Infectious Diseases, Immunizations


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*Handwashing is the best defense against the spread of infectious disease*

This link is for the CDC's Guidelines for Isolation Precautions

http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html

The videos below feature the diseases behind common childhood illnesses for which we have now have immunizations. These diseases used to and still do kill afflicted children. World wide 10 million children die every year! Global travel has made immunization even more important. Nurses must be able to educate parents about vaccination. If the parent has questions and concerns about vaccines remember, this is a parent who cares and an opportunity to teach!

The chain of infection:

The chain of infection begins with an infectious agent or pathogen.

This pathogen must survive without multiplying in a host or on an inanimate object.

Then the pathogen then leaves the reservoir or host through a portal of exit such as blood or bodily secretions such as urine, feces, respiratory secretions and saliva.

The mode of transmission to another host can be through direct bodily contact through saliva, droplets from the respiratory tract, body contact, blood, bodily fluid from the urinary, gastrointestinal route or reproductive tract. Pathogens can also spread through contaminated surfaces or food or through animal or insect vectors.

Portal of entry can be through the respiratory tract, the gastrointestinal tract, the urinary tract, the skin, mucous membranes or across the placenta.

Susceptible host can get ill when the pathogen invades and the host has no immunity or the immune system is dysfunctional.

Toddlers and Preschoolers:

At risk for fecal-oral route transmission due to tendency to put objects in their mouths
Often toilet training with inefficient hand washing
Playing with animals may get bit or scratched, can cause cat scratch fever or tineacorporis (ring worm)
Communicable diseases are high during this time period
The primary goal of nursing is to prevent these diseases through immunizations.
Once there is a breakdown the goal is to stop the spread and to decrease and prevent complications as able.
Children with immunodeficiency or those suppressed with steroids are susceptible to devastating complications.

Viruses:

Varicella (chicken pox)


(Varicella zoster virus) – Airborne (droplet) transmission and to a lesser degree direct contact with contaminated objects.

Incubation is 2-3 weeks.

The patient is contagious up to 24 hours prior to the first eruption and remains contagious until the last vesicles have crusted over.

Clinical Manifestations:
Fever, malaise, anorexia, rash beginning on the trunk and back and spreading to the face and limbs.

Therapeutic management:
Administration of anti-viral acyclovir (Zovirax)
varicella-zoster immune globulin or IVIG in immune compromised children.
Antihistamines to relieve itching and skin care to prevent infection.
Trim child's nails, keep hands clean
Oatmeal baths, calamine lotion
Popsicles, jello

Vaccine is available.

Chickenpox



Herpes Zoster (Shingles)
Painful varicella infection affecting a single dermatome (body area innervated by a specific area of the spinal cord).
Reactivation of virus which lies dormant in the spinal column

Roseola Infantum (Exanthem Subitum)
Caused by human herpes virus type 6, rarely 7
Peaks at 6-15 months, highest incidence 6-24 months, rarely after age 3
Most likely transmitted in the saliva of healthy adult mouths, and respiratory secretions
Incubation 5-15 days contagious unknown

Clinical Manifestations:
Persistent high fever for 3-5 days followed with sudden drop in temperature and appearance of rash, coryza, sore throat,
lymphadenopathy, cough and coryza (cold symptoms).

Management:
Fever control, maintaining fluid balance and comfort measures.
Antipyretics.
Teach parents fever control and discuss precautions for febrile seizures.

Red Measles (Rubeola)

Measles

From respiratory tract, blood and urine,
Droplet spread usually,
Incubates 10-20 days,
Contagious mainly in prodromal stage -4-5 days,
Clinical Manifestations:
Fever, malaise, cough conjunctivitis, Koplik spots then rash

Mumps (Paramyxovirus)
Saliva direct contact with droplet
Incubates 14-21 days
Most contagious before and after swelling, fever, malaise, headache, anorexia, ear ache,

