Infectious Diseases

Question 1

Natural (innate)

Immunity

Answer 1

1. Present at birth
2. Examples: skin & mucous membranes, intestinal flora & gastric acidity.

Question 2

Natural (aquired active)

Immunity

Answer 2

1. The immune system actively makes antibodies after exposure to disease.
2. This protection lasts for life, at least partially.
3. High risk of side effects excists because the child has the disease.

Question 3

Natural (acquired passive)

Immunity

Answer 3

1. No active immune process is involved; the antibodies are passively received.
2. The antibodies are acquired through placental transfer via IgG (the smalles immunoglobulin) and breast-feeding (colostrum).

Question 4

Artificial (acquired active)

Immunity

Answer 4

1. Medically engineered substances are inhaled or injected to stimulate the immune response against a specific disease.
2. Examples include all immunizations.

Question 5

Artificial (aquired passive)

Immunity

Answer 5

1. Antibodies are injected without stimulating the immune response.
2. The antibodies (immuneoglobulin) are used as antitoxins or for prophylaxis.
3. The antibodies provide immediate prodection that lasts for weeks, especially for those who are immunocompromised.
4. Examples include gamma globulin (a mixture of antibodies against disease that are prevalent in the community, pooled from 8,000 donors of human plasma) and hyperimmune or convalescent serum globulin (such as a tetanus immune globulin, hepatitis B immune globulin, and varicella-zoster immune globulin).

Question 6

Stages of Infectious Diseases

Answer 6

1. Incubation period: the time between the invasion of the organism and the development of first symptoms; a time of replication of the organism within the body
2. Prodromal period: the time between the onset of nonspecific signs and symptoms such as fever and malaise and the disease-specific symptoms
3. Communicability period: the stage when the disease is transmissible to others
4. Illness stage: the period when disease-specific symptoms are manifested
5. Convalescent period: the time between the disappearance of disease-specific symptoms and the complete return to wellness

Question 7

Live (attenuated)

Vaccines

Answer 7

1. A live organism, grown under suboptimal conditions, results in a live vaccine with reduced virulence.
2. The vaccine confers 90% to 95% protection for 20+ years with a single dose, although some now need a booster.
3. It promotes a full range of immunologic responses.
4. The organisms for the vaccine are modified by heat or chemicals but still retain their ability to replicate and stimulate immunity.
5. Examples include measles, mumps, and rubella (MMR) vaccine, varicella vaccine, rotavirus and live attenuated influenza nasal spray.
   a. Do not administer to those with a weakened immune system, such as those undergoing chemotherapy.

Question 8

Inactivated

Vaccines

Answer 8

1. An inactivated vaccine offers a weaker response than a liver vaccine, necessitating frequent boosters.
2. A toxoid is treated with formalin or heat and rendered nontoxic but still antigenic; it provides 90% to 100% protection.
3. A killed vaccine does not promote replication because it only involves the cell wall; it provides 40% to 70% protection.
4. Genetically engineered/recombinant DNA technology can use the smallest part of the antigen needed to stimulate immunity, thus significantly decreasing the side effects.
5. Examples of inactivated vaccines include the diptheria and tetanus toxoids, the acellular pertussis vaccine, inactivated polio vaccine, hepatitis B vaccine, and the inactivated influenza vaccine.

