Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 1 of 16

CHILH!! I""#$I%&'I!$(
'he introduction of vaccines against childhood diseases such as measles, mumps, rubella,
polio, )hooping Cough *pertussis+, diphtheria, smallpo,, haemophilus influen-a,
hepatitis b and varicella has greatl. improved the /ualit. of life for both children and
adults0
Vaccines need to be administered at specific ages and time intervals, timing for the first
sets of immuni-ations is determined b. the age in )hich transplacental immunit.
decreases or disappears, and the infant has the abilit. to ma1e antibodies in response to
the disease0
'he effectiveness of vaccines depends on proper storage and handling0 "ost vaccines
need to be refrigerated and Variva, *for varicella+ needs to be 1ept fro-en, )hen involved
in the administration of vaccine, the 2$ is responsible for both the proper storage and
handling0
'3P4( !5 I""#$I%&'I!$(
Live attenuated *live virus+ can cause illness
o ""2, Variva,
Inactivated *1illed virus vaccine+
o 'aP (Diptheria, Tentanus, accelerated Pertussis), Hi6 (influenza),
IPV (polio), Prevnar (pneumococcal disesases)
2ecombinant *geneticall. rendered+
o Hep &, 6
Immunoglobulins *IVI7+
o Varicella, "easles, 2(V, 2abies, 'etanus, hepatitis &, 6, C 6otulism
P4I&'2IC $#2(I$7 24(P!$(I6ILI'I4( &$ $#2(I$7 I$'42V4$'I!$(
6e prepared for life8threatening reaction whenever immuni-ing children0
&t ever. visit9encounter child:s immuni-ations record should be revie)ed0
2evie) of child:s allergies *food and medicine+0
2evie) potential contraindications to each vaccines
2evie) past immuni-ation histor. for past reactions
&ssess child for an,iet. and fear related to administration
!btain informed consent0
In females of child bearing age *118;0+ perform rapid urine HC7 before
administering Live vaccines *""29Varicella+0
Parent and patient education about the need for specific vaccinations, ris1 of not
getting vaccination and getting dieses and potential side effects of vaccine0
2ecord vaccines administered in patients chart and vaccine record *card+
5ederal la) re/uires that patient and parent are given VI( *vaccine information
statement+ in &PP2!P2I&'4 language before discharge0
"onitor child for 1; minutes post vaccination0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page < of 16
2eport all vaccine related reactions using the federal V&42( *vaccine adverse
reaction reporting s.stem+ and as per institution polic.0
'hings to have on hand )hen administering immuni-ations:
o 4pinephrine
o 6enadr.l
o &ir)a.
'aP V&CCI$4: IPH'H42I&, '4'&$#(, aC4LL#L&2 P42'#((I(
&ges: <, =, 6, 1;81> months?
=86 .ears )ith a separate 'd *tetanus booster+ at age 1181<.?
'd booster ever. 10 .ears for life?
'otal ; doses0
2oute: I"
Common side effects: 2edness, s)elling, pain at in@ection site? ' A1000B? dro)siness,
anore,ia0
(erious side effects: &naph.la,is, shoc1 or collapse, fever A 10<, persistent,
inconsolable cr.ing, sei-ure, encephalopath.0
Contraindications: !ccurrence of a serious side effect after previous dose0
$#2(I$7 C!$(I42&'I!$( 'aP V&CCI$4
#se the same brand )henever possible0
Carefull. /uestion parents if the. sa. the child had previous reaction to
immuni-ations
Inform parents of increased ris1 of reaction to doses = and ;
If child had a serious adverse reaction to an. previous dose, the ne,t doses should
be deferred0
This is the one children have reactions to.