Mumps



Polio 2013 outbreak in Syria


Polio (enteroviruses)
3 types, source fecal, oropharyngeal secretions,
Incubation 7-14 days but up to 35 days
Virus in throat up to a week after infection and in feces 4-6 weeks after infection.
Clinical Manifestations:
Abortive/inapparent – fever, uneasiness, sore throat, headache, anorexia, vomiting abdominal pain for a few hours to a few days,
Nonparalytic - same as abortive more severe with pain and stiffness in neck, back and legs,
Paralytic - similar to nonparalytic with recovery then paralysis

Polio




Rubella (German Measles)
3 day measles
Spread through nasopharyngeal secretions but also in blood, stool, urine.
Incubates 14-21 days
Contagious 7 days before to 5 days after,
Clinical Manifestations:
Low grade fever, headache, malaise, anorexia, mild conjunctivitis, coryza, sore throat cough, lymphadenopathy,
Rash gone by 3rd day
* Highly dangerous to pregnant woman




Conjunctivitis
Treatment depends on cause.
Infants can contract infections during birth, Chlamydia trachomatis, Neisseria Gonorrhoeae, or HSV.
Chemical conjunctivitis may occur from instillation of neonatal eye ointment.
Bacterial conjunctivitis traditionally treated with Polysporin, Polytrim, or Sulamyd.
Throw out eye makeup, do not rub or touch eyes
Viral

Stomatitis
Inflammation of the oral mucosa, infectious or noninfectious.

Aphthous stomatitis
Benign but painful associated with trauma (biting cheek), allergy or emotional stress.

Herpetic gingivostomatitis
Caused by HSV (type 1) – recurrent herpes labialis – cold sores or fever blisters.
Initial infection fever, red throat, with vesicles and swollen lymph nodes.
When it reoccurs vesicles due to emotional stress, dental procedures, sunlight.

Stomatitis also occurs with hand-foot-and-mouth disease and herpangina (same as hand-foot and mouth by only mouth manifestations) caused by enteroviruses (coxsackieviruses)
Problem is oral intake due to pain.
Acetaminophen, Motrin, may need codeine.
Orabase, Anbesol, Kank-A. Lidocaine or homemade mixture equal parts Benadryl and Maalox provides analgesia, anti-inflammatory, protective coating.
Bland liquids through a straw.





Bacterial infections:
Tetanus:

Tetanus caused by Clostridium bacteria.
The bacteria live in soil, saliva, dust, and manure; it can enter the body through a deep cut.
Symptoms:
Painful tightening of the muscles, all over the body, "locking" of the jaw, impossible to open your mouth or swallow.
Tetanus - medical emergency, need treatment in a hospital.
Routine childhood immunization.
Booster, every 10 years.
Proper wound care.

Pertussis, Whooping Cough


Bordetella pertussis,
Called the 100 day cough
Incubation 6-20 days, direct contact or droplet.
Clinical Manifestations:
Begins as a cold, with sneezing, cough and low-grade fever then paroxysmal coughing.
Nursing Measures/Treatment:
Culture with nasal swab and obtain slides to send to the lab for examination
Check vaccination status of patient, if unvaccinated, administer immunization
Check on vaccination status of family and contacts
Wear a mask if within 3 feet of patient
If no mask was worn and you find out patient was positive for Pertussis contact employee health for prophylactic antibiotics
If patient is positive for Pertussis administer Antimicrobials – erythromycin or azithromycin
Depending on patient age, symptoms, and stability of patient, follow respiratory measures as needed, i.e. hydration, O2, SAT monitoring, etc




Diptheria -



Diptheria (Corynebacterium diphtheriae)
Transmitted by direct contact with infected individuals or contaminated articles.
Incubation is 2-5 days. Can be contagious for 2-4 weeks.

Clinical Manifestations:
Symptoms may manifest in different areas. In the nasal area may present as a cold with mucopurulent discharge.
Tonsillar-pharyngeal symptoms include malaise, anorexia, sore throat, fever, white or grey membrane, and lymphadenitis.
In severe cases septic shock can occur with death in 6-10 days.

Therapeutic management:
Equine antitoxin IV (as long as no allergy)
Penicillin G
bed rest to prevent myocarditis
possible tracheostomy
treatment of infected contacts.

