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Chickenpox (Varicella)
The incubation period is 14 to 16 days after exposure, with a range of 10 to 21 days. The incubation period may be prolonged in immunocompromised patients and those who have received postexposure treatment with a varicella antibody–containing product. In individuals who have not been vaccinated with varicella vaccine, the rash is generalized and pruritic and progresses rapidly from macules to papules to vesicular lesions before crusting. The rash usually appears first on the head, then on the trunk, and then the extremities; the highest concentration of lesions is on the trunk. Lesions also can occur on mucous membranes of the oropharynx, respiratory tract, vagina, conjunctiva, and the cornea. Lesions are usually 1 to 4 mm in diameter. The vesicles are superficial and delicate and contain clear fluid on an erythematous base. Vesicles may rupture or become purulent before they dry and crust.

Diphtheria
Diphtheria may involve any mucus membrane and has an incubation period of 2-5 days. Classification is based on site of disease, with pharyngeal and tonsillar diphtheria being most common. Early symptoms include sore throat, malaise, anorexia, low-grade fever and within 2-3 days a bluish-white membrane forms on the tonsils.

Haemophilus influenzae type B (Hib)
The most common types of invasive disease are meningitis, epiglottitis, pneumonia, arthritis, and cellulitis. Meningitis is the most common clinical manifestation of invasive Hib disease, accounting for 50%-65% of cases in the prevaccine era. Hallmarks of Hib meningitis are fever, decreased mental status, and stiff neck (these symptoms also occur with meningitis caused by other bacteria). Incidence is strikingly age-dependent. In the prevaccine era, up to 60% of invasive disease occurred before age 12 months, with a peak occurrence among children 6-11 months of age.

Hepatitis A
The incubation period of hepatitis A is approximately 28 days (range 15-50 days). The clinical course of acute hepatitis A is indistinguishable from that of other types of acute viral hepatitis. The illness typically has an abrupt onset of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and jaundice. In children younger than 6 years of age, most (70%) infections are asymptomatic. In older children and adults, infection is usually symptomatic, with jaundice occurring in more than 70% of patients.

Hepatitis B
The incubation period ranges from 45 to 160 days (average 120 days). Clinical signs and symptoms occur more often in adults than in infants or children, who usually have an asymptomatic acute course. However, approximately 50% of adults who have acute infections are asymptomatic. The preicteric, or prodromal phase from initial symptoms to onset of jaundice usually lasts from 3 to l0 days. It is nonspecific and is characterized by insidious onset of malaise, anorexia, nausea, vomiting, right upper quadrant abdominal pain, fever, headache, myalgia, skin rashes, arthralgia and arthritis, and dark urine, beginning 1 to 2 days before the onset of jaundice. The icteric phase is variable but usually lasts from l to 3 weeks and is characterized by jaundice, light or gray stools, hepatic tenderness and hepatomegaly (splenomegaly is less common). During convalescence, malaise and fatigue may persist for weeks or months, while jaundice, anorexia, and other symptoms disappear.

Human Papillomavirus (HPV)
Most HPV infections are asymptomatic and result in no clinical disease. Clinical manifestations of HPV infection include anogenital warts, recurrent respiratory papillomatosis, cervical cancer precursors (cervical intraepithelial neoplasia), and cancers, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancer.

Influenza
The incubation period for influenza is usually 2 days, but can vary from 1 to 4 days. Influenza illness can vary from asymptomatic infection to severe. In general, only about 50% of infected persons will develop the classic clinical symptoms of influenza. “Classic” influenza disease is characterized by the abrupt onset of fever, myalgia, sore throat, nonproductive cough, and headache. The fever is usually 101°–102°F, and accompanied by prostration (bedridden). The onset of fever is often so abrupt that the exact hour is recalled by the patient. Myalgias mainly affect the back muscles. Cough is believed to be a result of tracheal epithelial destruction. Additional symptoms may include rhinorrhea (runny nose), headache, substernal chest burning and ocular symptoms (e.g., eye pain and sensitivity to light).

Measles
The measles incubation period is 10-12 days. The prodrome lasts 2-4 days, characterized by a stepwise increase in fever to 103°F–105°F. The fever is followed by the onset of cough, coryza, conjunctivitis. Koplik spots (rash on mucous membranes)is considered to be pathognomonic for measles. The maculopapular rash begins 2-4 days after prodrome, 14 days after exposure, and persists 5-6 days. It begins on face and upper neck, proceeding downward and outward, and the maculopapular lesions may become confluent. The rash fades in order of appearance.

Meningitis
The incubation period of meningococcal disease is 3 to 4 days, with a range of 2 to 10 days. Meningitis is the most common presentation of invasive meningococcal infection (meningococcal disease) and results from hematogenous dissemination of the organism. Meningeal infection is similar to other forms of acute purulent meningitis, with sudden onset of fever, headache, and stiff neck, often accompanied by other symptoms, such as nausea, vomiting, photophobia (eye sensitivity to light), and altered mental status. Meningococcal sepsis (bloodstream infection or meningococcemia) occurs without meningitis in 5% to 20% of invasive meningococcal infections. This condition is characterized by abrupt onset of fever and a petechial or purpuric rash, often associated with hypotension, shock, acute adrenal hemorrhage, and multi-organ failure.

