Chickenpox Epidemiology
Grand Canyon University: NRS-427V
June 7, 2014

Chickenpox is disease caused by the virus varicella-zoster. It is most common in children under the age of fifteen but still possible for older children and adults to obtain. Chickenpox appears as an itchy red rash all over the body, the rash can turn into fluid filled blisters other symptoms include, fevers, headaches, tiredness, and loss of appetite. Chickenpox is very contagious and can be spread even when there are no symptoms. Varicella incubation period is fourteen to sixteen days from time of exposure but potentially could be ten to twenty-one days (CDC, 2013). The mode of transmission for varicella is direct contact of the blisters, or through the respiratory system. The earliest signs and symptoms is are first fever and then a red rash. In children the rash may be noticed first before the fever. The rash begins as macules, to papules, vesicles, pustules, and then crusts over. Once the rash becomes crusted over the chickenpox is no longer contagious. Chickenpox can be in different stages of the disease process while some may be crust over and be non contagious there may be other blisters that are still active and contagious. Chickenpox can also be spread from an individual who has shingles. Complications of chickenpox are bacterial skin infections in children and adults pneumonia (these are the most common they may occur vice versa) (CDC, 2013). According to the Center for Disease and Control Preventions more serious complications can occurs such as, “...septicemia, toxic shock syndrome, necrotizing fasciitis, osteomyelitis, bacterial pneumonia, and septic arthritis. Other complications caused by varicella include cerebellar ataxia, encephalitis, viral pneumonia, and hemorrhagic conditions”(2013). People who are most at risk for complications are infants, adults, pregnant individuals, and immunosuppressed individuals. In healthy children who develop chickenpox generally there is no treatment prescribed but, to let the disease run its viral course. In chickenpox the symptoms may be treated with an antihistamine or lotion. When patients are considered high risk a health care provider may prescribe acyclovir, valacyclovir, famciclovir, or immune globin intravenous (CDC, 2013). The best outcome for an adult patient is to receive one of these anti-viral medication within the first twenty-four hours of symptoms. The anti-viral treatment is only approved for adults only. It is recommended that aspirin be avoided with a diagnosis of chickenpox to prevent Reye’s Syndrome. Once chickenpox virus (varicella-zoster) has been in an individuals system the virus varicella-zoster can lay latent in the body and develop into shingles also called herpes zoster. Shingles is a very painful rash with blisters that affect one side of the body. The rash follows dermatomes on the body such as along the abdomen, eye, and neck. A child is able to develop shingles as well but it is unlikely. Shingles is a very dangerous disease as well that can lead to serious complications such as post-herpetic neuralgia, pneumonia, hearing problems, blindness, encephalitis or death. Shingles is most common in adults past the age of sixty (CDC, 2014). In 1995 a chickenpox vaccination became available. The first vaccine to become available was Varivax (1995) , Proquad (2005), and Zostavax (2006) (CDC, 2013). Before the development of the vaccination in 1995 there were approximately four million cases a year, 11,000-15,000 hospitalizations a year, 100-150 deaths per year, and mainly affected children (CDC, 2013). The Varicella incidence decreased by 90% after the development of the vaccination and, the mortality rate decreased by 93% after the development of the vaccination (CDC, 2013). The determinants of chicken pox are mainly being exposed to a person who has chicken pox or shingles. Since the disease is spread by contact of the blisters or through the respiratory system directly or indirectly it is best to avoid an infected person and their home. If a person were to have a rash and then the same bedding was to be shared, the infected bedding could potentially infect the person that shared the bedding. Normally children under the age of fifteen years old develop chickenpox. Chickenpox is most common in the end of winter months and the beginning of spring. Chickenpox is a global disease but, the chickenpox vaccine availability is decreasing the prevalence of the disease (Mayo Clinic, 2013). In the epidemiologic triangle chicken pox is caused by the virus varicella-zoster. Varicella-zoster affects people globally. The host of the virus is humans living in the region. The host is normally below the age of