Vaccine is available ~ DTap


Scarlet fever
Group A beta-hemolytic streptococci transmitted by respiratory secretions.
Clinical Manifestations:
Acute fever, sore throat, headache and a red sandpaper rash. White strawberry tongue on day 1 followed by a red strawberry tongue on day 2. Pharynx and tonsils, red, swollen, and edematous.
Management:
Antibiotics,
school absence for at least 24 hours,
fever control,
saline gargles, maintain fluids with popsicles and cool jello.



Infectious Diseases: Germs and stuff, yikes!

surprise shock PJ Taylor.jpg
School age risk for infection:

Share friendships, clothes, hair brushes, bedding, food, drinks, toys, do not cover their mouths while coughing, ineffective hand washing:


Leads to head lice, scabies, pinworms, tineacorporis and tineacapitis (ring worm) Videos pertaining to these conditions are under Integumentary.


Mycoplasmapneumoniae leading cause of pneumonia


Erythema infectiosum or Fifth’s disease


Erythema infectiosum (Fifth disease)
Human Parvovirus, HPV B19
Transmitted by respiratory secretions and blood.
Incubation for 4-14 days. It is communicable prior to appearance of symptoms.

Clinical Manifestations:
Mild systemic symptoms, occasional fever, slapped cheek appearance followed by a lacy rash on the trunk and limbs. Rash appears on face first. The rash tends to fade and reappear. Other symptoms include fever, myalgia, lethargy, nausea, vomiting and abdominal pain. Incidence usually seen in the late winter and spring in the elementary and junior high school age students. Management of fever and symptoms.

Therapeutic Management:
Administration of analgesics, antipyretics, and anti-inflammatory medications.
May result in complications if mother is infected during pregnancy.
May attend school once the rash appears as they are not contagious.




FLU







Family teaching:

*Often in the outpatient and ambulatory care system and later before discharge in an acute care setting, children are sent home with illnesses to recuperate. Parental teaching is vital to guide these parents as they care for their child so teaching is crucial. Remember to provide clear, simple explanations, have the patients acknowledge their understanding and ask the patient or caregiver to repeat back the instructions. Then document, patient acknowledged understanding and returned demonstration. If this is not done you cannot be reimbursed for this effort!


Family teaching topics often discussed:

Daycare centers sick policies, where food is prepared, ratio of children to daycare workers.

Immunizations questions welcomed and answered.

Medications, comfort measures, therapies

Sick child care

Discharge instructions

How do I know if they are not getting better?

When can they return to school or daycare?



Educate: use of medications, comfort measures and when to call the doctor.

Illness information

How to handle illness at home
How long illness may last

How long they will be contagious
When can they return to school

Signs and symptoms of worsening illness – spell it out!

Who to call, what to do and where to go if the child gets worse



Common OTC Medications:

Tylenol - analgesic, antipyretic; may be in cold meds, helps with headaches, malaise, sore throat, muscular aches,pain

Ibuprophen (also known as Motrin, Advil) takes care of these symptoms and relieves inflammation as well.

Benadryl or Atarax for itching

Beware of aspirin products and derivatives

Do not assume that parents know the differences between medications or what is in a cold and flu OTC medication

*Some medications contain aspirin which is not recommended for ill children because of Reyes syndrome
This list is from the National Reyes Foundation

National Reyes Syndrome Picture 1.jpgNational Reyes Syndrome Picture 2.jpg

Comfort Measures:
Comfort Measures/Teaching tips:
Handwashing! Cover your cough! No kissing!
Popsicles, gatorade, pedialyte, ice chips, suckers for sore throats (Boo-Boo pops) and dehydration, cool or warm compresses
Integumentary:
Pruritic lesions (chicken pox) can be soothed with baking soda or oatmeal added to baths.
Calamine can be applied topically to dry the lesions
Scratching needs to be discouraged, pat.
Aquaphor for eczema
Fingernails should be kept short and clean.
Cool the burn, but no ice! Blisters are the body’s Band-Aid.
GI bugs:
ORT, clear liquids
Monitor for dehydration - output, fontanelles, sunken eyes, skin tugor, tears
GU:
Monitor symptoms, record occurrences, diary
Diet – increase fiber, fluid (constipation)
For diarrhea - increase fluid intake, yogurt with probiotics are good, crackers, clear soup. Avoid - caffeine, sugarless gum, milk -
Baths, barrier cremes
Respiratory illnesses:
Humidifiers
Place child in the bathroom with mist from the shower, cold night air.
Monitor how hard they are breathing, are they making sounds?
Monitor color
Neuro:
Headaches/ joint aches – Dim lights, decrease sound and visitors, warm baths, ice or warm compresses, monitor for fever, neck pain versus nuchal rigidity
Musculoskeletal:
Injuries – 5 P’s, monitor pain, swelling, color, RICE, Ibuprophen

