by Karen Swecker, RN, Infectious Control Liaison at MedFlight.
Would you be able to recognize an infectious patient? At this time outbreaks of vaccine preventable diseases such as chickenpox, measles, diptheria, and polio are occurring in several countries in Europe, Asia, the Middle East and the African continent. In the U.S. the evening news has been reporting an ongoing outbreak of measles – more than 465 cases as of April 4, 2019. “A health threat anywhere is a health threat everywhere” is the statement from a 2018 conference of infectious disease physicians from across the world. In today’s world of frequent international travel previously eliminated disease outbreaks in the U.S. are increasing. Your chance of seeing a case of the measles, diptheria, chickenpox or even polio are increasing. Would you be able to identify and protect yourself and others from one of these diseases during a patient transport?
Measles is a very contagious, acute viral respiratory illness that was eliminated in the U.S. from 2000 to 2008. Before vaccine availability, the U.S. averaged 549,000 cases of measles with approximately 500 related deaths annually. (The CDC states due to unreported cases the count of measles cases was in actuality closer to 3 to 4 million.) Of the reported cases, 48,000 were hospitalized and 1000 people developed chronic disabilities due to acute encephalitis. Signs and symptoms of the measles include:
- Fever – may be up to 105oF
- “3 C’s” – cough, coryza (runny nose) and conjunctivitis (pink eye)
- Koplik spots – white spots inside the mouth that look like tiny grains of sand surrounded by a red ring.
- Maculopapular rash that appears about 14 days after exposure. Spreads from the head to the trunk to the extremities. The immunocompromised typically do not develop the rash.
Chickenpox is a very contagious, vaccine preventable disease. Before the vaccine approximately 4 million people in the U.S. got chickenpox each year, more than 10,500 of those were hospitalized and 100-150 died each year. Side effects of the disease include skin infections (may have more than 500 blisters), dehydration, pneumonia and encephalitis. Symptoms last 7 to 10 days and include:
- Infectious 1 to 2 days before rash begins
- May start as “cold” symptoms – runny nose, sneezing, cough before rash begins
- Itchy rash of blisters, appears as very small red pimples that rapidly spread
Diptheria is very infectious bacteria whose toxin causes tissue death which creates a thick grey membrane. This membrane may cover the back of the throat, tonsils, or larynx which leads to difficulty breathing, swallowing and speaking. The bacterial toxin may also go systemic and cause damage to the heart, nerves and kidneys. Before the vaccine (tetanus/diptheria/pertussis) there were more than 200,000 cases in the U.S. annually with more than 15,000 deaths. Although still rare in the U.S., many countries continue with cases – more than 7,000 cases occur worldwide annually. The overall death rate from diptheria is 5%-10%, with a fatality rate of 20% for those under 5 and over 40. Diptheria is transmitted person to person via respiratory droplets from coughing or sneezing and via contact with contaminated surfaces or objects. Symptoms begin 2 to 10 days after exposure, can involve any mucus membrane including the tonsils and include:
- Sore throat
- Swollen glands in the neck
Polio is an infectious disease that is crippling and potentially deadly. It is caused by a virus that easily spreads from person to person mainly via fecal/oral route, although it is also transmitted through contaminated food or water. Polio multiplies in the intestinal track then invades the nervous system where it can cause permanent paralysis within a few hours. In the pre-vaccine years of the 1950s, polio outbreaks caused more than 15,000 cases of paralysis each year. Due to vaccination there have been no polio cases originating in the U.S. since 1979. In 1993 there was one case imported into the U.S. via an unvaccinated person who traveled to a country with wide spread polio. Due to vaccine, the number of cases worldwide has dramatically decreased (33 reported in 2018). However, as long as there is one case the unvaccinated are at risk. There is no cure for polio and 1 in 200 infections will result in permanent paralysis. Symptoms include:
|· Fever||· Fatigue|
|· Headache||· Vomiting|
|· Stiff neck||· Pain in the limbs|
What you can do to protect yourself and others from these diseases.
- Make sure you and your family’s vaccines are up to date.
- Familiarize yourself with signs/symptoms of rarely seen communicable diseases.
- Use airborne precautions If a patient has any of these signs/symptoms – wear a fit tested N95 mask, place a surgical mask on the patient if tolerated.
- Use contact precautions which include gowns and gloves. Remember not to touch surfaces with contaminated gloves.
- Thoroughly disinfect surfaces and equipment. Use EPA approved disinfectant wipes or sprays to clean surfaces. Change wipes frequently as the wipes quickly become contaminated and will spread the germs instead of removing them.