Epidemiology Research Paper (Chickenpox)

Epidemiology Research Paper (Chickenpox)

Epidemiology Research Paper (Chickenpox)

Epidemiology Paper: Chickenpox

            Chickenpox is one of the highly contagious diseases. It is common among children although it affects adults. However, the cases of chickenpox have reduced significantly following the introduction of the varicella vaccine. While the concept of chickenpox is broad, this paper will include a detailed description of this disease, the social determinants of health variable that influence the development of this disease, the epidemiologic triangle, the role of the community health nurse, a national agency that addresses this disease, and its global impact.

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A Description of Chickenpox

Causes

            Chickenpox is a communicable disease, which is caused by the Varicella-zoster virus (VZV) (Ayoade & Kumar, 2020). Most cases of this infection occur through contact with an infected person. The people around an infected person have high chances of contracting the virus in one or two days before the appearance of the blisters. Varicella-zoster virus is contagious for some time until when all the blisters have crusted over. VZV is mainly spread through coughing, saliva, sneezing, and contacting fluid from the blisters.

Symptoms

This disease is primarily characterized by an itchy blister rash, which appears between 10 and 21 days after being exposed to the virus. In most cases, the rash lasts between five and 10 days. Other major signs and symptoms of chickenpox include loss of appetite, fever, fatigue, feeling of being unwell, aching muscles, nausea, and headache (Van Seventer & Hochberg, 2017). These symptoms are usually experienced one to two days before the rash. Severe symptoms, including the skin around the blisters or spots, which become red and painful, and breathing difficulties occur in some people. One should contact a doctor on the onset of these symptoms. Nonetheless, most healthy individuals recover fully by drinking plenty of fluids and having adequate rest (Van Seventer & Hochberg, 2017).

An infected individual experiences three phases of this condition after the appearance of a chickenpox rash. The first phase includes red bumps that break out after some days. The second phase is characterized by small fluid-filled blisters also known as vesicles. They form for around one day before breaking and leaking. The last phase involves the formation of crusts and scabs that cover the broken blisters. They take some days before healing completely.

The Mode of Transmission

            Chickenpox is among the highly contagious infections, which are caused by VZV. The virus spreads from an infected person to others who have never had chickenpox or have never been vaccinated against this disease. The primary transmission of this virus involves getting into close contact with a person with chickenpox. Shingles are also caused by varicella-zoster. Thus, a person who has never had chickenpox or vaccinated against this disease can get it by coming into contact with an individual with shingles. The contagious duration of this disease is relatively long. It starts in 1 to 2 days before the appearance of the rash and lasts until all the chickenpox lesions have scabbed completely. Lesions may fail to crust if a vaccinated individual contracts this disease. These individuals remain contagious until no new lesions have formed for about 24 hours. Individuals take around 2 weeks (between 10 and 21 days) after being exposed to the virus for chickenpox to develop (Van Seventer & Hochberg, 2017). A vaccinated individual can transmit the virus to others if he or she gets the disease. Most people develop life immunity after getting chickenpox once. Some individuals can develop chickenpox more than once in their lifetime. However, such cases are very rare.

Complications

Although chickenpox is a mild disease it can lead to serious complications, including dehydration, pneumonia, toxic shock syndrome, inflammation of the brain (encephalitis), and Reye’s syndrome in children and teenagers if they take aspirin during infection duration (Van Seventer & Hochberg, 2017). Additionally, chickenpox causes bacterial infections that appear on various body parts such as the skin, bones, soft tissues, joints, or the bloodstream. Chickenpox leads to several birth defects if a woman is exposed to VZV during pregnancy. These birth complications include poor growth, eye problems, small head size, and intellectual disabilities. In some rare cases, chickenpox leads to death.

Treatment

            Chickenpox does not have a particular cure but it is prevented through vaccination. It resolves without treatment within a week or two after the onset of a rash. However, some medications are prescribed to manage and reduce the severity of the symptoms of this contagious illness. Additionally, medications prevent the infection from spreading to others or causing further complications. Tylenol (acetaminophen) is prescribed to manage pain or fever. It is usually prescribed if a patient has a high temperature and pain. A patient is advised to adhere to the manufacturer’s instructions strictly when using this drug to avoid side effects, including drug reactions. Products that contain aspirin should not be prescribed to patients with chickenpox to prevent further complications. Acetaminophen (Tylenol) is safe to be used at any time during pregnancy (Addo et al., 2019).