*Some diseases are reportable by law to local and state health departments, who then report them to the CDC. The CDC monitors disease trends and the effectiveness of intervention

When to call the doctor:

*Dehydration - dry mouth, low output (not going to the bathroom, decrease in wet diapers), sunken fontaneles or eyes.

*Worsening condition - spell it out

*Difficulty breathing, color off

*Change in LOC: unrousable, lethargic...



*Some diseases are reportable by law to local and state health departments, who then report them to the CDC. The CDC monitors disease trends and the effectiveness of interventions.

PPE




Contact Droplet and Airborne Precautions!


Remembering when to use Airborne Droplet or Contact Precautions

Airborne Precautions Picture.jpgDroplet Precautions Picture.jpgContact Precautions Picture.jpg


Remembering isolation requirements:

Airborne isolation precautions Picture 2.jpgDroplet isolation picture.jpgContact isolations picture.jpg


Modified contact for C-Diff
Modified Contact Isolation picture.jpg

Immunizations
Hiott_Home_and_Family_553.jpg
There are only two things a child will share willingly - communicable diseases and his mother's age. “ ~Benjamin Spock


~ FYI ~
Edward Jenner 1796 - first vaccine - inoculated assistant against smallpox with a cowpox lesion from a milkmaid.

Jonas Salk 1955 polio vaccine.

10 million children world wide die yearly from vaccine preventable diseases!

Global travel has made immunization even more important.


Recommended vaccines:

Hepatitis B, hepatitis A, diphtheria, pertussis, tetanus, measles, mumps, rubella, Haemophilus influenzae type b (Hib), invasive Streptococcus pneunomoniae, influenza, human papillomavirus, rotavirus, invasive meningococcal, and polio.


Polio is still endemic in Afghanistan and Pakistan.

Leaders in this area convinced the people that polio vaccinations were in reality an attempt to decrease fertility and spread HIV. Many children died or were paralyzed before the World Health Organization in combination with other leaders educated the public.


http://www.polioeradication.org/Polioandprevention/Historyofpolio.aspx


WHO disease notifications for 2016
WHO disease outbreak 2016.jpeg

Britain - Andrew Wakefield intimated that the MMR vaccine could be loosely linked to autism in the world-renowned publication The Lancet.

Studies show no link between autism and the MMR vaccine.

Wakefield had financial ties to attorneys representing autism victims.

Decline in MMR immunizations but autism rates increased.


Thimerosol, a mercury-containing agent that has been added to multiuse vaccine vials as a preservative. These are rarely used anymore.

Thimerosol is degraded to ethylmercury and thiosalicylate; not bioavailable and cleared by the body.

Similar agent, not in vaccines, methylmercury; bioavailable, can accumulate in the brain and cause neurologic damage.


2009, the U.S. Court of Federal Claims published Omnibus Autism Proceeding.

After reviewing 5,000 pages of transcripts, 939 medical articles, 50 expert reports, and testimony from 28 experts, that the MMR and thimerosal-containing vaccines, independently or together, were not causal factors in the development of autism or ASD.


1990 CDC and FDA initiated the Vaccine Adverse Event Reporting System (VAERS) to provide a single system as a replacement for the separate monitoring programs operated by the two agencies.



Practically Speaking ~

*Vaccinations are generally started at age 2 months because a fever prior to 2 months involves an automatic hospital admission and septic workup. *

Nurses must be able to educate parents about vaccination. If the parent has questions and concerns about vaccines remember, this is a parent who cares and an opportunity to teach!