Question 9

Vaccine Schedule

Answer 9

Schedule
1. updated annually at www.cdc.gov/vaccines

Timing of doses and cautions
1. Vaccines generally require at least 4 weeks between doses; some require more.
2. Boosters are used to maintain optimal titers of antibodies by stimulating antigenic memory.
a. The primary response takes 10 to 14 days to develop an antibody titer.
b. The booster response takes 1 to 3 days to reach a high antibody titer.
c. Boosters are determined to provide the optimal protection during a time when the child is at the greatest risk for suffering the sequelae of the disease.
3. Review the child’s immunization status at every health encoungter.
4. If the schedule is interrupted, do not repeat earlier doses; continue the schedule according to previous guidelines.
5. Identify contraindications to the administration of given vaccines and seek further evaluation of the child before immunizations are given. These include the following:
a. A history of life-treatening reaction or allergy to a previous dose of the vaccine; ask which side effects (if any) the child had from the last immunization and when the symptoms occured.
b. Moderate to severe acute illness; not not vaccinate if the child has an elevated temperature; this side effect of the vaccine would be difficult to differentiate from an exacerbation of the original condition.
(1) Reschedule vaccine administration when the child is well.
c. Immune suppression (including receipt of chemotherapy or gamma globulin within the past 6 weeks).
d. Pregnancy for some vaccines.
e. Withhold the pertussis vaccine if the child has a progressive and active central nervous system problem; the child with cerebral palsy can receive all vaccines.
f. Measles, mumps, and rubella should be withheld if child has a life-treatnening allergic reaction to gelatin or neomycin; polio vaccine also should be withheld if there is a life-threatening allergic reaction to neomycin, streptomycin, and polymyxin B.
g. Heptatitis B vaccine should be withheld if the child has a life-treatening allergic reaction to baker’s yeast.
6. Administer the greatest possible number of immunizations at each health encounter; all active vaccines may be administered simultaneously with different needles and at different sites.
a. Use vastus lateralis (anterolateral thigh) site in the infant up to 12-18 months; avoid deltoid site in infants because of small muscle mass and the potential for nerve damage.
b. Use deltoid for those older than 12-18 months if there is enough muscle, and vastus lateralis for any age.
c. Multiple vaccines administered at the same time is safe and does not increase the likelihood of experiencing side effects. However, do not mix vaccines that do not already come mixed and give injections in different sites.
7. Side effects from bacterial vaccines typically occur within hours and days of the vaccine; side effects from live virus vaccines typically occur 2 to 4 weeks after administration and may mimic the symptoms of the disease. Do not give antipyretics prior to vaccination administration in order to identify whether side effects occur.
8. The first MMR vaccination is scheduled between 12 and 15 months to prevent interference with maternal antibodies that develop a protective titer.
a. During an epidemic, give the measles vaccine to the child as young as age 6 months, but this dose will not count toward the two required doses.
9. Active and passive vaccines are seldom given at the same time, except for tetanus, because a passive vaccine can inhibit the production of a protective titer.
10. Cutting doses in half is not effective and does not count as a dose of the immunization and does not decrease the incidence of side effects.
11. Do not give the tuberculosis (TB) purified protein derivative test and the measles vaccine at the same time; the measles vaccine may make a TB-positive individual appear to be TB negative.
12. Illness with Hib in the young child does not confer immunity; immunization is still required through age 5.
13. Vaccines are no longer given when the risk of side effects is greater than the risk of sequelae from getting the disease.
14. Pediatric vaccines no longer contain thimerosal because of mercury and its potential effect on neurologic development.

Question 10

Storage of vaccines

Answer 10

1. Light can inactivate the MMR vaccine viruses. Once reconstituted, protect from light, refrigerate but do not freeze, and use within 8 hours.
2. Influenza vaccine should never be frozen.
3. Varicella vaccine should be frozen and protected from light; it can be refrigerated for 72 hours; once reconstituted, use within 30 minutes.

Question 11

Parent-child education of vaccines

Answer 11

**Review signs and symptoms:
1. High fever
2. Behavioral changes

Severe adverse reaction
1. Difficulty breathing
2. Hoarseness or wheezing
3. Hives
4. Pallor
5. Lethargy
6. Dizziness
7. Tachycardia**

Question 12

Diphtheria

Bacterial Infection

Answer 12

1. Caused by bacteria that proliferate in the respiratory tract and multiply on dead tissue in the throat, producing exotoxin and exudate consisting of a tough fibrous membrane (pseudomembrane) across the respiratory tract; this results in mechanical airway obstruction; rare in the United States.
2. More serious in infants
3. Can cause renal, cardiac, and nervous system damage

Interventions
1. Follow droplet precautions; administer antibiotics as ordered; maintain bedrest; use suctioning as needed; administer humidified oxygen as prescribed.

