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Epidemiology

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Thesis How has Chicken Pox evolved over time related to advances in community and public health nursing? Chicken Pox is a very common childhood disease caused by the Varicella-Zoster virus. This contagious itchy red rash covers the entire body with red blistery spots causing discomfort (Web MD 2013). Immunization, education, awareness and the epidemiology of Chicken Pox has made drastic improvement in the occurrence and mortality of disease (Centers for Disease Control and Prevention 2014).
Description of Communicable Disease Chicken Pox can be easily transmitted from one person to the next by means of sneezing, coughing, saliva and surface contact (Web MD 2013). The fluid filled blisters rupture and accelerates the probability of transmission by contact. This disease is contagious 2-3 days prior to the rash appearing having an impact on how quickly this disease is transmitted due to the patient being asymptomatic (Web MD 2013). The ones who remain most at risk are those who’ve never had the disease or obtained a vaccine. The preliminary symptoms start to appear 14-16 days after contact with someone who had the disease (Web MD 2013). Symptoms include flu like symptoms with a fever, decreased appetite, headache, cough and sore throat. The itchy red spots appear taking approximately 2 days to go through the stages of blistering, bursting, drying and crusting over (Web MD 2013). Spots continue to appear everyday for about one week. It will take about one and half weeks after first symptoms appear before all blisters crust over and they are able to return to work/school.
Complications
Although uncommon, complications from Chicken Pox can occur especially in pregnant women, newborns, teens, adults and people who are immunosuppressed. Also included would be those with cancer, transplants, chemotherapy treatment, immunosuppressant medications and long-term use of steroids (Centers for Disease Control and Prevention 2011). Serious complications can include encephalitis, pneumonia, dehydration, bone/joint infection, bacterial infection and blood infection ( Centers for Disease Control and Prevention 2011). These serious complications could require hospitalization. The worst-case scenario but also a possibility would be fatality even in healthy unvaccinated children and adults.
Treatment
Treatment involves the use of calamine lotion and colloidal oatmeal baths to relieve itching. It is suggested to trim fingernails to avoid scratching to lessen transmission. Acetaminophen is used to relieve fever. Aspirin is avoided due to the possibility of developing Reye’s syndrome (Centers for Disease Control and Prevention 2014). As stated by the Mayo Clinic 2014, Reye's (Ryes) syndrome is a rare but serious condition that causes swelling in the liver and brain. For those who are immunosuppressed, pregnant women, have chronic illness or those on steroid treatment, acyclovir an antiviral medication is prescribed (Centers for Disease Control and Prevention, 2011).
Demographic of Interest The Chicken Pox vaccine was introduced in 1995 and has since seen a rapid decline in the outbreak of disease, hospitalizations and deaths. The incidence peaks between the months of March and May. Despite the fact Chicken Pox used to be common in the United States, it has reduced 82% from the year 2000-2010 (Centers for Disease Control and Prevention 2014). Prior to 1995, 4 million people got chicken pox and since the vaccine 3.5 million cases of chicken pox have been prevented. In addition approximately 9,000 hospitalizations and 100 deaths per year have been avoided due to the vaccine (Centers for Disease Control and Prevention 2014).
Determinants of Health The factors affecting the health of society is based on circumstances and environment including where we live, income, genetics, relationships and education level (World Health Organization 2014). Even the access to health care has less of an impact than these determining factors. Other factors contributing to health include a person’s behavior/character, physical environment and their social well being. In order to prevent illness it is beneficial to have a primary care physician and medical insurance as well as access to medical services. Detection of health problems during an early stage, the most treatable stage, is desirable in determining health outcome (Healthy People 2014). Due to the high cost of medical coverage and lack of medical attention compounded by the factors of determinants of health all inclusively impact disease and long-term health.
Epidemiologic Triangle The epidemiologic triangle as it relates to chickenpox consists of 3 vertices, the Agent (Varicella Zoster Virus), The host (human) and the Environment (external factors). Varicella Zoster Virus causes chicken pox and is present in the disease (Centers for Disease Control and Prevention). The host is the harboring mechanism for the agent itself. The host is exposed to the agent and disease is transmitted and harbors in the host. The host is more common in children under the age of 15 but others can be susceptible if they haven’t received the vaccine. Complications and fatality can occur in hosts with predispositions including pregnancy, infancy, those with immunosuppression’s and steroid treatment. The agent can remain in the body and exude later in the form of Shingles as an adult. The environment has factors that either cause or allow disease transmission. Environmental factors and external conditions can be favorable to allow the disease to transmit (Centers for Disease Control and Prevention). Chicken pox is transmitted through contact, sneezing, coughing and bodily fluids. Chicken pox is highly contagious and can disseminate quickly unless society is vaccinated. The final component of the triangle is the Time factor, the incubation period and duration of the disease (Centers for Disease Control and Prevention). Chicken pox is contagious 2-3 days prior to symptoms appearing. The first symptoms appear 14 – 16 days after contact. It will take approximately 10 days after first symptom before all blisters crust over.
Role of Community Health Nurse The role of the community health nurse is vast and essential in a society where education, promotion and facilitating need driven access to heath care is necessary. In addition to promoting a healthy environment and providing and coordinating direct care, the community health nurse screens and addresses communities assessing cases needing attention and intervention (Maurer and Smith 2012). Once a case is identified, reporting is essential to gather information and draw resolution to the prominent cause. Data is collected from the community or multiple demographics and analyzed by the nurse, which enables her to focus in on an area of treatment or research (Maurer and Smith 2012). The nurse is responsible to follow up with clients to obtain results and conclusions of such treatment, education and disease efficacy.
National Agency/Organization The National Foundation for Infectious Disease (NFID) contributes to resolving and reducing the impact of Chicken Pox by providing awareness, education and prevention for disease. This website provides a description of the disease, frequently asked questions and professional resources. It is up to date with current press releases, news conferences, stories and related links. Blogs are included and encouraged to relate to others facing the same issues (National Foundation for Infectious Disease 2014). This website and organization is all-inclusive in providing information related to Chicken Pox to enable society to reduce and resolve the impact of disease.
Conclusion
Community Health Nurses provide our communities with education, awareness, prevention strategies and statistics driven change reducing disease contraction and elimination. They provide resources, assistance and social service referrals when needed (Maurer and Smith 2012). Chicken Pox has significantly declined since the introduction of the vaccine in 1995 reducing outbreak significantly. Hospitalizations, complications and death have become almost obsolete (Centers for Disease Control and Prevention 2014). The epidemiology for Chicken Pox has changed dramatically over the years and due to education, awareness and treatment, has profoundly impacted society related to disease prevention. The National Foundation for Infectious Disease and other organizations contribute to awareness, prevention and resources giving society tools needed to resolve and reduce impact of disease.
References
Centers for Disease Control and Prevention (2011, November 16). Complications. Retrieved from http://www.cdc.gov/chickenpox/about/complications.html

