Chickenpox and Its Epidemiology

Published: 2021-07-09 23:35:04
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Chickenpox is a viral infection caused by the Varicella Zoster Virus (VZV) transmitted via the respiratory route that causes itchy, blisters-like rashes usually lasting about 5-10 days. It is highly contagious transmitted by person to person contact (direct) from respiratory secretions or indirectly through contact with airborne respiratory droplets, via soiled inanimate objects infected by discharge from skin lesions, vesicle discharges or nasopharyngeal secretions.
The incubation period lasts about 10-21 days and the disease is communicable 1-2 days before and until the lesions become crusted. The symptoms includes a low grade fever, headache and listlessness which occurs in the prodromal period. This is followed by the appearance of an itchy rash usually mostly on the scalp and trunk but can affect the entire body and mucus membranes such as the mouth with an appearance of shallow white ulcers. The pruritic rash has three phase; macular, papular and vesicular which forms scab and crust over.
Fetal effects are rare congenital symptoms which presents as congenital varicella 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). Treatment of acute infection includes isolation of the infected person at home until the lesions have crusted and supportive by rest, relief of itching with the use of calamine lotion, tepid oatmeal baths and antihistamines, use of mittens and wearing nails short to prevent developing bacterial infection of the skin due to scratching.
The use of antipyretics but non aspirin containing medication as this is associated with Reyes Syndrome. Antiviral may be used for immunocompromised persons are those at risk for developing a severe case of the disease to decrease symptoms. Complications includes; secondary bacterial skin infections caused by scratching, encephalitis, pneumonia and death. Prevention of the disease is achieved by vaccination with the varicella vaccine in children, adolescents and adults, and the herpes zoster vaccine for persons 60 years and older (Maurer & Smith).
The prevalence of chickenpox it’s highly contagious and more than 95% of Americans get infected by adulthood. The CDC estimates that approximately 4 million cases occur each year worldwide. It occurs mostly in late winter to spring. Incidence approximately 1 in 2,254 or 0. 04% or 120,624 people in the Unites States acquire the disease annually. Every year 5000-9000 hospitalizations and 100 deaths from chickenpox in the US ass documented by the CDC-OC. Adults are shown to develop a more severe case of chickenpox with a higher rate of complications and death.
Since the availability of the varicella vaccine in 1995 it has shown to be highly effective in reducing the incidence of chickenpox and protective against severe cases (CDC-OC n. d). The determinants of health addresses factors that causes some people to be more healthy than others and how we can adjust situations in our environment to make a society where everyone have a better opportunity to living healthy lives. The determinants of health are identified as the range of personal, social, economic and environmental factors that influences health status.
These factors can be categorized under several broad topics such as policymaking, social factors, health services, individual behavior and biology and genetics. To achieve individual and population health these factors have to be interrelated. Determinants of health focuses its efforts beyond traditional health care and public health sectors. It is inclusive of education, housing, transportation, agriculture and environment to be important areas in improving population health (HealthyPeople. gov n. d) Policymaking addressed at different levels affect individual and population.
In the case of how this contributes to the development of chickenpox and its possible complications in the fetus it is required by the state that the varicella vaccine be given as a routine childhood vaccination therefore all pregnant mothers should have had the vaccination in childhood. Social and physical determinants of health can have impact on the range of health functioning and quality of life outcome. These factors addresses the social and physical conditions in a person’s environment. Some social determinants
Includes; the availability of resources to meet daily needs such as educational and job opportunities, healthy foods, exposure to mass media, internet and cell phones, socioeconomic conditions and public safety. Some physical determinants includes the natural environment, climate change, population density, building environment, housing and neighborhoods to name a few. These determinants contributes to the development of chickenpox when individuals and population fail to adhere to public safety during an outbreak of chicken pox.
Also in areas that are densely populated 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 knowledge about the disease and precautionary measures to prevent contracting the disease. Poor health outcomes are often worsened by the individual’s interaction with their social and physical environment. The access to health services and its quality can also impact health. Lack of access or limited access to health services is a major determinant of an individual health status.
This contributes to the development of chicken pox in individuals who don’t have health insurance or is an illegal immigrant, they will be less likely to participate in primary prevention and more likely to delay obtaining medical treatment. Some barriers to health services that contributes to the development of the disease includes high cost, lack of availability or in the case of vaccine shortage mostly seen in developing countries and limited language access. These barriers can cause unmet health needs and inability to receive preventative services.
