Chickenpox is a highly contagious viral infection caused by the Varicella-Zoster virus. It is transmitted from person to person by direct touching the blisters, saliva, or mucus of an infected person and through air by coughing and sneezing. Chickenpox is characterized by an itchy rash on the face, scalp, and trunk with pink spots and tiny fluid- filled blisters that dry and become scabs four to five days later. The incubation of chickenpox is ten to twenty-one days and the disease is contagious 1 to two days before the appearance of the rash until the blisters have dried and become scabs ( CDC, 2011). Approximately four million people get this disease every year and it is commonly seen in children and mos frequently in the late winter and early spring. The symptoms includes a sudden onset of low-grade fever, feeling tiredness, and weak followed by itchy blister like rash all over the body. The other symptoms are low appetite, muscle and joint pain, feeling ill, and it appears fourteen to sixteen days after the exposure to someone with chickenpox. Mild or asymptomatic infections occur in children but it is more serious in infants and adults. Chickenpox is life threatening to infants and adults and those who have impaired immune system ( Maurer & Smith, p.212, 2012). Fetal effects are rare congenital symptoms which presence as congenital vericella syndrome with infection during the first trimester of pregnancy, low birth weight, extremity atrophy, scarring of the skin, and eyes and neurological abnormalities ( Maurer & Smith, 2013). The treatment of chickenpox in acute infection include isolation of the infected person until the lesions have crusted and rest, to relief of itching with the use of calamine lotion, oatmeal bath, and antihistamines. Also use mittens and cut the nail short to prevent bacterial infection of the skin due to scratching. Acyclovir is the medication used for chickenpox in people who are at risk of moderate to severe varicella. Also use antipyretics drugs (non-aspirin containing drugs) to decrease the severity of the symptoms ( Maurer & Smith, p.212, 2012). Complications include bacterial skin infection caused by scratching, encephalitis, pneumonia, and death. Newborn children whose mother are not immune may suffer severe, prolong or fatal chickenpox ( CDC, 2011). Any person with a weakened immune system like HIV, cancer, or taking drugs that suppress the immune system may have an increased risk of developing chickenpox. Another complication is Reye syndrome, which occurs to children who take aspirin or aspirin containing products during the illness ( Mauer & Smith, 2013). Prevention of the disease is by vaccination. Vaccination for chickenpox is available and was first licensed in 1995. Children who have never had chickenpox should administered two doses of Varicella vaccine, and the first dose is at the age of 12 to 15 months and the second dose is 4 to 6 years age. A person who is 13 years and older who have never had chickenpox or have not received the vaccine should get two doses of varicella vaccine at least twenty-eight days apart. In New York State, varicella vaccine is required for children who enrolled in pre-kindergarten program and schools. The chickenpox is highly contagious and more than 95% of Americans get infected during adulthood. The CDC estimates that approximately 4 million cases occur each year worldwide. Every year 5,000 to 9,000 hospitalizations and 100 deaths from chickenpox in the U.S as documented by the CDC-OC. In children the chickenpox vaccine is given along with MMR called Measles ,Mumps ,Rubella vaccines. Since the availability of this varicella vaccine shows a highly effective introducing the incidents of chickenpox and protective against severe cases ( Maurer & Smith). The determinants of health addresses the factors that causes people to be more healthy than others and how we can adjust the situation in our environment to make a society have a better opportunity to lead healthy lives. The determinants of health are identified by the range of personal, social, economic, and environmental factors that influences health status. These factors can be characterized by several topics such as policy making, social factors, health services, individual behavior, and biology and genetics. An individual to achieve these factors have to be interrelated. Determinants of health focuses its efforts beyond traditional health care and public health sectors. It include education, housing, transportation, agriculture, and environment to be important areas in improving population health ( HealthyPeople.govn.d ). Policy making addressed at different levels affect individual and population. This contributes to the development of chickenpox and the possible complications in the fetus. It is required by the state of New York that the varicella vaccine is to be given as a routine childhood vaccination. All pregnant mothers should have had the vaccination in childhood. The social and physical determinants of health can have an impact on the range of health functioning and quality of life outcome. Some of the social determinants include, the availability of resources to meet daily needs such as educational and job opportunities , healthy food, exposure to mass media, internet and cell phones, socioeconomic conditions ,and public safety. The physical determinants are the natural environment, climate change, population density, building environment, housing and neighborhoods. These determinants contribute to the development of chickenpox when individuals and population fail to adher to public safety during the outbreak of chickenpox. Densely populated areas as a large number of persons will be exposed to getting the virus. Persons with poor socioeconomic standings might not have access to mass media or other sources of technological information to the knowledge of the disease and the precautionary measures to prevent contracting the disease. The lack of access or limited access to the health services is a major determinant of an individual health status. This contributes to the development of chickenpox in individuals who do not have health insurance or is an illegal immigrant because they will be less likely to participate in primary prevention and more likely to delay obtaining medical treatment. The barriers to health services that contribute to the development of the diseases include high cost, lack of availability or vaccine shortage mostly seen in developing countries. The individual behavior as a determinant of health plays a major role in health outcomes and it consists of diet, physical activities, hand washing, and compliance with vaccine preventable disease. These factors contribute to the development of chickenpox when the individual refuse the vaccination and they do not have the natural immunity against the disease. Biological and genetic factors affect specific populations. For example of genetic determinants of health is Sickle Cell Disease which is a condition characterized by the offspring inheriting the disease. In case of chickenpox there is no biological or genetic factors that contribute to develop the disease and it is caused by a virus. The epidemiological triangle relates to chickenpox consists of three factors: the agent ,the host, and the environment in the disease process and all these factors have to be present for the disease to occur.