fifteen but adults are able to obtain the disease as well. If an adult were to develop chicken pox the possible complications from it are greater than if a child were to develop the disease. Any healthy person is able to develop chicken pox if exposed to the disease. If a person is vaccinated the chances are decreased by seventy-five percent. The disease can be transferred directly from infected person to well person, or indirectly such as sharing bedding with an infected person who has sores or rash present. The varicella-zoster virus does have short life once outside it’s host (Mayo Clinic, 2013). Varicella-zoster is a virus that is categorized in the herpesvirus group. Varicella-zoster’s primary infection leads to chicken pox but also has the ability to be latent in the system and later in life appear as shingles (herepe’s zoster, most likely in adulthood). When the virus is transmitted through the respiratory system it is thought to begin to replicate itself in the nasopharynx and lymph nodes (Mayo Clinic, 2013). It can also be spread through contact of rash or blisters that are not yet crust over. Once a person becomes infected the virus begins to spread through out the rest of the body. In 1995 after the development of the varicella vaccination chickenpox became a disease that was tracked by the Center for Disease and Control (CDC) and for selected states became a National Notifiable Disease. There is a form called Varicella Notification Message Mapping Guide that is to be completed and submitted to the National Notifiable Diseases Surveillance System. The four most important pieces of information to submit are age, vaccinations status, severity of disease, and outcome (CDC, 2013). Varicella reporting regulations vary from state to state. To have accurate data the CDC relies on community nurses to collect and submit data. The community nurse must be able to educate the community and provide vaccinations to individuals who need them. The nurse can educate and show the general public why the vaccine is necessary and its past success. If an individual already has chickenpox the nurse can direct the patient to see a doctor and help identify the disease. The nurse will be able to educate the patient of signs and symptoms and length of disease. If the individual was an adult explain that a better outcome my happen if anti-viral are started with in the first twenty-four hours. In tertiary prevention the nurse may help with recommendations to treat the symptoms such calamine lotion and other antihistamines. It is important for the nurse to educate the patient to try not to scratch to prevent infection of the skin. The nurse will instruct the patient to see a doctor and educate them that the plan of treatment is to let the disease run it’s course. It’s also important to educate that the disease is very contagious, and how it is spread. The National Shingles Foundation is a non-profit organization that is designed to fight against varicella-zoster virus that includes chickenpox, shingles, and post-herpetic neuralgia. The website provides information regarding each varicella-zoster virus disease. The National Shingles Foundation Hopes to better the lives of those are affected by the disease through education to the public and research. Their website also provides people with the ability to donate to research on the main page (National Shingles Foundation, n.d.). Although chickenpox still exists today the disease has already been reduced drastically in the United States. With more education to the public and easy access to the vaccine in the coming years chickenpox occurrences should be on the decrease even further. Through vaccinations, education, and research maybe this disease can even be eradicated.
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References
CDC. (2014, May 1). Shingles (Herpes Zoster). Retrieved June 7, 2014, from Centers for Disease Control and Prevention website: http://www.cdc.gov/shingles/about/overview.html

CDC. (2013). Chickenpox (Varicella). Retrieved June 7, 2014, from Centers for Disease Control and Prevention website: http://www.cdc.gov/chickenpox/about/transmission.html

Health Department of New York. (2014, January). Chickenpox (varicella zoster infection). Retrieved June 7, 2014, from http://www.health.ny.gov/diseases/communicable/chickenpox/fact_sheet.htm

Mayo Clinic. (2013, May 26). Diseases and Conditions Chickenpox. Retrieved June 7, 2014, from http://www.mayoclinic.org/diseases-conditions/chickenpox/basics/treatment/con-20019025

National Shingles Foundation. (n.d.). National Shingles Foundation. Retrieved June 8, 2014, from http://www.vzvfoundation.org

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