Epidemiology Paper - Chickenpox

Description of Chickenpox Disease

Chickenpox is an infectious disease that is commonly associated with young children. It, nonetheless, can be found in adults though this is not common place. In most cases this would occur in an adult who has a weakened immune system probably one who has contract Hiv/Aids. The outbreak of this infectious agent usually causes “red bumps” that spread throughout the whole body. A huge percentage of the population is infected by this communicable disease, which is attributed to the varicella-zoster virus (VZV). The virus is transmitted from one person to another through the air or by direct body contact. Physicians can diagnose this virus through medical examination. The chain of infection of chickenpox makes it relatively easy to spread from one person to another. It is a dangerous disease to young children and especially adults but when properly treated, it does not have a serious impact on the long-term health of people. Chickenpox is highly contagious, especially one or two days before the rash appearance and until they dry up and transform into scabs. After the infection, chickenpox can take between ten to 12 days before symptoms begin to develop. 


Description of the Determinants of Health

Chickenpox is a communicable disease that is highly contagious and is attributed to varicella-zoster virus (VZV), which is an example of herpes virus. This mild disease is usually associated with an itchy on the scalp, face, and trunk. These rashes have tiny blisters that are filled with fluids, and the spots are pink in color. After the spots dry, they turn to scabs after a few days. Although serious complications of VRV are rare, most of the people who are commonly affected include infants, teenagers, adults and individuals who have a weak immunity. Some of these serious infections include pneumonia, bacterial complications of skin blisters, encephalitis (brain inflammation), Reye syndrome, ataxia, and death. These serious infections are attributed to the secondary bacterial complications such as group. A beta-hemolytic Streptococcus, which include (cellulitis, septicemia, necrotizing fasciitis, and toxic shock syndrome).  Chickenpox tends to occur often in temperate climates during the winter period and early spring. 

Epidemiologic Triangle

Human beings are the main sources of infection of the chickenpox virus. Varicella complications and severity tends to increase among people whose immunity is compromised, including children between the age of one to five years and adults with weak immune system. Nevertheless, infants and adults who are healthy also suffer from serious varicella infections and may even die. The main characteristics of congenital varicella syndrome include hypoplasia of an extremity, encephalitis, skin abnormalities, ocular abnormalities, low birth weight, pneumonia, mental retardation, and microcephaly. These complications often affect 0.4%-2.0% of children whose mothers were infected with the varicella virus around five days before giving birth and two days after delivery. These are mainly the victims who are at the highest risk of suffering from severe forms of neonatal varicella. Mothers who are infected by the virus during their first and second trimesters of their pregnancy are also at a high risk of transferring chickenpox to their children.

A Portal of Exit from the Reservoir

The portal of exit from the reservoir includes direct touch of the blisters, mucus, and saliva of an individual who is infected. In addition, it is also possible to transfer the virus through the air when an infected person either sneezes or coughs. It is also possible for the chickenpox virus to exit the portal of the reservoir and rest on contaminated items. It is an indirect form of spread, and it can infect an individual who touches the contaminated items, which include freshly infected clothes. Moreover, when a person gets into direct contact with an individual with blisters and shingles, he can end up being infected with the varicella virus. This especially applies to those individuals who have never been infected by the virus and have never been vaccinated. Scholars argue that dried and crusted blisters do not have the ability of spreading the chickenpox virus but individuals who are yet to be vaccinated or suffer from the disease are at a higher risk of being infected by the contagious virus.

Mode of Transmission

The mode of transmission refers to the method in which an infectious agent is transferred from one host to another. Certain types of communicable diseases such as chickenpox can be transmitted by more than one means, like airborne transmission and body contact. Direct skin contact can with an infected person as well as touching some freshly contaminated items can lead to the transmission of the varicella virus. Some of these items include sharing combs, towels and clothes that have been used by an infected person. Chickenpox is also spread through infectious agents that float in the air. These agents usually float in the air for a given period before they can enter the body of the host through the respiratory tract. 