The agent/ pathogen of chickenpox is the causative factor and highly virulent and can infect many people with small amounts of virus. The agent is transmitted via the respiratory tract through direct or indirect contact with the respiratory secretions. The incubation period of disease is 10 to 21 days with agent being communicable 1 to 2 days before the lesions are crusted. The host is reservoir or the person susceptible to the disease. The host is determined by factors such as ethnicity, gender, age or race, genetic risk factors, physiological and anatomical factors, nutrition or fitness and defense mechanism. In chickenpox none of these host factors are determinants for an individual contacting the disease . All humans process defense mechanism to prevent against communicable disease agent. Natural defense include tears, mucus membrane, saliva, and cilia ( nose hair). Natural immunities occurs when the individual develops immunity after exposed to the disease because of the body's antigen-antibody reaction to the infection (Maurer & Smith, 2013). The environment in the epidemiological triangle determines how the disease is spread. In chickenpox, it strives in a cool climate and environments are densely populated will see a higher incidents of the disease. Isolation of the infected person from the environment can help to prevent the transmission. Encourage the population to wear masks when there is a epidemic. The community health nurse is equipped with the skills of assessing the households and the communities for favorable environments, susceptible hosts and the viability of the agent. The nurse should educate the families and the communities to make the environment less favorable for the agent. For example, keep the infected person isolated, washing and cleaning inanimate objects with the infected persons separately to prevent the spread of the disease. The community health nurse has an important role in the prevention of chickenpox in individuals, families, and populations. To achieve this goal the nurse must know the basic information about the chickenpox such as the causative agent, incubation period, mode of transmission symptoms, protected measures and treatment ( Smith , 2013). The nurses role to assisting individuals and families, and communities to identify and access necessary resources in order to resolve the problem. Data collection and analysis by the nurse include screening individuals with unrecognized health risk factors or asymptomatic disease conditions ( Webn.d) and this is the secondary prevention and early detection. Tertiary prevention is aimed at existing disability in the early stages of the disease and providing rehabilitation for persons who have experienced loss of functions and developed severe complications from chickenpox. The nurse would provide education to prevent deterioration in the persons condition or referral to resources that can help clients minimize loss of function. One of the national organizations that addresses chickenpox is the Centers for Disease Control and Prevention which is the leading organization in providing epidemiological services to promote health. The National Center for Immunization and Respiratory Disease is a part of the CDC ,and is responsible for preventing disease, disability and death from respiratory and enteric viral diseases by providing immunization and other preventing measures ( NRICD, 2012). The CDC recommends chickenpox vaccine for children, adolescents and adults which is about 98% effective at preventing chickenpox (CDC, 2014).

References:
Smith,C. Maurer F. (2013): Community/Public Health Nursing Practice; Saunders, Pageburst online 5th edition retrieved from www. Evolve.elsiver.com
Fact about Chickenpox( Varicella) CDC-OC( n.d) retrieved from http://www.rightdiagnosis.com/article/factsaboutchickenpoxvaricellacdcoc.htm
Determinants of Health: HealthyPeople.gov(n..d)retrieved from http://www.healthypeople.gov/2020/about/DOHAAbout.aspx
Strohschein, S., Olson Keller, L., Briske, L. ( webn.d) Population-Based Public Health Nursing Practices: The intervention Wheel retrieved from http://www.coursewareobjects.com/object/evolvebookpages/Stanhope/pdfs/StanhopeCh09
CDC Chickenpox Varicella ( 2014) retrieved from http://www.cdc.gov/chickenpox/vaccination.html
NCIRD ( 2012) retrieved from http://www.cdc.gov/ncird/DVD.html