Question 13

Tetanus (lockjaw)

Bacterial Infection

Answer 13

1. Caused by anaerobic spore-forming bacteria that produce an exotoxin, which is present in soil, house dust, and animal feces.
2. The exotoxin is introduced through the skin, such as puncture wound, burn, or crush injury.
3. It reaches the axons of the nerves, causing voluntary muscle contraction, muscular rigidity, and painful paroxysmal seizures.
4. There is no transplacental immunity; attacks are equally dangerous in adults and children.
5. There are approximately 30 cases of tetanus a year in the United States, but the mortality rate is 11%.
6. First symptoms are trismus (lockjaw) and difficulty swallowing.
7. It can cause laryngospasm, respiratory distress, intramuscular hemorrhage, and death.

Interventions
1. If the child has a clean wound, has completed the primary series, and has boosters less than 5 years old, no treatment is needed other than cleaning the wound.
2. If the wound is contaminated, the immunization series is complete, and immunization was 5> years ago, administer a toxoid (Td).
3. If the child has a contaminated wound and an incomplete initial series of immunizations, or if the child’s immunizations are more than 5 years old, give the toxoid and immunoglobulin.

Question 14

Pertussis (whooping cough)

Bacterial Infection

Answer 14

1. Pertussis is caused by bacteria that proliferate in the respiratory tract.
2. It is transmitted primarily by intimate respiratory contact and is highly contagious.
3. Major breakouts occur in the United States.
4. The classic sign is paroxysmal or spasmodic cough that ends in a prolonged inspiratory whoop; cough can last for weeks.
5. Respiratory distress can result in anoxia during coughing spasms, with cyanosis and loss of consciousness.
6. The disease can result in encephalopathy (seizures, apnea, intellectual disability, hernia, stroke), pneumonia, and death (risk of death decreases with increasing age).
7. Incubation period is 6 to 20 days.

Interventions
1. Droplet and standard precautions
2. Maintain patent airway; keep suctioning and ventilation (bag and mask) equipment available.
3. Maintain bedrest until coughing subsides.
4. Administer erythromycin as ordered.

Vaccine: Diptheria, acellular pertussis, and tetanus
1. Four doses during infancy and one at school entry
2. One additional dose for adolescents
3. Contraindications: active unresolved neurologic conditions (e.g., seizures and progressive encephalopathy); previous dose that resulted in collapse or shock-like state or persistent inconsolable crying for 3 hours within 48 hours of dose

Question 15

Haemophilus Influenza, type b (Hib)

Bacterial Infection

Answer 15

1. Prior to the vaccine (1985), Hib was the leading cause of serious bacterial disease (bacterial meningitis, epiglottits, sepsis, and cellulitis) in U.S. children under 5 years of age.
   a. Sixty percent of those affected are under 1 year of age.
   b. Hib is not common in older children and adults; most Hib dease strikes infants who are not immunized; especially common in day care settings.
   c. Transmission is through respiratory droplets; rarely spread through contact with environmental surface.
2. Mortality rate is 3% to 7% with increased morbidity (deafness, intellectual disability, ataxia).
3. Vaccine: Three to four doses during infancy

Interventions
1. Droplet and standard precautions
2. Administer antibiotics as ordered.
3. Promote hydration
4. Care depends on system involved

Question 16

Sepsis (septicemia)

Bacterial Infection

Answer 16

1. A generalized bacterial infeciton in the bloodstream.
2. Infants, particularly under 1 month of age, are at risk because of their immature immune systems.
3. Mortality related to sepsis has diminished, but the incidence remains constant.
4. Group B streptococci and Escherichia coli are the most common causes of neonatal sepsis.
5. Central line sepsis: prevention through aseptic care of the central line

Assessment
1. Neonates and young infants

a. Prodromal stage
1. Fever or hypothermia
2. Poor feeding
3. Lethargy/increased sleeping
4. Irritability

  b. *Illness stage*
	   1. Pallor
	   2. Cyanosis
	   3. Temperature instability
	   4. Tachycardia
	   5. **Hypotension**
	   6. Apnea
	   7. Dehydration
	   8. Tense fontanel
	   9. Seizures

2. Children
   a. Prodromal stage
   1. Fever
   2. Malaise
   3. Stiff neck
   4. Headache

Interventions
1. Monitor and support cardiorespiratory function.
a. provide airway/ventilation equipment at the bedside
b. monitor for signs and symptoms of shock such as decreased level of consciousness and hypotension; note that hypotension is a late and ominous sign in the pediatric patient.
2. Assist with collection of blood, urine, and cerebrospinal fluid cultures as needed.
3. Administer antibiotic therapy as ordered.