IPH'H42I&
& bacterium that occurs in )inter0 (.mptoms can be mild C severe )ith a gradual onset
*18< da.s+0 Lo)8grade fever, malaise, anore,ia, rhinorrhea *)ith foul odor+, hoarseness,
stridor, cervical l.mphadenitis, phar.ngitis0
'here is a characteristic membrane that covers the tonsils, it is a membranous thic1 bluish
)hite to gra.ish blac1 in color, can spread to the soft D hard palates0 &n. attempt to
remove the membrane results in significant bleeding0
'reatment : &dministration of IV antito,in )ithin E da.s of onset of s,0 &lso PC$
7 and surgical removal of membrane if occluding air)a.0
"aternal antibodies last as long as 6 months
'ransmission : Contact )ith infectious nasal or e.e discharge, unpasturi-ed mil1
can also serve as a mode of transmission0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page E of 16
Complications : Produces an endoto,in that causes m.ocarditis, peripheral
neuropath. and a ascending paral.sis *similar to 7uillain86arre s.ndrome+0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page = of 16
P42'#((I( *FH!!PI$7 C!#7H+
"ost common in children under 6 months of age
!ccurs fre/uentl. in HC )or1ers and adults that are immunosuppressed, adults
have mild illness but spread to nonimmuni-ed 1ids0 (tarts )ith runn. nose
follo)ed b. an irregular, non8productive cough, cough becomes severe at night
and changes into spasms of paro,.smal coughing follo)ed b. inspirator. stridor
or G)hoopingH, the )hooping sound is produced b. forceful inhalations and a
narro)ed glottis0 Non-stop coughing.
&ccompanied b. flushing, c.anosis (from coughing fits), vomiting, and profuse
drainage from e.es, nose, and mouth0
eh.dration ma. occur from decreased P! inta1e0
Paro,.smal coughing ma. last up to < )ee1s0
'reatment: er.throm.cin
'4'&$#(
Characteri-ed b. painful muscular rigidit., usuall. of the mastoid bone and nec1
muscles0
'etanus spore are found in soil, dust and the gut of humans and animals0 'etanus
is not an invasive organism but enters a susceptible host through an opening in the
s1in, usuall. a puncture )ound, burn or crushed in@ur.0
In the ne)born, infection ma. occur through the umbilical cord *)hen child is
delivered in an unsanitar. )a. using a Gdirt.H instrument to cut the cord+0
(ubstance abusers are particularl. susceptible through using contaminated
in@ectable drug e/uipment0
!rganism multiples and gro)s rapidl. in GuncleanH )ound and the endoto,in
affects the C$(, there are several forms of 'etanus but the most common form is
the most lethal0
Initial s, : stiff nec1, tenderness of the muscles in the @a) D nec1, eventuall. all
voluntar. muscles are affected, complete recover. is possible
"ortalit. is about E0I, infections in the ne)born are almost al)a.s fatal0
P!LI! V&CCI$4
!PV: !ral polio vaccine, live virus 8 $! L!$742 #(4 I$ #(&0
IPV: Inactive Polio Vaccine, 1illed virus0
&ges: <, =, 681> months, booster at =86 .ears0 'otal = doses
2oute: (J
Common side effects: ()elling and tenderness at in@ection site, irritabilit.0
(erious side effects: &naph.la,is
Contraindications: H.persensitivit. to vaccine components, allerg. to neom.cin,
streptom.cin and pol.m.,in 6
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page ; of 16
0
P!LI!"34LI'I(
E identified t.pes and a G)ild8t.peH0
Polio affects the C$( and causes paral.tic disease0
Causes fever, headache, decreased deep tendon refle,es, progressive )ea1ness
and paral.sis0
'he paral.sis results from damage to neurons? onset of paral.sis ma. be sudden
or gradual *E8 ; da.s+ and is accompanied b. respirator. difficulties leading to
respirator. distress and respirator. failure0
Pt )ill re/uire intubation9tracheostom. and mechanical ventilation
!PV: !ral polio vaccine, live virus vaccine0 Virus is e,creted in stool0 No longer used in
the U.S.
Complications of Polio: Permanent motor paral.sis, respirator. arrest, m.ocardial failure,
aseptic meningitis0
""2 V&CCI$4: "4&(L4(, "#"P( D 2#64LL& 8 Combination Live Vaccine
&ges: 1<8 1; months, =86 .ears (Total 2 doses)
2oute: (J
Common side effects: 4levated temperatures 18< )ee1s after immuni-ation,
redness9pain at in@ection site, @oint pain0
(erious side effects: &naph.la,is, encephalopath., thromboc.topenia, chronic
arthritis0
Contraindications: &llerg. to neom.cin or gelatin
(everel. impaired immune s.stem *HIV9&I(, cancer or
other immunosuppressant medications or treatments0
""2 cannot be given to an. child )ith a histor. of cancer
*accept order for ""2 onl. from a Pediatric
Hematologist9!ncologist+0
Children )ith HIV can get ""2 *C= count must be
assessed prior to administration+
Cannot be given )ithin E months of blood or blood product
transfusion
Cannot be given to pregnant )omen
$#2(I$7 C!$(I42&'I!$(:
&llerg. status
#rine Hc7 for all )omen capable of being pregnant
Juestion pt9parents abut immunosuppression
Vaccine is a clear .ello) solution that must be mi,ed )ith diluting before
administration
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 6 of 16
MMR and aricella need to !e mi"ed# MMR is pale $ello% (li&e urine).