Parents need to be reassured that they can call anytime that they have concerns or worries. We encourage parents to utilize a medical home.

Many times children present with various different immunization records. These are recorded into the office record and cosolidated for them. They must sign a consent and give permission for records to be sent from another office. Records may be available on the state DHEC site.

Sites for Administration:
IM in Vastus lateralis (thigh) muscle up to age 4.
Subcutaneous immunizations can be given in the fatty outer thigh area.
Older child - deltoid muscle IM, Subcutaneous injections, fatty area, back of the upper arm.
Comfort holds which can help stabilize the leg and comfort the child located in the PowerPoints located in this Wiki. Pain Change PowerPoint which discusses the importance of sweetease, frezzy spray, stickers and bandaids!

Center of Pediatric Medicine:
Background Immunization Information:

needles.jpg

Sites for Administration:
Up to age four - vastus lateralis muscle (large upper outer thigh muscle), subcutaneous immunizations - fatty outer thigh area.
Older child - intramuscular immunizations deltoid muscle, subcutaneous injections fatty portion on the back of the upper arm. Comfort holds which can help stabilize the leg and comfort the child located in the PowerPoints located in this Wiki.


Mechanics of Vaccine Preparation:
Aseptic technique
Label any vaccines as needed.
Wipe the hub of the vial with alcohol before drawing up the vaccine.
Aspirate prior to injection with intramuscular injections but not with subcutaneous injections.

MMR and Varicella need reconstituting, only 2 live injectable vaccines and the only two administered subcutaneously.
Polio by itself is also injected subcutaneously but it is rarely given alone.
All other vaccines are injected IM
Rotavirus is also a live virus, administered orally.
Place extra alcohol wipes and band-aids on the tray along with some stickers or a prize and you are ready to go!

Severe allergic reactions are reported
Children who died or received a severe injury can receive compensation. Required to have health records which indicate:
  • the month, day and year of the administration
  • the vaccine administered
  • manufacturer
  • lot number and expiration date
  • site and route of administration
  • Name, address, and title of healthcare provider administering the vaccine

Contraindications to vaccine administration:
  • A history of severe anaphylactic reaction to a vaccine or its components
  • Encephalopathy within 7 days of the administration of DTP/DTaP
  • A history of seizures
Precautions:
  • need to be taken when administering live viruses such as Chicken pox (varicella) and MMR (Measles, mumps, rubella) to teenage girls or women of childbearing age.

* Note: If caregivers fall behind on immunizations you do not start the series over! Simply administer the absent, needed shots.

Teach Parents child may experience:
Redness and soreness at the site
Low grade fever
Slight irritability

*If the child were to cry uncontrollably for 3 hours or more after the administration of tylenol or more or run a fever over 102 they need to be seen.*

Give acetaminophen (Tylenol) for pain
Make sure that parents understand some OTC cold medicines may also have Tylenol in them.
Motrin should not be given to infants under 6 months of age.
Entirely different medicine however, pediatricians usually recommend one or the other so parents do not get confused. Motrin, ibuprophen, can be given every 6-8 hours.
Warm compresses to legs
Bicycle legs

A common vaccine schedule is listed below.

Routine Childhood Vaccination Schedule:
2, 4, 6 months:
Hep B, polio (IPV), Diptheria tetanus pertussus (Dtap) = (Pediarix), haemophilus influenzae (Hib) = (Pedvax), Pneumococcal = (Prevnar 13) and Rotavirus = (Rotateq)

These first year shots protect the children from hepatitis B, polio, diptheria, tetanus and pertussis, 13 strains of pneumococcal infection, haemophilus influenzae and rotavirus.

12 months:
Hepatitis A, Prevnar 13, MMR (Measles, Mumps, Rubella), Chicken pox (Varicella), hemoglobin and lead blood check

*At 12 months the child is given the first MMR, Varicella and Hepatitis A shots. From this point on until the child is a teenager all shots have been given ideally and boosters are given from this point forward.
In the state of SC these shots are required for school and daycare and can only be omitted by the parents signing a religious waiver.*

18 months:
DTAP, Pedvax, Hepatitis A (2nd Hep A must be six months from the first)

2 year check up:
Catch up any needed immunizations and hemoglobin and lead blood check

4 year check up:
Dtap, polio (Kinrex), MMR, Varicella

11 years or up:
Menactra, HPV (Gardisil), Tdap (booster)

Controversies...