Question 17

Methicillin-Resistant Staphylococcus aureus (MRSA)

Bacterial Infection

Answer 17

1. Skin infections (pimples that become pustules, abscesses, and boils that are red, swollen, painful and have pus or other drainage) often at sites of visible skin trauma, such as cuts and abrasions and areas covered by hair.
2. Transmitted by direct skin-to-skin contact with shared items or surfaces that have come into contact with someone else’s infection, such as gym mats and towels. (Immunosuppressed childrena re at highest risk).

Interventions
1. Cover skin lesion with a dry bandage until healed; the child does not need to be excluded from school unless drainage cannot be contained.
2. Avoid sharing personal items (towels, razors) that come in contact with bare skin; disinfect gym equipment immediately after use before next person uses it.
3. Practice good handwashing
4. Contact precautions

Question 18

Tuberculosis

Bacterial Infection

Answer 18

1. Caused by Mycobaterium tuberculosis.
2. Respiratory spread, usually ffrom a household member or someone frequently in the home.
3. Can be in the lungs or disseminate to other sites, such as the brain, bone, and kidneys; dissemination is called miliary TB.
4. High-risk groups should be tested include those with known contact with someone wtih TB, children who were born in or have traveled to countries where TB is endemic, and those exposed adults engaging in high-risk activities (IV drug use) or in high-risk environments (jails, homeless settings, migrant farm workers).

Assessment
1. Most children are asymptomatic.
2. Symptoms may reflect the organ involved or may appear as flu symptoms.
3. First indication may be a positive purified protein derivative TB test (TST).

Interventions
1. Latent TB infection (LTBI) is treated with isoniazid (INH); TB disease is treated with INH, rifampin, ethambutol and pyrazinamide. Treatment is critical because 10% of those with LTBI will go on to develop TB disease in their lifetime.
2. These cases are reported to the public health department; it will provide guidance if any environmental restritions are needed.
3. Droplet (airborne) precautions

Question 19

Scarlet Fever

Bacterial Infection

Answer 19

1. Caused by Group A B-hemolytic streptococci usually from nasopharyngeal secretions of infected person and carrier.
2. Prodromal symptoms: abrupt high fever, tachycardia, vomiting, headache, chills.
3. Symptoms: enlarged tonsils, edematous, reddened, and covered with patches of exudate; during first 1-2 days tongue is coated with papillae become red and swollen (white strawberry tongue); by 4-5 days white coat sloughs off, leaving prominent papillae (red strawberry tongue); palate is covered with erythematous punctate lesions; rash appears within 12 hours after prodromal signs, red pinhead-sized punctate lesions rapidly become generalized but are absent on face, which becomes flushed with striking circumoral pallor; by end of first week desquamation begins (fine sandpaper-like on torso, sheet- like sloughing on palms and soles) which may be complete by week 3 or longer.
4. Interventions: antibiotics, rest, comfort measures, oral hydration, discard toothbrush, avoid sharing drinking and eating utensils

Question 20

Rubeola (measles)

Viral Infection

Answer 20

1. Respiratory tract virus that lasts 10 days; highly contagious
2. Prodromal symptoms; fever, malaise, a harsh, rasping cough, conjunctivitis, and coryza
3. Later symptoms; maculopapular, red, pruritic rash; photophobia, and Koplik spots on the buccal mucosa
4. Potential consequences; bacterial superinfections, such as pneumonia and encephalitis with possible intellectual disability, subacute sclerosing panencephalitis, and death
5. Vaccine: 2 doses of Measles, Mumps, and Rubella (MMR) [first dose 12-15 months; second dose 4-6 years]
   a. Avoid vaccine if pregnant, immunosupporessed, or have anaphylactic reaction to neomycin or gelatin.
   b. Administer TB test at same time as MMR or delay for 4 weeks after MMR is given.
   c. Side effects: 2 weeks after administration may develop fever, measles-like rash or arthralgia.