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page K of 16
"4&(L4(9 2#64!L& (' ()*T()
& viral illness that occurs most often in the late )inter D earl. spring0 "ost cases are
reported from children )ho immigrate to the #( from countries )hich do not re/uire
vaccination and children )ho do not get vaccinated for various reasons0
Vaccination provides life long immunit.0
"easles is a cause of significant cause of infant and child morbidit. in developing
countries0
Measles
'reatment: $one, supportive onl., ab, used for secondar. bacterial
infections *)hich are ver. common+
"ode of transmission: &irborne *resp droplets+
Incubation: >81< da.s
Period of communicabilit.: uring prodromal phase, ends <8= da.s after rash appears0
Complications of "easles: iarrhea, !", bronchopneumonia, encephalitis
L"easles in an immunocompromised child can be fatal
CLI$IC&L "&$I54('&'I!$( "4&(L4(
Children are /uite ill during prodromal phase )ith:
High fever
Con@unctivitis
Cough
&nore,ia
(mall, irregular, bluish8)hite spots on buccal mucosa 1no) as GMopli1 spotsH
Characteristic red, blotch. maculorpapular rash appears <8= da.s after prodromal
phase, rash begins on face and then spreads to trun1 and e,tremities, (, subside in
<8= da.s
"#"P(9P&2!'I'I(
& param.,ovirus that occurs )orld )ide in unvaccinated children, most often in
late )inter9earl. spring0
6oth infection and vaccination provide life long immunit.0 "aternal antibodies
begin to disappear in the infant 1<81; months0
Clinical manifestations of Mumps
"alaise
Lo) grade fever
ecrease appetite
ecreased activit. level
#nilateral parotid s)elling, s)elling pea1s around da. E0
"eningeal signs: stiff nec1, headache, photophobia *in about 1;I of pts+
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page > of 16
Mumps
'reatment: $one, supportive onl.0
"ode of transmission: saliva droplets and direct contact )ith secretions
Incubation: 1<8<; da.s
Period of communicabilit.: K da.s before s)elling till B da.s after s)elling subsides
*can be as long as <8E )ee1s+
Complications of "easles: !rchitis *unilateral scrotal s)elling+0
(terlit. is a rare occurrence0
!ophoritis, pancreatitis, aseptic meningitis and
unilateral deafness *permanent and fairl$ common+
2#64LL&9 742"&$ "4&(L4(
7erman measles is a mild disease )ith a characteristic pin1, maculorpapular rash that
appears on the face, nec1, trun1, legs and disappears in the same order0
Clinical manifestations Ruella
Prodromal s, begin 18; da.s before rash
Lo) grade fever
headache
"alaise
(ore throat
&nore,ia
7enerali-ed l.mphadenopath. involving the postaricular, suboccipital and
posterior cervical l.mph nodes, common up to K da.s before rash begins0
7erman "easles is a self limiting disease in children )ith ver. rare side effects0
!erman Measles
'reatment: $one, supportive onl.0
"ode of transmission: roplets, direst contact )ith infected persons, or contact
)ith articles soiled b. nasal secretions
Incubation: 1=8<1 da.s
Period of communicabilit.: K da.s before rash until about = da.s after0 Infants )ith
C2( shed virus for months and should not be cared to b.
susceptible persons, strict isolation from pregnant
)omen *or potentiall. pregnant )omen+ is re/uired0
Complications of "easles: 2are but includes arthritis in the adolescent, encephalitis,
b. far the most common and serious complication is C2(
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page B of 16
C2(: C!$74$I'&L 2#64LL& (3$2!"4
If mother is infected in the first trimester of pregnanc., the fetus can be severel. affected:
(pontaneous abortion
(till birth
5etal death
10I of infected fetuses die after birth
"ultiple significant congenital anomalies are common,
(evere congenital heart disease *pulmonar. atresia8P&, tricuspid atresia8'&
h.poplastic left heart s.ndrome8HLH(+
I#72
4ar defects *causing deafness+
4.e defects *causing congenital cataracts+
Caused b. mother not being immuni-ed as a child, rates of C2( are on the rise? seen in
immigrant populations0 +nfant can shed virus for months so ), %or&ers, especiall$
pregnant ones need to ta&e contact precautions.