Centers for Disease Control and Prevention (2011, November 16). Prevention and treatment. Retrieved from http://www.cdc.gov/chickenpox/about/prevention- treatment.html

Centers for Disease Control and Prevention (n.d.). Understanding the epidemiologic triangle though infectious disease . Retrieved from http://www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf

Centers for Disease Control and Prevention. (2012, August 30). Monitoring the impact of varicella vaccine. Retrieved from http://www.cdc.gov/chickenpox/hcp/monitoring-varicella.html

Healthy People (2014, August 21). Access to health services. Retrieved from http://www.healthypeople.gov/2020/LHI/accessCare.aspx?tab=determinants

Maurer, F. A., & Smith, C. M. (2012). Community/Public health nursing practice: Health for families and populations (5th ed.). St. Louis, MO: Saunders Elsevier. ISBN- 13: 9781455707621
Mayo Clinic. (2014). Reye's syndrome. Retrieved from http://www.mayoclinic.org/diseases-conditions/reyes- syndrome/basics/definition/con-20020083

National Foundation for Infectious diseases. (2014). National foundation for infectious disease. Retrieved from http://www.nfid.org

Web MD. (2013, January 15). Chicken pox (varicella) topic overview. Retrieved from http://www.webmd.com/vaccines/tc/chickenpox-varicella-topic-overview

World Health Organization. (2014). The determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/

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