Interventions
1. Promote hydration, prevent scratching and infeciton, promote darkened room to ease photophobia, Vitamin A may be ordered to prevent eye damage, airborne precautions.

Question 21

Rubella (German Measles)

Viral Infection

Answer 21

1. Respiratory tract virus that lasts 3 days
2. Symptoms: subauricular and suboccipital lymphadenopathy; a pink mild maculopapular rash
3. Intervention: comfort measures or fever and pruritis;
4. Airborne precautions
5. Potential consequences: arthralgia and arthritis, idiopathic thrombocytopenia purpura, and encephalitis.
6. Congenital rubella syndrome
   a. Seen in infants whose mothers contracted rubella during pregnancy.
   b. Results in growth retardation, intellectual disability, cataracts, deafness, and cardiac anomalies.

Question 22

Parotitis (mumps)

Viral Infection

Answer 22

1. Respiratory tract virus, usually lasting 7 to 10 days
2. Symptoms: swelling in the parotid glands and painful swallowing
3. Potential consequences: aseptic meningitis, orchitis, and epididymitis in older males, nerve deafness, and encephalitis

Interventions
1. encourage fluids, refrain from acidic food and drink due to swallowing difficulty
2. topical application of cold packs to swollen parotid glands
3. droplet and contact precautions
4. analgesics for pain and antipyretics for fever

Complications: aseptic meningitis, orchitis, and epididymitis in older males, nerve deafness, and encephalitis

Question 23

Poliomyelitis (polio)

Viral Infection

Answer 23

1. Fecal-oral enterovirus that replicates in the gastrointestinal tract and then enters the blood; spread by contaminated saliva, feces, sewage, or water
2. Symptoms: initially, a stiff neck and muscle pains, followed by neve cell damage and asymmetrical flaccid paralysis; no sensory deficit
3. Oral, live attenuated vaccine no longer given in the United States because of live virus being excreted in stool and resulted in vaccine-associated paralytic polio in unprotected individuals
4. Vaccine: 4 doses of inactivated polio vaccine
   a. Do not give if child has anaphylatic reactions to neomycin, gelatin, or polymyxin B
   b. Interventions: supportive care, contact precautions

Question 24

Varicella (chickenpox)

Viral Infection

Answer 24

1. Respiratory herpes zoster virus; no protection provided from maternal antibodies.
2. Highly contagious from 1 to 2 days before the appearance of a rash until all the blisters are all dried up, which usually takes 4 to 6 days after the rash appears; incubation period = 21 days
3. Symptoms: pruritic vesicular rash beginning on the trunk and going proximodistally
   a. The lesions occur in all stages at the same time; they then crust and scab. Hallmark is that they appear on mucus membranes such as the mouth.
   b. The scabs are not infectious.
   c. The child may return to school when all of the lesions have scabbed.
4. Potential consequences: bacterial superinfections, pneumonia, encephalitis, Reye syndrome, and shingles
5. Do not give aspirin or other salicylates. There is a high association between the administration of aspirin during varicella infection and the development of Reye syndrome, an acute encephalopathy with cerebral cortex swelling but without inflammation, accompanied by fatty changes in the liver and impaired liver function and hyperammonemia.
6. Interventions:
   a. Keep the child’s nails short to prevent scratching.
   b. Pat (do not rub) the sores.
   c. Apply calamine lotion.
   d. Give lukewarm otameal baths.
   e. Administer antihistamines.
   f. Dress the child in light, loos-fitting clothes.
   g. For high-risk groups who are immunocompromised and exposed to varicella, administer Varicella Immune Globulins within 10 days of exposure.
   h. Airborne and contact precautions.
7. Vaccine: 2 doses (12-15 months and 4-6 years)
   a. Effective for postexposure prophylaxis if given within 3 days
   b. Do not give to those immunosuppressed, pregnant and with anaphylactic reactions to neomycin or gelatin