H&4"!PHIL#( I$5L#4$%& '3P4 6 V&CCI$4 *Hi6+ trivia - causes epiglottitis
&ges: <, =, 6, 1<8 1; months *= doses total+
2oute: I"
Common side effects: pain, redness or s)elling at in@ection site
(erious side effects: anaph.la,is
H&4"!PHIL#( I$5L#4$%& '3P4 6
& bacterium )hich has several serot.pes0 !ccurs in spring and summer0 "ost commonl.
affects infants and children in da. care settings, L6F children, children )ith chronic
illnesses0 Invasive Hi6 disease )as a ma@or source of mortalit. and morbidit. before
routine vaccination )as implemented *1B>K+0
Clinical manifestations of "i# disease
Hi6 starts as a viral #2I, the organism can pass though out the nasal mucosa to directl.
invade the blood stream, it causes several severe invasive illnesses:
"eningitis
4piglottis
Pneumonia
(eptic arthritis
!"
6ronchitis
Pericarditis
HiB disease is a leading cause of sepsis in newborns.
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 10 of 16
'reatment is ampicillin, ho)ever 19E of strains are resistant0 2ifampin ma. be
given to unimmuni-ed contacts0
H4P&'I'I( &, 6, C, , 4 &$ 7
Hep & C H&V "ost contagious form, fecal8oral route
Hep 6 C H6V 6lood and blood products *high . of ), %or&ers+
Hep C C HCV 6lood9 blood products, se,ual
Hep 8 HV !nl. present )ith Hep 6 most common in IV#9hemophiliacs
Hep 4 C H4V *non8& non86+ fecal8oral route
Hep 78 H7V 'ransfusions and organ transplants e,clusivel.
)ep / and )ep 0 are preventa!le %ith a vaccine.
Hepatitis N an acute inflammation of the liver0 &cute viral Hepatitis is the most
common cause of hepatitis0
Hepatitis can also be caused b. drugs *including alcohol+ chemicals and
autoimmune liver disease 0 It is a significant cause of morbidit. and mortalit. in
)orld )ide0
'he changes in the liver tissue results in var.ing degrees of s)elling, infiltration
of the liver )ith subse/uent degeneration, necrosis and fibrosis of the liver0
Hepatitis can be self limiting and complete regeneration of liver cells can occur
but it is un1no)n )hich case of Hepatitis )ill do so
5#L"I$&'4 H4P&'I'I(
(evere, acute disease )ith massive destruction of the liver )hich results in rapid liver
failure follo)ed b. death 18< )ee1s after infection, usuall. caused b. Hep 6
accompanied b. Hep 0 "ost common cause is to,ic reactions to drugs0
(#6 &C#'4 !2 CH2!$IC H4P&'I'I(
Progressive destruction of liver cells can be present for .ears as an as.mptomatic
infection but )ill eventuall. result in cirrhosis and liver failure
P42I$&'&L H4P 6
"ost hepatitis 6 infections are ac/uired in childhood either from the mother *perinatal+
or as an adolescent *se,ual transmission and IV drug use+0
2oute of transmission from mom8fetus if the mother is a carrier or has active infections0
'he virus )ill cross the placental barrier late in pregnanc. or during labor, )hen the child
ingests amniotic fluid or via breast mil10 "ost )omen )ho pass Hep 6 to their fetus are
una)are of their status0
'he infection can lie dormant for <8E decades and in their E0:s or =0:s the
hepatitis can become active and can lead to cirrhosis and liver failure0
Hepatitis 6 is the O1 cause of liver failure in the )orld and the number one reason
for liver transplants in the #(0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 11 of 16
Clinical Manifestations of "ep #
Insidious onset
Paundice
&nore,ia
"alaise
$ausea
&bnormalities in L5':s *(7!'9(7P'96ilirubin+
Prodromal s,:s: rash, arthritis, Gaches D painsH
'24&'"4$' 5!2 H4P 6:
$o specific treatment, supportive0 Prevention is the !est treatment.