            In addition to medication, patients are educated about other management measures. First, they are advised to avoid dehydration. Patients with chickenpox are advised to take plenty of fluids especially water frequently to prevent dehydration. Sugar-free popsicles are recommended for children who do not drink plenty of fluids. Additionally, sugar-free popsicles are recommended to ease the severity of symptoms of soreness in the mouth. A patient with chickenpox should avoid taking salty or spicy foods. Soup is a good option if a patient has difficulty with chewing. Furthermore, a person infected with this disease should avoid scratching the rashes to lower the risk of scarring. Scratching can be prevented by keeping fingernails as short as possible and keeping them clean to avoid further complications. In the case of a child, mittens should be placed at the hands to prevent scratching. Scratching can also be reduced by having an oatmeal bath or applying calamine lotion. Wearing loose clothing is also good to prevent pressing the rashes, thus triggering scratching. During pregnancy, a clinician can prescribe antiviral medication to a patient with chickenpox. Acyclovir is an example of antiviral medication that can be prescribed to an expectant woman in case of an early diagnosis in individuals with a weakened immune system and a newborn. According to Van Seventer and Hochberg (2017), Acyclovir is efficacy in lowering the severity of symptoms if administered within 24 hours of developing symptoms. However, it does not cure chickenpox.      

The Demographic of Interest

The demographic of interest for this disease are children. Chickenpox is very common in children. Before the introduction of vaccination in the mid-1990s, it was perceived as a childhood rite of passage that was a must for every child. Before the introduction of the early-childhood vaccination program, varicella was declared endemic in the United States. All individuals acquired this virus by adulthood. Approximately, the annual rate of this infection in the US was 4 million. About 90% of the infections occurred among children below 15 years1990s (Lopez et al., 2015). One to four years was ranked as the age bracket with the highest incidence of varicella in the 1990s (Lopez et al., 2015). Children in this age bracket accounted for around 39% of all cases of chickenpox. This high incidence was attributed to the earlier exposure to VZV in two settings, including child care and preschool. Only 7% of cases of infection were reported among adults aged 20 years and above1990s (Lopez et al., 2015). Similarly, morbidity and mortality of chickenpox were higher among children between one and four years.

A significant decrease has been reported in the incidence of varicella and varicella-related hospitalizations following the adaption of the national varicella vaccination program, which was introduced in 1996. Approximately 97% decline in the incidence of this virus was reported in 2014 compared to pre-vaccine years1990s (Lopez et al., 2015). This data was obtained from four states in which cases of varicella are continuously reported to the National Notifiable Diseases Surveillance System (NNDSS) from before the introduction of the varicella vaccination program to date. This decline has occurred in all age groups, including infants who were given priority during the vaccination due to their high risk of contracting this virus than other groups of people in the community. The rate of infection reduced further following the inclusion of the second dose of varicella vaccine to the national program in 2007. About 85% decline was reported during the 2-dose era1990s (Lopez et al., 2015). This percentage was based on the data that was obtained in 40 states, which reported the cases of varicella to NNDSS. Children age between 5 and 14 years reported the greatest decline in the infection rate (85% to 89%) in the data collected between 2013 and 20141990s (Lopez et al., 2015).  

Reporting of Chickenpox

In 1981, Varicella was eliminated from the list of nationally notifiable diseases. However, some states still report cases of varicella outbreak to the National Notifiable Diseases Surveillance System (NNDSS) and the Center for Disease Control (CDC). Reporting is done through the National Electronic Disease Surveillance System (NEDSS). For instance, cases of varicella were reported to the National Notifiable Diseases Surveillance System (NNDSS) by 34 states in 2007. Additionally, individuals use varicella (chickenpox) Reporting Form to inform local or regional health office of any cases of varicella within 24 hours after the outbreak (Lopez et al., 2015). Additionally, four states in which cases of varicella are continuously reported to the National Notifiable Diseases Surveillance System (NNDSS) from before the introduction of the varicella vaccination program to date (Lopez et al., 2015).

The Impact of Social Determinants of Health on the Development of Chickenpox

            The development of chickenpox is substantially influenced by the social determinants of health. According to Catalyst (2017), social determinants of health refer to the situation under which an individual was born and raised and influence his or her health status. Key aspects of social determinants of health include occupation and employment level, income, educational attainments, housing, gender inequity, social support, and availability of transportation services. The development of chickenpox is primarily influenced by the housing plan. This disease is mainly transmitted by coming into contact with a person with varicella. Poor housing plan like in the case of slums increases the contact rate of individuals. Thus, a person living under such a housing program is at a higher risk of becoming into contact with an infected person, thereby contracting the virus and developing chickenpox.