Question 25

Rotavirus

Viral Infection

Answer 25

1. Most common cause of severe diarrhea in infants and children
2. Virus is stable and remains viable for weeks or months if not disinfected.
3. Virus enters the body through the mouth; replicates in small intestine; droplet and contact isolation is essential.
4. Incubation period less than 48 hours.
5. Symptoms: mild to severe diarrhea, fever, vomiting; can lead to dehydration, metabolic acidosis, and electrolyte imbalance
6. Effective vaccine available for infants
   a. Side effects are mild, mimic the symptoms of the disease, and occur within 7 days.
   b. Give doses between 2 and 8 months of age.
7. Interventions: Oral rehydration, contact precautions, comfort measures.

Question 26

Fifth disease (erythema infectiosum)

Viral Infection

Answer 26

1. Caused by parvovirus B19
2. Transmission by droplet; most contagious before the rash appears - either during the incubation period or when experiencing only mild respiratory symptoms; once the rash appears and the child feels well, they may return to school, as they are no longer contageous.
3. Incubation of 6 to 14 days
4. Signs and symptoms: intensely red facial rash, forming a “slapped face” appearance that eventually fades; rash on the extensor surfaces of extremities 1 day later and lasting 1 or more weeks.
5. Interventions: comfort measures, analgesics as ordered, cutting child’s fingernails to avoid injury from scratching, lukewarm water baths with baking soda or oatmeal to soothe itching.
6. Droplet or standard precautions.

Question 27

Mononucleosis

Viral Infection

Answer 27

1. A self-limiting viral infection transmitted by direct contact of oropharyngeal secretions
2. Usually caused by the Epstein-Barr virus; may also be due to cytomegalovirus
3. Incubation period of 2 to 6 weeks
4. Prevalent among adolescents, but can occur in young children
5. Signs and symptoms: complete blood cell count shows atypical monocytes, positive Monospot test, splenomegaly, hepatomegaly, possible lymph node enlargement, sore throat, and lethargy
6. Interventions: comfort measures, rest, fluid intake, avoid contact sports to prevent splenic rupture (splenomegaly may persist for weeks after the acute phase)

Question 28

Hand-Foot-and-Mouth Disease

Viral Infection

Answer 28

1. Spread person-to-person through respiratory droplet, the resulting blisters, and feces
2. Assess for fever, painful mouth sores and maculo-papular skin rash, often on the palms of teh hands and soles of the feet.
3. interventions: Assure adequate hydration and pain relief; wash hands to avoid spread

Question 29

Roseola Infantum (Exanthem Subitum)

Viral Infection

Answer 29

1. Generally limited to children <3 years old with peak age 6-15 months
2. Human herpesvirus type 6
3. Possibly acquired from saliva of healthy adult; entry via nasal, buccal, or conjunctival mucosa
4. Symptoms: persistent high fever for 3-7 days in child who appears well; then drop in fever with appearance of rash. Rose-pink non-pruritic macular rash appearing first on trunk, then spreading to neck, face and extremities, fades with pressure, lasts 1-2 days
5. Interventions: Comfort measures, antipyretics to control fever, Standard precautions

Question 30

COVID-19

Viral Infection

Answer 30

1. Also calledthe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); multiple variants exist
2. Transmission: respiratory spread; contagious for 20 days, including 4-5 days before symptoms begin
3. Incubation period: 1-14 days
4. Symptoms: fever, cough, headache, fatigue, nasal congestion, respiratory difficulty, loss of smell and taste; 1/3 have no symptoms
5. Prevention: handwashing, social distancing, use of face masks

Question 31

Pneumococcal Disease

Answer 31

1. This is now the most common cause of vaccine-preventable death.
2. It causes meningitis, sepsis, pneumococcal pneumonia, ear infections.
3. There is increased incidence in day care settings.
4. There is increased incidence of antibiotic resistance.
5. Pneumococcus is also known as streptococcal pneumonia.
6. There are 90 different serotypes, but 7 account for 80% of invasive disease.
7. The disease is spread by respiratory droplets.
8. Vaccine is especially important for those with chronic conditions, especially asplenia, sickle cell disease, and immune suppression.

