarette representing the remnants of the blister roof Slide 69 BACTERIAL SKIN DISORDERS IMPETIGO These multiple lesion have spread as a result of autoinoculation Slide 70 INFESTATIONS LICE Head Lice Scabies Slide 71 INFESTATIONS HEAD LICE Pathogen- Insect (Pediculosis) Incubation Period Eggs hatch in seven to ten days Symptoms Scratching of head Identification of nits (eggs) attached to hair and lice present Mode of Transmission Direct contact with an infested person, clothing or article Period of Contagiousness As long as eggs are not treated Management Application of 1% Permethrin Creme leave on 10 mintues then wash out Consider second treatment 1 2 weeks later Slide 72 INFESTATIONS HEAD LICE Nits and Lice Visible on hair Slide 73 INFESTATIONS SCABIES Pathogen Body Lice Arthropods Mite Obligate human parasite Incubation Period Two to six weeks first time One to four days future infestations Symptoms Itching, scratching, papulosquamous lesions Slide 74 INFESTATIONS SCABIES Mode of Transmission Direct contact with infested individuals Possibly fomites Period of Contagiousness Until 24 hours after treatment Management Application of Permethrin Wash off in 8 hours Slide 75 INFESTATIONS SCABIES Slide 76 INFESTATIONS SCABIES Slide 77 INFESTATIONS SCABIES Scabies lesions with burrows of egg deposits under the skin Slide 78 INFESTATIONS SCABIES Slide 79 COMMUNICABLE DISEASES QUESTIONS? Slide 80 References Hurwitz: Clinical Pediatric Dermatology, third edition Nelsons Textbook of Pediatrics, 19th edition Communicable Disease Guide, Illinois Department of Public Health 2002 Web M.D.