Chicken Pox - Epidemiology Paper
By
Brett Birkeland
Grand Canyon University

NRS-427V

July 29, 2015

Chicken Pox - Epidemiology Paper
In this paper, the nurse author will discuss the communicable disease called Varicella, also known as chicken pox. The nurse author will discuss the causes, symptoms, and mode of transmission, complications, and treatment, as well as mortality, morbidity, incidence, and prevalence of the disease. The determinants of health will be described, and the factors that add to the progression of the disease. The epidemiologic triangle, as it relates to Varicella, will be examined, including host factors, absence or presence of agent factors, along with environmental influences. The role of the community health nurse will be discussed as related to case finding, data collecting, reporting, data analysis, and follow-up. Lastly, a national agency or organization will be revealed that addresses chicken pox, and how it contributes to resolving or reducing the impact of the disease on the public.
The infectious disease of varicella, or chicken pox, is very contagious. A virus named varicella-zoster causes it. Furthermore, chickenpox can also be spread from those who have shingles. Since the same virus causes shingles, caution should be taken since an individual with shingles can infect those who have never had chickenpox, or those who have not been vaccinated against the disease. People most at risk to contract the disease are those who have not had the disease before, or received chicken pox vaccine. People who contract the virus can expect it to last anywhere from five to ten days. The most common indication of the infectious disease is a rash the turns in to an outbreak of fluid-filled blisters that frequently itch profusely, and ultimately scab over. The timeframe of being contagious to others ranges from one to two days before a rash appears up until the chickenpox blisters have scabbed over. The rash can appear first on the back, face or chest, and then extend to the rest of the body, incorporating the genital region, inside the mouth, or eyelids. It takes approximately one week for the blisters to turn into scabs. One may experience loss of appetite, high fever, headache, or malaise one to two days before the rash emerges. Chicken pox is a very serious disease, and is exceedingly dangerous for people with weakened immune systems, infants, adolescents, adults, and pregnant women. There are many serious complications that stem from the disease. Examples are bone and joint infections, dehydration, toxic shock syndrome, pneumonia, blood stream infections or sepsis, bleeding problems, bacterial infections of the soft tissues and skin of kids, and inflammation or infection of the brain. It is spread rather easily from a person who is infected to those who never have had the disease, or to an individual who has never had the Varicella vaccine. The virus is transmitted through the air by sneezing or coughing, and inhaled from an infected host. It can also be spread by coming in contact with the virus particles that come from the blisters chickenpox produces on the body. Currently, the drug Acyclovir is an antiviral medication approved for the treatment of the disease. Other medications that may be uses to treat the chickenpox virus are Famciclovir, and Valacyclovir. To help alleviate itching symptoms of the disease, colloidal oatmeal baths, and Calamine lotions may be used to provide some relief. To decrease the risk of skin infections, it is best to keep fingernails trimmed neatly, or not itch the sores at all. Over the counter medications, such as Tylenol, may be used to ease high temperatures. One must be careful not to use aspirin to treat fevers with anyone since it can lead to Reye’s syndrome, a dangerous disease that affects the brain and liver, and may cause death. The best prevention to avoid contracting the disease is a chickenpox vaccine. Roughly four million individuals in the United States have come down with the disease before the invention of the vaccine. (Centers for Disease Control 2015)
The mortality and morbidity of chicken pox have dramatically decreased 70%-90% with the introduction of the varicella immunization program in 1995. Re-exposure to the Varicella-zoster virus via close contact with individuals with the disease has been proposed to boost specific immunity, therefore reducing the risk of contracting chicken pox. In contrast, however, this may have lead to a higher incidence of shingles in older adults. The shingles immunization is now recommended for people sixty years and older to offset contracting the shingles virus. (Chavez, Santibanez, Gargiullo, & Guris, 2007) Chickenpox is seasonal infectious disease, and usually has an uptick of incidence in the late winter and early spring. For the most part, chicken pox is a childhood disease, accounting for greater than 90% of incidences occurring in kids less than ten years of age. It is typically nonthreatening in a healthy child, with a morbidity in immune-compromised patients and adults.
The agent factor is the presence of the virus, Varicella zoster, in the epidemiologic triangle. The host factor would include mostly children less than fifteen years of age, but anyone who has not had chickenpox would be vulnerable to contract the disease. In most cases, a person usually only has one occurrence of chickenpox in their lifetime. After having chickenpox, however, the virus lies dormant in nerve tissue the brain and spinal cord, and may come back as shingles years later. The environment in the epidemiologic triangle comes from the transmittal from inhaling around an infected person that coughs or sneezes, and from the fluid the chickenpox blisters produce. The virus can also thrive when there are periods of moderate temperatures. (Maurer & Smith, 2009)
The community health nurses play an essential role with primary prevention of chicken pox. Community health nurses can help reduce the spread of the disease by providing health education, and prophylactic precautions such as immunizations. As an example, when outbreaks occur with preschool children, two doses of the chickenpox vaccine are advocated for optimal defense. Prevention of transmission should be geared towards decreasing the risk of inhaling droplets the infected individual may cough or sneeze in to the air. Affected persons with chickenpox should be taught to cough and sneeze into tissues, and dispose of the tissues properly. The role of the community health nurse with secondary prevention involves identifying new cases of chickenpox, confirmation of an outbreak of chickenpox, providing over site, and administration of medication. The community health nurse may also provide support to caregivers, give education, and oversight to those affected with varicella. Tertiary prevention is intended to minimize any disabilities chickenpox may cause with the public, and maximize practical ability. One of the easiest ways to prevent and control chickenpox outbreaks is to encourage patients to get a chickenpox vaccination. Outbreaks can last long as four to five months in setting such as schools, and child day care centers. The benefit of suggesting the chickenpox vaccine may be the best line of defense in protecting individuals not yet exposed to the virus, and curtail the time frame of the outbreak. (Maurer & Smith, 2009)
The Centers for Disease Control is an excellent national agency and organization for addressing chicken pox. The CDC works with state health departments to supervise outbreaks of chickenpox. Each state is highly urged to inform the CDC either quarterly or annually about chickenpox outbreaks. The CDC offers health care professionals ways to interpret laboratory tests, managing people at risk for severe varicella, monitoring the impact of varicella vaccination, and preventing chickenpox in health care settings. (Centers for Disease Control 2015)
Chickenpox is one disease I will never forget having when I was in the third grade. For the most the part, the disease is not fatal, and can be prevented with a vaccination. While it can produce extremely uncomfortable symptoms, with time and rest, it passes in to a childhood memory. As a nurse, it is extremely important to emphasize the benefit of the vaccination to parents so their children to do not have to go through the same experience parentages did as a child.

References
Centers for Disease Control, Chickenpox Overview, (2015). Retrieved July 29, 2015, from http://www.cdc.gov/chickenpox/about/overview.html
Chavez, S. S., Santibanez, T. A., Gargiullo, P., & Guris, D. (2007). Chickenpox Exposure and Herpes Zoster Disease Incidence in Older Adults in the U.S. Public Health Reports, 122(2), 155-159. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820439/
Maurer, F. A., & Smith, C. M. (2009). Community/Public Health Nursing Practice: Health for Families and Populations (4 ed.). W.B. Saunders Company [VitalBook File]. Retrieved from http://pageburstls.elsevier.com/books/9781416050049/id/B9781416050049000081_t0010