This paper will give an overview of the varicella-zoster virus. This paper will also discuss the detriments of health from the chickenpox virus. The epidemiologic triangle will be outlined as it depicts the chickenpox virus. The aspect of the community health nurse will be discussed and information on a national organization for infectious diseases will be provided.
Chicken pox and shingles are caused by the virus varicella-zoster. The varicella-zoster virus is spread through the air by coughing or sneezing and can also be spread by touching the blisters or inhaling particles from the blisters ("CDC," n.d.). Chicken pox (varicella) is a highly contagious virus. The reactivation of the chickenpox virus (varicella-zoster virus) is called shingles. It usually is dominant in the nervous system for years or decades. Shingles (varicella-zoster) is spread through direct contact with fluid from the blisters and causes chickenpox if the person who comes in contact with the fluid from the blisters has never had the virus ("CDC," n.d.). Early symptoms of chickenpox may include fever, fatigue, irritability, loss of appetite and body aches with the appearance of itchy red rash usually occurs one to two days later. The rash usually last about five to ten days and heals with scabs ("National Foundation for Infectious Diseases," n.d.). Shingles symptoms are manifested as a painful vesicle filled rash to one side of the body. This usually occurs on the trunk or face. Numbness may be present for several days prior to outbreak. Shingles blisters scab over in about seven to ten days and may take two to four weeks to completely go away ("CDC," n.d.).
People at the highest risk for complications from chickenpox include infants, adolescents, pregnant women, individuals with compromised immune systems and adults. Some of the severe complications can include encephalitis, bacterial infections (including Group A Streptococcal infections), sepsis, pneumonia, dehydration, bone and joint infections and bleeding problems ("CDC," n.d.). Severe complications arise in about twenty percent from the cases of chicken pox. Data from a 1992 report about one hundred deaths out of one hundred fifty eight thousand cases that were reported ("National Vaccine Information Center," n.d.). Complications from shingles can included organ damage and post herpetic neuralgia ("National Foundation for Infectious Diseases," n.d.).
Treatment of chickenpox can include colloidal oatmeal baths and calamine lotion to prevent itching, keeping fingernails short to help skin infections and acetaminophen can be used to relieve fever ("CDC," n.d.). Only complications of chickenpox were treated with the appropriate medical intervention. In the 1990’s, it is estimated that about four million people were infected with chicken pox. A vaccine became available for chicken pox in 1995 and in 2010 there was a recommendation of a second vaccine in children ages four to six years old. The number of cases of varicella dropped by eighty-two percent from 2000 to 2010. Prior to the chickenpox vaccine, adults only counted for about five percent of the reported cases but thirty-five percent of the mortality rate. The treatment for shingles can include pain relieving medication, corticosteroids and anti-viral medication.(Stankus, Dlugopolski, & Packer, 2000) There is also a vaccine for shingles that became available in 2006. The shingles vaccine reduces the risk of developing shingles by fifty-one percent and decreases the risk of developing post herpetic neuralgia by sixty-seven percent ("CDC," n.d.).
The detriments of health range from personal, economic and environmental and social factors that influence health. Poor outcomes are often made worse by the correspondence of individuals between their social and physical environment ("Healthy People," n.d.) Education on risks of communicable disease is important for people to seek out appropriate medical treatment and health care for themselves and their families. Prevention of communicable disease is important not only to the individual but to the community. Receiving the appropriate vaccinations is important not just to the individual, but is important to the community as well. An individual not receiving the appropriate vaccines can put the entire community at risk. The detriments of health can reach further than common healthcare, partnering with sectors of public health is important to improve the overall health of the community.
The epidemiological triangle has three vertices: “the microbe that causes the disease” (agent), “the organism harboring the disease” (host), and the “external factors that allow the disease transmissions” (environment) ("CDC," n.d.) If one of the sides of the triangle are broken, a disruption occurs between the agent, host or environment halts the continuation of the disease. Varicella-zoster only occurs in humans. Chickenpox occurs most commonly in children under the age of fifteen and less commonly in adults ("CDC," n.d.).
The agent for this example of the epidemiological triangle is varicella-zoster. Viruses have core genetic material and take over cells to reproduce that genetic material. Varicella-zoster is a virus that is spread through airbourne droplets such as by coughing or sneezing, inhaling infected particles from the blisters or by touching the blisters. Chickenpox is highly contagious. It can take ten to twenty-one days for symptoms to appear. Infected individuals can be contagious for one to two days prior to outbreak of blisters. Infected individuals should be isolated at home for the length of the illness, which is about five to ten days. Chickenpox usually only occurs once in a lifetime, but the virus can be dormant and reoccur as shingles later in life ("CDC," n.d.).
Host are organism that harbor the disease, in the case with varicella-zoster is spread only from human to human. Different people can have different reactions to the same agent. Chickenpox usually causes more severe complications with adults versus children. Pregnant women, immunocompromised persons, adults and infants are at higher risk for complications. Chickenpox in a healthy child is usually self-limiting and management of the symptoms of chicken are the only thing needed. Vaccination is the key to helping prevent the host from developing the disease ("CDC," n.d.).
The environment is the favorable conditions are the external factors to the host that allow the disease to be transmitted ("CDC," n.d.). Places with large populations such as daycares and school allow favorable conditions with the large population and mode of transmission. The virus is susceptible to heat and disinfectants. Surfaces should be kept disinfected to prevent the spread infection. Incidence and mortality of chickenpox has decreased since the development of the chickenpox vaccine ("CDC," n.d.).
The community health nurse has many responsibilities that can impact the incidence of outbreak by hasty case finding which can help expedite immediate health alert. This can help protect those at higher risk like pregnant women, adults and immunocompromised individuals. Surveillance and data collection are necessary to monitor the success of the chickenpox vaccine and effectiveness of prevention. Other health agencies can gain insight and watch for developing trends with data reporting. Investigation of high incidence of outbreaks can help determine whether the vaccine effectiveness is lower than expected or lower vaccination rates have occurred. Community nurses have the ability to identify high risk populations and implement plans of action based the resources available and the need of the population.
The National Foundation for Infectious Disease is a non-profit organization that was founded in 1973 for the purpose of educating the public and health care professionals about the causes, prevention and treatment of infectious diseases across the lifespan. The foundation is based in Bethesda, Maryland. More information can be found at www.nfid.org/info. References
Chickenpox the Disease and Vaccine Fact Sheet. (n.d.). Retrieved November 22, 2015, from http://www.nvic.org/vaccines-and-diseases/Chickenpox/chickenpoxfacts.aspx
Chickenpox (Varicella). (n.d.). Retrieved November 22, 2015, from http://www.cdc.gov/chickenpox/index.html
Facts About Chickenpox and Shingles for Adults. (n.d.). Retrieved November 22. 2015, from http://www.nfid.org/publications/factsheets/varicellaadult.pdf
Social Detriments of Health. (n.d.). Retrieved November 22, 2015, from http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health
Stankus, S. J., Dlugopolski, M., & Packer, D. (2000, April). Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia. American Family Physician, 61(8), 2437-2444. Retrieved from http://www.aafp.org/afp/2000/0415/p2437.html
Understanding the Epidemiologic Triangle Through Infectious Disease. (n.d.). Retrieved November 22, 2015, from http://www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf