Epidemiology: Chickenpox Grand Canyon University: NRS-427V
August 10, 2014

Epidemiology: Chickenpox (Varicella) Communicable Disease Overview: Chickenpox Chickenpox also known as varicella is a very contagious disease caused by the varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can have serious consequences, especially in babies, adults, and immunocompromised persons. The disease spreads easily from infected people to others who have never received the chickenpox vaccine or had chickenpox. Chickenpox spreads in the air through coughing or sneezing through the respiratory tract. The virus particles that come from chickenpox blisters are highly contagious. If a person touches or breaths in the virus particles it will become infected ("Chickenpox (varicella)," 2011). The first symptoms usually develop 14 – 16 days after the person is exposed to the infection. The infected person will have fever of 38C – 39.4C, feeling tired, decreased appetite, headache, cough and sore throat. Adults and teens can experience severe symptoms while in children’s symptoms are mild. The itchy rash develops 1- 2 days after the first symptoms. The upper body is mostly affected and can spread to the face, arms and legs. The varicella is most contagious from 2-3 days before the rash develops until the blisters have dried and formed crust. The most serious complication is skin infection for children under age 5. When the blister is scratched, the bacteria under the fingernail settles in the chickenpox blister and grows. If the infection is not treated it will cause serious complications ("Vaccines health center," 2013). Other complications include sepsis, pneumonia, encephalitis, toxic shock syndrome and Reye’s syndrome if aspirin is taken during chickenpox. For persons who are at high risk of complications the treatment may include Zovirax or Immune globulin intravenous. The medications may be given within 24 hours after the first rash. The antiviral medications can make the diseases less severe. Taking medications containing aspirin is contraindicated for children or adults with chickenpox because this will cause Reye’s syndrome. The treatment of complications vary, skin infection and pneumonia may be treated with antibiotics, and antiviral drugs are prescribed for encephalitis. Persons with severe complications of chickenpox may be hospitalized ("Chickenpox complications," 2013). The same varicella zoster virus (VZV) that causes chickenpox can cause shingles (herpes zoster). That can occur later in life, because the VZV lives in the person’s body and can erupt again. Older adults can get vaccinated for shingles. Varicella has been mostly affecting preschool and school-aged children, however it has been noticed among adults too. In adults the pocks are darker and the scars more noticeable than in children. In the US 55 % of chickenpox deaths are among people over 20 years old. The highest incidence of chickenpox was among children 1 to 4 years old. It is believed that this age group accounted for such a high incidence in a result of exposure to the virus in preschool (Gibson, 2013). The incidence of varicella and varicella-related hospitalizations, has declined tremendously since the vaccine became available in 1995. By 2004 varicella cases decreased by 93% when compared with 1995. With the use of varicella vaccine the incidence rate has greatly declined. Because of the higher incidence in breakthrough infection, in 2006 it was recommended that people should be vaccinated with second routine dose varicella vaccine (Gibson, 2013). The chickenpox vaccine is the best way to prevent chickenpox. Before the vaccine became available, each year about 4 million people would get the disease in the United States. In addition about 10,600 people were hospitalized. As a result about 100 to 150 died each year from chickenpox ("Chickenpox (varicella)," 2011).
Determinants of Health The determinants of health are the personal, social, economic, and environmental factors that have impact on health status. There are number of health behaviors that have influence on the disease process. Hand hygiene, poor education, inadequate living conditions and low income can attribute to the spread of the chickenpox. Improper hand washing, or not washing hands at all will increase the probability of spreading the virus. People who live in overcrowded houses can easily transmit the virus to one another. People with low income may not have access to healthcare and cannot afford to pay for vaccination. Also lack of proper nutrition is an issue for those people and they become more vulnerable to infections. Under educated people often lack the knowledge about the diseases process, how to prevent the spread of chickenpox or how to treat the infection. Educating people on disease prevention with simple hand washing and avoiding contact with infected person can make a difference. In addition to education improving health determinants will have great impact on the health status of the population ("Determinants of health," 2014).
Epidemiologic Triangle The epidemiological triangle consists of three main parts agent, host and environment. The best way to prevent or eliminate the disease is to break one of the weakest part in the triangle. In this case with chickenpox would be varicella vaccination. The agent is the varicella zoster virus which causes the chickenpox. Chickenpox is highly infectious disease and small amount of the virus can make many people sick. The disease spreads through air or when a person touches the fluid from the vesicles. The host for varicella zoster virus is the human. If a person had varicella vaccination or had chickenpox in the past, this person builds immunity and is less likely to become infected (Maurer, 2013). The virus breaks down easily outside the host and lives in the external environment for few hours, sometimes for 1-2 days. In the USA the highest varicella incidence is noted to be in the months of March through May and lowest between September and November ("The pink book. Varicella," 2012).
Role of the Community Health Nurse The community health nurse is extremely important to control, prevent and teach about communicable diseases such as chickenpox. The public has to be protected from infectious diseases and receive the education needed about the disease. In collaboration with public health agencies, the community health nurse can bring awareness to the population. There are five steps when investigating a communicable disease. Recognizing the disease, isolating the agent, defining the mode of transmission, identifying vulnerable population, and determination of the effect on the population. The public/community health nurse is involved in this investigating process and helps the public health officials to develop successful program against the disease. The nurse may be the one who will recognize the beginning of an epidemic and identify new victims and the contact cases as well as the way the communicable disease spreads. The earlier the disease is detected the faster treatment can be initiated which in turn will result in prevention of spreading of the infection. In addition the community nurse can provide treatment, follow-up observation, support and education (Maurer, 2013). The main goal of the World Health Organization (WHO) is to make health care accessible and to decrease tremendously the incidence of the communicable diseases. The National Immunization Program at the Centers for Disease Control and Prevention (CDC) established an immunization registry. The registries keep track of each child's immunization record. This information is helpful to protect the population from vaccine-preventable diseases such as chickenpox and to recognize at risk children when exposed to infectious diseases. A Healthy People 2020 goal is to have 95% of children under age 6 enrolled in the immunization registry. As of 2008, 75% of children were registered (Maurer, 2013). I chose to write about Chickenpox, because I can relate to that awful disease. When I was twenty years old and working at McDonalds, where the majority customers were children, I end up catching chickenpox. It was surprise to me that I got childhood disease this late. My immunizations were up to date, however it is possible and dangerous to contract the chickenpox in adulthood as well as childhood.
References
Chickenpox complications. (2013, May). Retrieved from http://www.mayoclinic.org/
Chickenpox (varicella). (2011). Retrieved from http://www.cdc.gov/
Determinants of health. (2014). Retrieved from http://www.healthypeople.gov/
Gibson, M. (2013). Epidemiology and demographics. Retrieved from http://www.wikidoc.org/
Maurer, Smith, F. (2013). Community/Public Health Nursing Practice [VitalSouce bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/978-1-4557-0762-1/id/B9781455707621000087_p1840
The pink book. Varicella. (2012). Retrieved from http://www.cdc.gov/
Vaccine Health Center. (2013). Retrieved from http://www.webmd.com/