The Epidemiologic Triangle associated with Chickenpox

            Chickenpox relates to the epidemiologic triangle, which was developed to enhance the understanding of infectious disease (Van Seventer & Hochberg, 2017). In particular, this infectious disease is related to the three vertices of this triangle. The first vertex of this triangle portrays the agent that causes a particular infectious. In this case, this corner represents the Varicella-zoster virus (VZV), which causes chickenpox. The second corner of the epidemiologic triangle represents the host. In this case, it represents humans who are the host of VZV. The third corner of this triangle represents the external factors, which enhance the transmission of the virus from an infected person to others in the surrounding. In this case, the external factor is becoming into contact with an infected person, which supports the transmission of the VZV. The community should be notified about the mode of transmission of this disease to prevent it from spreading out in the event of an outbreak.

The Role of the Community Health Nurse

The community health nurse has a major role to play in preventing the spread of VZV among the community members. Their role involves several activities, case finding, reporting, data collection, data analysis, and follow-up. Case finding focuses on identifying incidents of chickenpox outbreaks in the community. The second role involves reporting in which they should inform the relevant agencies, including local or regional health officials and the National Notifiable Diseases Surveillance System (NNDSS) of any cases of varicella. Data collection and analysis involves gathering information of the affected demographic, including age and gender, and analyzing it to guide the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID) in taking the most appropriate action. Data analysis. Finally, follow-up involves evaluating the effectiveness of the implemented measures in preventing the spread of VZV. Demographic data are necessary to the health of the community since they indicate the most affected population group, thus guiding in the prevention strategies. Prevention of the outbreaks of this virus improves the health and the overall quality of life of the community members.

A National Agency for Addressing the Outbreaks

The U.S. Centers for Disease Control and Prevention (CDC) addresses the outbreaks of VZV in the states that still report the outbreak of this condition following its inclusion to the list of nationally notifiable diseases in 2003. According to Lopez et al. (2015), CDC resolved the outbreak of varicella in 40 states, which were reported after conducting case-based varicella surveillance. This issue was addressed through state and local health department staff who participated in the surveillance program. The outbreak is resolved through the introduction of a vaccine program to prevent future outbreaks. For instance, the inclusion of the second dose of varicella vaccine to the national program in 2007 aimed at reducing the rate of infections in the future (Lopez et al., 2015).

The Global Implication of Chickenpox

Chickenpox has an impact on various countries globally. This disease is common in children than in other populations. Despite being mild in children, it can lead to serious complications. Approximately, 4.2 million serious complications associated with varicella virus were reported by the World Health Organization (WHO) in 2014. These complications result in several hospitalization and 4200 death cases worldwide each year. The medication administered to the hospitalized patients increases countries’ economic burden (Arlant et al., 2019). This disease has been addressed through vaccination in most countries irrespective of their culture. Currently, chickenpox is not endemic to a particular region globally due to the efficacy of the varicella vaccine.

Overall, chickenpox is a communicable disease, which is caused by the Varicella-zoster virus (VZV). Most cases of this infection occur through contact with an infected person. The housing program is the social determinant of health factors that influence the development of this disease. The epidemiologic triangle relates to this disease since its three vertices represent the agent, host, and external environment. The community health nurse plays a significant role in the management of this disease through data collection and analysis. CDC is the national agency that addresses this disease to prevent future outbreaks. This disease has a global impact by increasing the economic burden of nations.

References

Addo, K. A., Bulka, C., Dhingra, R., Santos Jr, H. P., Smeester, L., O’Shea, T. M., & Fry, R. C. (2019). Acetaminophen use during pregnancy and DNA methylation in the placenta of the extremely low gestational age newborn (ELGAN) cohort. Environmental epigenetics, 5(2), dvz010.

Arlant, L. H. F., Garcia, M. C. P., Aguero, M. L. A., Cashat, M., Parellada, C. I., & Wolfson, L. J. (2019). Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review. BMC public health, 19(1), 1-18.

Ayoade, F., & Kumar, S. (2020). Varicella Zoster (Chickenpox). StatPearls [Internet].

Catalyst, N. E. J. M. (2017). Social determinants of health (SDOH). NEJM Catalyst, 3(6).

Lopez, A; Harrington, T., & Marin, M. (2015). Varicella. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf

Rodriguez-Santana, Y., Sanchez-Almeida, E., Garcia-Vera, C., Garcia-Ventura, M., & Martinez-Espligares, L. (2019). Epidemiological and clinical characteristics and the approach to infant chickenpox in primary care. European journal of pediatrics, 178(5), 641-648.

Van Seventer, J. M., & Hochberg, N. S. (2017). Principles of Infectious Diseases: Transmission, Diagnosis, Prevention, and Control. International Encyclopedia of Public Health, 22.

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Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.
Communicable Disease Selection
Chickenpox
Tuberculosis
Influenza
Mononucleosis
Hepatitis B
HIV
Ebola
Measles
Polio
Influenza
Epidemiology Paper Requirements
Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.