Vaccine tricks
Handle injection site as little as possible
Arnica or ledum homeopathy (before)
Give sweet ahead of time
VIS
Post vaccine
Arnica, ledum, thuja, silica homeopathically
reassure parents, low fever ok
Tetanus vaccine sequalae
Anaphylaxis
brachial neuritis
Pertussis vaccine sequalae
Anaphylaxis
Encephalopathy
MMR Vaccine Seq
Anaphylaxis
Encephalopathy
Rubella Vaccine Seq
Chronic arthritis
Measles Vaccine Seq
High fever
Rash
Thrombocytopenia purpura
Measles
Polio Vaccine seq
Paralytic polio
Polio
Hepatitis B Vaccine Seq
Anaphylaxis
Rotavirus Vaccine Seq
Intussusception
Measles
Paramyxovirus
communicable 2-4 days before rash
**never give MMR vaccine before 12 mos, maybe wait until 2 yrs
Measles sxs
1st-fever, cough, conjunctivitis, photophobia, coryza, Koplik spots on oral mucosa
2nd- maculopapular rash
Measles Dx
Koplik spots!
helpful- coryza+photophobia
Measles Complications
UNCOMMON
pneumonia, OM, strep
TP, encephalitis, subacute pancencephalitis
Measles Managment
150-400,000 IU Vit A
Rubella Sxs
prodrome: 1-5 days, malaise, LAD
rash: face/neck to trunk and body. Gone in 3 days
“Scarlantiform rash” (appears like Scarlet fever)
Rubella Dx
NO Koplik spots, mild, no photophobia
Rubella Complications
Congenital Rubella Syndrome if contracted in first trimester (rare after 20 weeks)
deafness, eye problems, heart defects, mental retardation
Roseola infantum
most commonly HHV6
sxs: high fever, fever leaves then rash (starts on trunk), alert and active
convulsions during febrile phase
Roseola Dx
rule out UTI, OM, meningitis, pneumonia, sepsis…you can presume Roseola!
Roseola complications
seizures most common
aseptic meningitis
encephalitis
thrombocytopenic purpura
Erythema infectiosum
ParvoB19 infection
can recur for several weeks
sxs: mild; slapped-cheek rash that spreads to extremities and trunk, (maybe arthralgia)
Erythema infectiosum Dx
cx rash
IgM during acute
Erythema infectiosum Complications
during preg can cause fetal death (but NOT teratogenic)
aplastic crisis
arthritis can last for mos
Varicella sxs
prodrome: HA, low fever, malaise
rash: vesicular, comes in crops, crust over
Varicella dx
lesions
can titer or immunoflourescnece or PCR of vesicular fluid
Varicella complications
arthritis, GI organ involvement, pneumonia, encephalitis, nephritis, congenital varicella
Varicella vaccine Seq
chicken pox, pain, fever, rash
*probably will need booster for rest of life
Coxsackie virus
Hand, foot, mouth vesicular exanthem
Herpangina (mouth blisters)
Coxsackie TX
mouthwash: clove oil in carrier oil
Magic mouth wash: Maalox (milk of magnesia) with liquid benadryl
Bordatella pertussis
incubation 7-14
catarrhal–most transmissible! sneezing, lacrimation, coryza, hacking nocturnal cough
paroxysmal–most transmissible! 2 weeks after cough starts, thick mucus, may vomit after coughing paroxysms
convalescent–starts week 4, lasts 1-3 months
Pertussis dx
PCR
Pertussis management
oral erythromycin or azithromycin during catarrhal and early paroxysmal
quarantine
Pertussis vaccine
acellular
2, 4, 6 mos, 15-18 mos, 4-5 years
DTap
diptheria toxoid, tetanus toxoid, acellular pertussis
only need Td every ten years for children > 7 yrs/adults
Corynebacterium diptheriae
toxin causes tissue necrosis –> pseudomembrane
sxs: rhinorrhea that becomes bloody/mucopurulent
pharyngeal/tonsillar pseudomembrane
Diptheria complications
myocarditis (most are transient)
nerve palsies, dysphagia
Diptheria Management
Antitoxin ASAP
Clostridium tetani
“lockjaw”
following deep wound, jaw stiffness
complications: from tetany- fractures, urinary retention, dysphagia, cerebral hemorrhage
Tetanus Tx
hospitalization, air way maintenance, Ig, antibiotics
Mumps
Paramyxovirus
painful swelling of parotid glands or testicles
BL, non-erythematous
Mumps complications
orchitis in post-pubertal males (sterility rare)
meningoencephalitis
self-limiting pancreatitis
any glandular tissue can be involved
Mumps management
avoid acids/things that increase salivation
homeopathic parotidinum
vaccine- 12-15 mos and 4-6 yrs
Mononucleosis
Espstein-Barr
malaise/ fatigue then
fever, paharyngitis, LAD, splenomegaly
Mono Dx
CBC with diff– atypical lymphocytes!
monospot for heterophil Abs
Mono complications
strep pharyngitis
splenic rupture
airway obstruction from LAD (tx with roids)