2est
H.dration
$utritional support *high calorie, high protein, high carboh.drate, lo) fat diet +
Vitamin supplementation
$o &lcohol or drugs metaboli-ed b. the liver
Hospitali-ation )hen s, are severe or clotting factors are altered
"ore importantl. treatment involves earl. detection, monitoring, recognition of chronic
liver disease and the prevention of spread0
'reatment )ith Monolclonal antibodies, a8interferon, and antiviral agents: Riavirin has
sho)n some success0
"epatitis # $accine
&ges: #irth, < 8 mths, 6 C 1> mths *E or = doses+
2oute: I"
Common side effects: Pain9redness at in@ection site, headache, photophobia, altered
L5':s
(erious side effects: &naph.la,is, 7uillianC6arre t.pe illness )ith progressive
muscle )ea1ness0
$#2(I$7 C!$(I42&'I!$(
&ll pregnant )omen should be screened before birth *or immediatel. follo)ing
birth+,
If mom is Hbs&7Q, vaccine must be given to infant )ithin 1< hours, follo)ed b.
H6I7 to prevent transmission to infant0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 1< of 16
$ariva%
&ges: 1<81> months0 & dose
2oute: (J
(torage and handling: "ust be 1ept fro-en and used )ithin E0 minutes, cannot be re8
fro-en
Common side effects: Pain9redness at in@ection site, fever up to E>0> *10<+, generali-ed
rash, sub8acute varicella infection0
(erious side effects: &naph.la,is
$#2(I$7 C!$(I42&'I!$(
Prior to immuni-ation a carefull. assessment of medical histor. must be obtained
)ith emphasis on possible immunosuppression
#rine Hc7 of all )omen that can potential be pregnant prior to immuni-ation
&ssess for allerg. to neom.cin or gelatin
V&2IC4LL& *CHICM4$ P!R+
& viral illness caused b. the varicella8 -oster virus, a herpes virus 60 !ccurs in
late fall, )inter and spring0 "aternal antibodies disappear <8E months after birth0
'he onset of s.mptoms is acute, mild fever, malaise, and irritabilit. occurs before
rash0
2ash begins as a maculae on an er.thematosus base and progresses to a papule,
then a clear filled vesicle0 Lesions of all stages can be present at one time0
Rash starts on !od$.
$#2(I$7 C!$(I42&'I!$(8 V&2IC4LL&
&n. child )ith a rash as described above should be put in isolation
I""4I&'4L3
If a case of varicella is diagnosed, &LL contacts at school, )or1, da.care, clinic,
pla.group must be notified and assessed for infection0
'reatment: $one, supportive onl.0
"ode of transmission: irect contact )ith lesions, airborne spread of secretions
Incubation: 1=8<1 da.s
Period of communicabilit.: up to ; da.s before the onset of rash and until &LL lesions
are crusted over0 'he incubation period ma. be e,tended
in immunocompromised children
Complications of "easles: In the health. child complications are rare can include:
secondar. bacterial infections, hepatitis, pneumonia
thromboc.topenia, 7lomerulonephritis, 2e.e s.ndrome,
encephalitis
In the immunosuppressed child the results of a varicella infection can be catastrophic0
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 1E of 16
'24&'"4$' !5 V&2IC4LL&
$one, care is supportive0
!ral and IV ac.clovir *retroviral+ is used for immunocompromised children
!$L30
"ost children )ith varicella recover full. )ith onl. supportive care *prevention
of deh.dration, reduction of fever, prevention of secondar. bacterial s1in
infections+
In an immunosuppressed child, prompt recognition and aggressive treatment )ith
V%I7 must begin immediatel. to prevent varicella pneumonia9over)helming
infection0
Varicella immunoglobulin *V%I7+ is used to prevent varicella in e,posed,
susceptible individuals at ris1 for complications0 'he use of V%I7 has been
recommended for immunosuppressed individuals, pregnant females, neonates,
and health personnel0
Children infected prenatal or postnatal have a ver. poor prognosis
Varicella lesions are fre/uentl. seen in various stages: maculae on an
er.thematosus base and papule, clear filled vesicle0
Lesions of all stages can be present at one time
P$4#"!C!CC&L V&CCI$48 PCV8K 9 P24V$&2
&ges: <, =, 6, 1<81; months
2oute: I"
Common side effects: (oreness, redness, s)elling at in@ection site0 "ild8moderate
fever, irritabilit.0
(erious side effects: &naph.la,is
Contraindications: H.persensitivit. to diphtheria to,oid