A Portal of Entry into a Susceptible Host

The portal of entry into a susceptible host includes direct contact with the mucus or blisters of an infected person, as well as breathing the air when an infected person sneezes or coughs. Immunity, after being infected by the varicella virus, is often regarded as long-lasting even when a person’s portal of entry is exposed to the virus. Moreover, second cases of being infected by the virus are said to be rare. Nevertheless, second cases of varicella infection tend to commonly occur among individuals with a weak immunity, and these new cases are increasingly incurring when compared to the past. However, studies have shown that increased rate of children vaccination has reduced the overall burden of the illness. Higher rate of reported cases tends to be reported among older children, teenagers and matured people who have never been infected by the disease or did not receive chickenpox vaccination. 

Another point to note when it comes to portal of entry is that varicella virus remains in human nerve tissues in a latent state. Therefore, it can reactivate in close to one in three individuals who have been infected in the past, and this will consequently lead to herpes zoster. Studies have shown that herpes zoster tends to present itself as a vesicular rash with itching and pain in a dermatomal distribution. Incidence of herpes zoster usually increases as a person ages, particularly after clocking fifty years. These incidences are also more common among immune-compromised individuals, children who have a history of intrauterine varicella, or they were infected with the virus before reaching one year old. In addition, such children have an increased exposure to herpes zoster while they are still at their tender age. A relative absence or decline of cell-mediated immunity is regarded as a significant factor in the occurrence and development of herpes zoster especially among these groups of individuals who are at higher risk of suffering from complicated forms of chickenpox illness. Moreover, Zostavax, Merck & Co., Inc. is a zoster vaccine that has been licensed and recommended for adult use over the age of 60 years in the U.S.

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A Susceptible Host

A host stands for that part of the population that is susceptible to an infectious agent. Some individuals are usually more prone to specific types of infections, and they end up becoming a host. For example, young children are more susceptible to being infected by chickenpox compared to adults. On the other hand, patients and elders have a body immunity that is weakened and, therefore, are more likely to be infected. In addition, 90% of chickenpox cases are reported among young children who are below ten years. Before the development of the varicella vaccine, almost each person was infected by the disease. Nevertheless, most individuals who receive the chickenpox vaccination are usually protected from suffering from this virus. Individuals who receive the vaccination and develop the disease commonly suffer from its milder form, have a reduced number of spots, and their recovery rate is higher. 

The Role of the Community in Health Nurse

The community health nurse is tasked with carrying out a thorough investigation as soon as the first suspicious case of varicella disease has been reported. Incidents of the virus have declined considerably since the first introduction of the vaccine. Nevertheless, laboratory confirmation of the disease has become fewer since health nurses have increased experience with contagious infections. Chickenpox usually has a typical appearance, which leads to reduced lesions and absence of characteristic vesicles. Nurses are required to report all varicella virus hospitalizations and deaths and confirm cases of unusual and severe diseases so that they can be routinely confirmed in the laboratory. 

Post-vaccination should be carried out for various kinds of specimen of the disease that seem to be severe. They include rashes that have more than 50 lesions and occur within seven to 42 days following the vaccination. The same applies to already vaccinated individuals who have herpes zoster, suspicious vaccine virus that has been secondarily transmitted, and any form of severe and adverse effect. It the case of the chickenpox outbreak, a health nurse is advised to confirm a minimum of three to five cases, irrespective of the vaccination status. Such an activity will lead to the confirmation of varicella infection. The preferred diagnostic tests involve DNA detection techniques for virus identification. Nurses are also advised to be skilled with recommended techniques of specimen collection, virus identification and isolation. Skin lesions are basically the preferred specimens to be used for the laboratory confirmation of the chickenpox virus. Varicella immunity is usually confirmed through blood specimens.  

The Role of the Missouri Department of Health and Senior Services (DHSS)

The DHSS has classified Varicella deaths and varicella (chickenpox) as Category 3 diseases. Medical practitioners are required to report such cases to the local authority within a span of three days after the first suspicion or knowledge. DHSS officials can be contacted seven days a week, 24 hours a day at 800-392-0272. When the first case of chickenpox is reported, officials are required to fill a Disease Case Report (CD-1). This information is then collaborated with the WebSurv application, or it can be sent to officials at the health district for entry. The DHSS has been an active department in the prevention and treatment of varicella virus. It ensures that all health professionals in the state collaborate with their District Health Office. Special circumstances of varicella cases must be entered into WebSury, and any incomplete CD-1 information will not require an urgent investigation unless under special circumstances.

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