Question 32

Lyme Disease

Tick-carried Infection

Answer 32

1. The most common tick-borne disorder
2. Symptoms
   a. Tick bite followed in 3 to 30 days by erythema at the bite site; this area increases in size over several days to reach 12 inches across and looks like a bulls-eye (starts on day 7) with a red outer ring, a central area of clearing, and a red center (erythema migrans).
   b. Development of headache, fatigue, anorexia, stiff neck, and fever
   c. Progresses to systemic involvement 2 to 11 weeks later
   (1) Neurologic symptoms (Bell’s palsy, aseptic meningitis)
   (2) Cardiac conduction problems
   (3) Musculoskeletal symptoms (arthritis)

Interventions
1. Prevention is the best treatment…
a. Wear long pants and shirt while in wooded areas. Also, insect repellent with at least 20% DEET.
b. Shower with soap after being in wooded areas or near outside pets that have been in these areas.
2. Admin antibiotics (amoxicillin or erythromycin).

Question 33

MMR Vaccine

Answer 33

1. As long as the infant is over the age of 6 months, it is recommended that the child receive an extra dose of MMR in the case of a measles outbreak. In the case of a measles outbreak, children under 12 months should recieve an extra dose of MMR, but this dose should not replace the scheduled first dose at 12-15 months.
2. Normally, it is not recommended for an infant to receive the first dose of MMR until 12 to 15 months (due to the presence of maternal antibodies prior to 12 months).
3. 2 doses of Measles, Mumps, and Rubella (MMR) [first dose 12-15 months; second dose 4-6 years]
   a. Avoid vaccine if pregnant, immunosupporessed, or have anaphylactic reaction to neomycin or gelatin.
   b. Administer TB test at same time as MMR or delay for 4 weeks after MMR is given.
   c. Side effects: 2 weeks after administration may develop fever, measles-like rash or arthralgia.
4. Live (attenuated) examples include measles, mumps, and rubella (MMR) vaccine, varicella vaccine, rotavirus and live attenuated influenza nasal spray.
   a. Do not administer to those with a weakened immune system, such as those undergoing chemotherapy.
5. Storage: Light can inactivate the MMR vaccine viruses. Once reconstituted, protect from light, refrigerate but do not freeze, and use within 8 hours.

Question 34

Red man syndrome

Answer 34

a common reaction to the administration of vancomycin, is characterized by flushing and a puritic erythematous rash to the upper extremities and torso. It is managed by slowing the rate of administration of the medication and the administration of diphenhydramine.

Question 35

Infant born to HIV-positive woman

Answer 35

An HIV-positive woman who is treated with an antiretroviral (ARV) during pregnancy, avoids breastfeeding, and avoids feeding her baby premasticated (prechewed) food will have only a 1-5% risk of transmitting HIV to her baby. However, at birth, the HIV status of an infant born to an HIV-positive woman cannot be confirmed due to the presence of maternal antibodies. Infants born to HIV-positive women, should receive AZT and Bactrim during infancy until the HIV status is confirmed. Typically, confirmatory tests for HIV status are performed using virologic testing during the first six months of life to determine the baby’s HIV status.

Question 36

Caring for a child with HIV

Answer 36

HIVis only spread by an exchange of body fluid, including breast milk. A 10% solution of household bleach in water applied over one minute will kill HIV outside the body.

Question 37

An increased estimated serum sedimentation rate (ESR) indicates which of the following?

a. Red bone marrow activity is depressed.
b. Hyperactive bone marrow activity
c. An inflammatory process is present in the body
d. increased hemolysis of red blood cells

Answer 37

c

The ESR is a test that reflects an inflammatory process in the body. Bone marrow activity is reflected by the reticulocyte count. An indirect reflection of red blood cell hemolysis is reflecte dby unconjugated bilirubin, a byproduct of red blood cell hemolysis.