Mumps
The incubation period of mumps is 12 to 25 days, but parotitis typically develops 16 to 18 days after exposure to mumps virus. The prodromal symptoms are nonspecific, and include myalgia, anorexia, malaise, headache, and low-grade fever. Parotitis is the most common manifestation. Parotitis may be unilateral or bilateral, and any combination of single or multiple salivary glands may be affected. Parotitis tends to occur within the first 2 days and may first be noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after one week and usually resolve after 10 days.

Pertusiss (Whooping Cough)
The incubation period of pertussis is commonly 7–10 days, with a range of 4–21 days, and rarely may be as long as 42 days. The first stage, the catarrhal stage, is characterized by the insidious onset of coryza (runny nose), sneezing, low-grade fever, and a mild, occasional cough, similar to the common cold. The cough gradually becomes more severe, and after 1–2 weeks, the second, or paroxysmal stage, begins. It is during the paroxysmal stage that the diagnosis of pertussis is usually suspected. Paroxysmal attacks occur more frequently at night, with an average of 15 attacks per 24 hours. During the first 1 or 2 weeks of this stage, the attacks increase in frequency, remain at the same level for 2 to 3 weeks, and then gradually decrease. The paroxysmal stage usually lasts 1 to 6 weeks but may persist for up to 10 weeks.

Pneumococcal Disease
The major clinical syndromes of pneumococcal disease are pneumonia, bacteremia, and meningitis. Pneumococcal pneumonia is the most common clinical presentation of pneumococcal disease among adults. The incubation period of pneumococcal pneumonia is short, about 1 to 3 days. Symptoms generally include an abrupt onset of fever and chills or rigors. Other common symptoms include pleuritic chest pain, cough productive of mucopurulent, rusty sputum, dyspnea (shortness of breath), tachypnea (rapid breathing), hypoxia (poor oxygenation), tachycardia (rapid heart rate), malaise, and weakness.

Polio
The incubation period for nonparalytic poliomyelitis is 3-6 days. For the onset of paralysis in paralytic poliomyelitis, the incubation period usually is 7 to 21 days. Up to 72% of all polio infections in children are asymptomatic. Infected persons without symptoms shed virus in the stool and are able to transmit the virus to others. Approximately 24% of polio infections in children consist of a minor, nonspecific illness without clinical or laboratory evidence of central nervous system invasion. This clinical presentation is known as abortive poliomyelitis, and is characterized by complete recovery in less than a week. This is characterized by a low grade fever and sore throat. Nonparalytic aseptic meningitis (symptoms of stiffness of the neck, back, and/or legs), usually following several days after a prodrome similar to that of minor illness, occurs in 1%–5% of polio infections in children. Increased or abnormal sensations can also occur. Typically these symptoms will last from 2 to 10 days, followed by complete recovery. Paralytic symptoms generally begin 1 to 18 days after prodromal symptoms and progress for 2 to 3 days.

Rotavirus
The incubation period for rotavirus diarrhea is short, usually less than 48 hours. The clinical manifestations of infection vary and depend on whether it is the first infection or reinfection. The first infection after 3 months of age is generally the most severe. Infection may be asymptomatic, may cause self-limited watery diarrhea, or may result in severe dehydrating diarrhea with fever and vomiting. Up to one-third of infected children may have a temperature greater than 102°F (39°C). The gastrointestinal symptoms generally resolve in 3 to 7 days.

Rubella
The incubation period of rubella is 14 days, with a range of 12 to 23 days. Symptoms are often mild, and up to 50% of infections may be subclinical or inapparent. In children, rash is usually the first manifestation and a prodrome is rare. In older children and adults, there is often a 1 to 5 day prodrome with low-grade fever, malaise, lymphadenopathy, and upper respiratory symptoms preceding the rash. The rash of rubella is maculopapular and occurs 14 to 17 days after exposure. The rash usually occurs initially on the face and then progresses from head to foot. It lasts about 3 days and is occasionally pruritic. The rash is fainter than measles rash and does not coalesce. The rash is often more prominent after a hot shower or bath.

Shingles (Herpes zoster)
Herpes zoster, or shingles, occurs when latent varicella zoster virus (VZV) reactivates and causes recurrent disease. The immunologic mechanism that controls latency of VZV is not well understood. However, factors associated with recurrent disease include aging, immunosuppression, intrauterine exposure to VZV, and having had varicella at a young age (younger than 18 months). In immunocompromised persons, zoster may disseminate, causing generalized skin lesions and central nervous system, pulmonary, and hepatic involvement. The vesicular eruption of zoster generally occurs unilaterally in the distribution of a sensory nerve. Most often, this involves the trunk or the fifth cranial nerve. Two to four days prior to the eruption, there may be pain and paresthesia in the involved area. There are few systemic symptoms.

Tetanus
The incubation period ranges from 3 to 21 days, usually about 8 days. In general the further the injury site is from the central nervous system, the longer is the incubation period. Shorter incubation periods are associated with a higher chance of death. In neonatal tetanus, symptoms usually appear from 4 to 14 days after birth, averaging about 7 days.

Content last updated: July 24, 2017

 
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