Individual behavior as a determinant of health plays a major role in health outcomes. Individual behavior consists of diet, physical activity, hand washing and compliance with vaccine preventable diseases. This factor contributes to the development of chickenpox when individuals refused be vaccinated and do not have natural immunity against the disease. Therefore in an epidemic of chickenpox these individuals have a higher risk of contracting the disease. Biological and genetic factors affects specific populations more than others.
An example of a genetic determinant of health is Sickle Cell Disease which is a condition characterized by the offspring inheriting the disease because both parents carry the sickle cell gene. In the case of chickenpox there is no biological or genetic factors that contributes to a person developing the disease as it is caused by a virus rather than by genes. In discussing the epidemiological triangle as it relates to chickenpox the triangle consists of three factors; the agent, the host and the environment in the disease process.
All factors have to be present for the disease to occur. Below is a diagram of the triangle; The agent/pathogen of chickenpox is the causative factor which is highly virulent and can infect many people with exposure to a relatively small amounts of virus. The agent is transmitted via the respiratory tract through direct or indirect contact with respiratory secretions. The incubation period is 10-21 days with agent being communicable 1-2 days before or until the lesions are crusted. The host is the reservoir or the person susceptible to the disease.
The host is determined by specific factors such as ethnicity, gender, age or race, genetic risk factors, physiological and anatomical factors, nutrition or fitness and defense mechanism. In the case of chickenpox none of these host factors are determinants for an individual contracting the disease but a person’s response to stress may impact the host response to the disease. All humans possess defense mechanism to prevent against communicable disease agent. Natural defenses includes; tears, intact skin, mucous membrane, saliva and cilia (nose hair).
The host immune system also acts as a defense mechanism and immunity can be natural or artificial. Natural immunity occurs when the individual develops immunity after exposure to the disease because of the body’s antigen-antibody reaction to the infection. Artificial immunity can be passive or active and is given by vaccination (Maurer & Smith 2013). The environment in the epidemiological triangle determines how the disease is spread. For chickenpox it strives in a cool climate and environments that are densely populated will see a higher incidence of the disease.
Isolation of the infected person from the environment can help to curb its transmission. The population can be encouraged to wear mask when there is an epidemic. Having knowledge of the interrelation of the factors of the epidemiological triangle and its transmission of chickenpox is essential for the community health nurse. With this knowledge the nurse is equipped with the skills of assessing the households and communities for favorable environments, susceptible hosts and the viability of the agent. The nurse
Should have the expertise to educate families and communities to make the environment less favorable for the agent. For example the nurse can educate families and communities about the time in the cycle when an infected person is likely to transmit the agent to the susceptible host and how to prevent the spread of the disease like keeping the infected person isolated, washing and cleaning inanimate objects that were in contact with the infected person separately. The community health nurse has varied roles in the prevention of chickenpox on populations, individuals and families.
To achieve this the nurse must have basic information about chickenpox such as the causative agent, incubation period, mode of transmission, symptoms, protective measure and treatment (Smith 2013). The community health nurse role in case finding includes location of individuals and families with identified risks factors which connects them to the source. This can be achieved by implementing primary preventive measures which is aimed at reducing persons who are susceptible and reducing their exposure.
This is achieve through health promotion and implementation of specific measures before the disease occur such as health education and vaccination and isolation of infected individuals. The nurse’s role in follow up involves 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 involves screening individuals with unrecognized health risk factors or asymptomatic disease conditions (web n.
This is where secondary prevention comes in which is aimed at early detection through screening person who are asymptomatic, identifying persons at risk and implementation of treatment to cure the disease to prevent any disability or complications. Tertiary prevention is aimed at limiting existing disability in the early stages of the disease and providing rehabilitation for persons who have experience loss of function such as person who have developed severe complications from chickenpox.
The nurse would provide education to prevent deterioration in the person’s condition or referral to resources that can help clients minimize loss of function. One national organization that addresses chickenpox is the Centers for Disease Control and Prevention (CDC) which is the leading organization in providing epidemiological services to promote health. The National Center for Immunization and Respiratory Diseases (NCIRD) is a part of the CDC that is responsible for preventing
Disease, disability and death from respiratory and enteric viral diseases by providing immunization and other preventive measures. The main objective of the NCIRD is aimed at optimizing the safe, efficient and effective use of vaccines and other measures to prevent viral diseases (NRICD 2012). The CDC recommends two doses of the chickenpox vaccine for children, adolescents and adults which is about 98% effective at preventing chickenpox (CDC 2014).

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