Newborn Testing:
IMG_0740.JPG IMG_0739.JPG



This is a fact sheet about newborn screening located at the SCDHEC.
The link is below.

http://www.scdhec.gov/health/mch/nbs/index.htm

Newborn Screening F.A.Q. Sheet

How long has DHEC done this testing?
Testing for phenylketonuria (PKU) began in 1965. A 1976 law made testing mandatory unless parents had religious objections. The other tests were recommended by the Newborn Screening Advisory Committee and approved by the DHEC board.

What diseases are on the test panel?
The SC newborn screening panel includes all 28 core metabolic conditions that are recommended by the March of Dimes and the American College of Medical Genetics. In addition it also includes screening for 24 secondary metabolic conditions that can cause severe problems if not found very early in life. The most common conditions are described below.

Phenylketonuria is an error in amino acid metabolism resulting in profound mental retardation. The consequences can be avoided by very early detection and a diet low in the amino acid phenylalanine. About three babies with PKU are detected each year. Testing can also identify babies with other amino acid metabolism disorders as well as babies with certain organic acid metabolism disorders.

Congenital Hypothyroidism results from the lack of thyroid hormone leading to mental retardation and slow growth. If detected early, thyroid hormone can be given and the consequences reduced or eliminated. About 20 babies are found each year with primary congenital hypothyroidism.

Persons with Hemoglobinopathies (like Sickle Cell Disease) may have impaired oxygen transfer ability and many painful and life-threatening conditions, some of which can be prevented through early diagnosis and monitoring. About 100 babies a year are identified with hemoglobinopathy disorders including sickle cell disease while another 2,400 are identified as carriers.

Galactosemia is caused by an inability to metabolize galactose, a component of lactose found in milk and other foods. Serious gastrointestinal disturbances, failure to gain weight and jaundice may occur. Children with untreated galactosemia develop mental retardation, cataracts and speech delay. Some babies die in the early neonatal period from bacterial sepsis. If detected early, diets low in galactose can minimize the effects of the condition. About one baby a year is born with this condition. Other, less severe forms of galactosemia can also be found through this testing. In SC, around 15 babies are found with less severe forms of galactosemia each year.

Congenital adrenal hyperplasia is an enzyme defect that affects the functioning of the adrenal gland with the overproduction of testosterone. Children with CAH may begin puberty at 3-5 years of age. In some cases, the child may experience dehydration, shock and death. Administration of adrenal hormones can prevent some serious consequences. About three babies a year are identified with this condition.

Medium chain acyl-CoA dehydrogenase deficiency causes an error in fatty acid metabolism resulting in a child's blood sugar becoming dangerously low. About 20 percent of children with MCADD die before diagnosis if screening is not in place and those who survive may have serious residual effects. If detected early, the condition can be treated by making sure the child gets enough carbohydrate, especially during illness or other stressful times. About four babies a year are found with this condition. Testing can also identify babies with other fatty acid metabolism disorders.

Biotinidase deficiency causes a baby to have difficulty using biotin, a vitamin that is found in foods, including breast milk and infant formula. Without biotin, the baby will not grow and develop properly. He or she may have seizures, hearing loss and skin problems. About one baby a year is found with this disorder.

Cystic fibrosis is a genetic disorder that is detected in 10 to 15 babies born in SC each year. When a baby has CF, some fluids in the body that should be thin and slippery are thick and sticky. These fluids can plug up some of the “tubes” or “channels” in the body. This affects the lungs and digestive system the most. Babies with CF often cough or wheeze and can get lung infections that need treatment with strong drugs. They also may not digest their food well, often in spite of a huge appetite. Poor digestion can cause diarrhea and poor growth. Babies found through screening often have not yet started to show much of these problems or to “act sick”.