P$4#"!C!CC&L I(4&(4
Caused b. streptococcus pneumoniae, a gram Q bacteria0 'he organism is found
in the phar.n, of health. people0 !utbrea1s occur in the )inter and spring under
cro)ded conditions0
"ost common in the 6 month8 < .ear age group0
( D ( of disease are related to the focal area of infection0 Pneumococcal disease
can cause: !", sinusitis, #2I, Lar.ngotracheobronchitis, pneumonia, meningitis
and bacteremia0
'reatment of invasive pneumococcal disease
PC$ 6#' up to =>I of infections are PC$ resistant0 "acrolide antibiotics
*er.throm.cin, a-ithrom.cin and clairthrom.cin+ or third generation cephalosporins
*Cefota,ime or Ceftria,one+
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 1= of 16
(C&2L4' 54V42
4tiolog.: 7roup &8 beta hemol.tic strep
"ode of transmission: irect contact )ith droplets, contact )ith contaminated
items, and ingestion of contaminated food9mil10
Incubation: <8; da.s
Period of communicabilit.: uring incubation period and illness *about 10 da.s+
Potential complications: !tits media, peritonsillar and retrophar.ngeal abscess,
sinusitis, 7lomerulonephritis, Carditis
Clinical manifestations of Scarlet 'ever
4nlarged edematous tonsils covered )ith e,udate *in some cases loo1s li1e
membrane seen in diphtheria+0
6eef. red phar.n,,
a. 1 D < tongue is coated *)hite+
a. =8;, )hite coating sloughs off leaving tongue9papillae prominent and
Gstra)berr. tongueH appears, palate is covered )ith lesions0
2ash: appears )ithin 1< hours of onset of fever,
2ed pin8si-ed lesions, generali-ed but absent on face, face becomes flushed )ith
circumoral pallor0
2ash more intense in folds of s1in *elbo)s91nees+ especiall$ femoral region.
&t end of 1st )ee1 des/uamation begins, fine sandpaper consistenc. )ith
sloughing of s1in on palms D soles0
Can ta(e up to ) wee(s for rash to resolve completel*.
Treatment:
Penicillin *or er.throm.cin in allergic children+ fever should disappear after <=
hours of antibiotic treatment0
2espirator. precautions for <= hours0
!ral antibiotic for 10 da.s0
'reat sore throat )ith analgesics, gargles, lo-enges, and antiseptic throat spra.0
$#2(I$7 C!$(I42&'I!$(
2espirator. precautions until <= hours after initiation of antibiotics0 2est during febrile
phase? push fluids during febrile stage0
423'H4"& I$54C'I!(#" 95I5'H:( I(4&(4
4tiolog.: Caused b. human parvovirus 61B
"ode of transmission: #n1no)n but believed to be spread b. respirator.
secretions and blood0
Incubation: =81= da.s
Period of communicabilit.: uring incubation period and illness *about 10 da.s+
Potential complications: #ncertain, but before onset of s.mptoms and for about 1
)ee1 after onset of s.mptoms
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 1; of 16
Chapter 10: Vaccines and Preventable Communicable Illnesses of Childhood, Page 16 of 16
Clinical Manifestations of 'ifth+s disease
2ash that appears in ) stages
1st8 stage8 4r.thema of face Gslapped chee1H rash, disappears in8= da.s0
<nd stage8 &bout 1 da. after rash appears on face, maculopapular red spots on upper
D lo)er e,tremities0 Progresses from pro,imal to distal and ma. last up to
1 )ee10
Erd stage8 2ash is gone but )ill return if s1in is irritated *heat9cold9sun9friction+
Complications: self8limiting but can result in fetal death if mother is infected during
pregnanc. in the first half of pregnanc.0 *10I ris1 of fetal death+0&plastic crisis in
children )ith hemol.tic disease or immunodeficienc.0
Treatment: none, s.mptomatic use of '.lenol9"otrin, blood transfusions for 1ids )ith
aplastic crisis0
4R&$'H4"& (#6I'#"9 2!(4!L&
4tiolog.: Human herpes virus t.pe 6 *HHV86+
"ode of transmission: #n1no)n, almost e,clusivel. in children 6 months8E
.ears0
Incubation: ;81; da.s
Period of communicabilit.: #n1no)n
Potential complications: 2ecurrent febrile sei-ure, rare encephalitis

Clinical manifestations,
Persistent high fever for E8= da.s, child appears )ell, fever disappears )ith
appearance of rash0
2ash: discrete light8 pin1 macules or maculopapules that appear on trun1 spreads
to nec1, face and e,tremities0 5ades )ith pressure, lasts 18< da.s
See lac(oard for additional documents on immuni-ations