Do parents sign a consent form?
There is no DHEC consent form for newborn screening. The DHEC Newborn Screening Manual; Law, Regulations, and Official Departmental Instructions states, "The provision of the screening test is covered under the informed consent signed by the parents at the hospital." Parents may refuse the tests only on religious objections.

Do parents get any information in advance?
The regulation requires hospital staff to provide information about the testing. The hospital may give the parents a pamphlet with information about the testing.

How long does it take to do the testing?
On average, testing is completed three working days after the specimen arrives in DHEC’s laboratory. If the results indicate a high likelihood that the infant has a newborn screening disorder, the physician of record is notified by phone by staff in the Division of Women and Children’s Services. If the results are less definite but still abnormal, the physician will be notified by mail. The laboratory needs to keep the specimens, which are blood spots, long enough to complete testing and allow for requests for routine additional tests or repeats.

What happens to the information?
Results are sent to the hospital or mid-wife and to the physician of record. Abnormal results are also immediately sent to DHEC’s Division of Women and Children’s Services for follow-up. The results from children with sickle-cell trait (carriers of sickle cell) are sent by the Laboratory to regional sickle-cell centers for counseling and follow-up.

What happens to the blood specimens after laboratory testing is completed?
The laboratory will destroy the residual blood specimens once they are no longer needed for testing. They are not used in research or for any purpose other than newborn screening.

Does DHEC do any DNA-based newborn screening or store purified DNA?
No. DHEC does no DNA-based (gene) newborn screening. The DNA is stored only because DNA is present in the blood cells. No purified DNA is stored.


References:

Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

Creative commons licensed photo by P J Taylor

Videos located at:
Pertussus
http://youtu.be/wuvn-vp5InE

Hand foot and Mouth Disease
http://youtu.be/oRSe98lOv28

Scarlet Fever
http://youtu.be/ZptvC4GVE6U

Pertussus
http://youtu.be/wuvn-vp5InE

Hand foot and Mouth Disease
http://youtu.be/oRSe98lOv28

Scarlet Fever
http://youtu.be/ZptvC4GVE6U

Diptheria
https://youtu.be/poK8YMA2RtQ

Immunize every child
http://youtu.be/myoH9ogEYKk

Whooping Cough by the Mayo Clinic
http://youtu.be/l5SHtdczSBc

Tetanus by unicefusa
http://youtu.be/jPUQakhyPDA

Polio
https://youtu.be/Pdyb1FzG6nQ

Hepatitis
https://youtu.be/1uBh7Z8QXUE

Rotavirus by Pkidsorg
http://youtu.be/sYoCIfeVcFk

Pneumococcal disease by Pkidsorg
http://youtu.be/ij6jMchYyFE

HIB by Pkidsorg
http://youtu.be/iy9iywzE0z0

Measles by Ten
http://youtu.be/6T5W-EWHjWg

Measles Outbreak by CBS
http://youtu.be/wPAS11Ufe4I

Mumps
https://youtu.be/ioUi727k9JM
https://youtu.be/FkdQHaOxxyI

Chickenpox by Florida Dept. Of Health
http://youtu.be/gMGsf8vwyC0

Polio in Africa by coleyyd
http://youtu.be/oFm-Zq3XPGo

Fifth Disease by Healthy Kid Tips
http://youtu.be/fXJhzMUA53I
https://youtu.be/3yht6AIuihE

How Flu Viruses Attack by National Geographic
http://youtu.be/TVLo2CtB3GA

Flu Attack by npr
http://youtu.be/Rpj0emEGShQ

Sick care child video at
http://youtu.be/AZ8G0_WTpn0

PPE
https://youtu.be/OdpGKsredP0

Isolation:
https://youtu.be/K3vrl47PzxU

References:

Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

Newborn Testing FAQs:
http://www.scdhec.gov/Health/FHPF/LabCertificationServices/NewbornMetabolicScreening/FrequentlyAskedQuestions/

Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

Videos:
Vaccine safety:
https://youtu.be/fMsa7o48XBE

Court finds vaccines don't cause autism by Associated Press
http://youtu.be/223o0pliEMs

Should I immunize my child by intermountain moms
http://youtu.be/_0_Q7zuhunY