Submitted By pnorthway
Grand Canyon University
April 20, 2014
Varicella infection, commonly known as Chickenpox, is a member of the herpes virus group. Varicella has the capacity to stay latent in the human source. It stays in the sensory nerve ganglia and the recurrent infection is called Herpes Zoster or Shingles. This essay gives the description, causes, symptoms, mode of transmission and the treatment of varicella. It describes the mortality, morbidity, incidence and prevalence of the disease. It explains the determinants of health and how they contribute to the development of varicella. This essay discusses the epidemiologic triangle and how it relates to chickenpox. It explains the role of the community health nurse regarding their case findings, reporting, data collecting, data analysis and the follow-up related to chickenpox. It identifies on great national agency that addresses the virus and describes contributes to resolving and reducing the impact of the disease.
Varicella was confused with smallpox until the late eighteenth century. Rudolf Steiner was scientist who discovered that varicella virus was caused by an infectious agent in 1875. Steiner removed fluid from the blisters of chickenpox and put it on the skin of volunteers that were healthy. It resulted in the volunteers to contract the virus (Centers for Disease Control and Prevention [CDC], 2012).
The symptoms of the virus develop about 15 days after being exposed to an infected person. Symptoms are fever, headache, cough, sore throat, and a decreased appetite. The rash goes through stages. It appears as a red spots on the face and torso and then spreads to the extremities, 1 to 2 days after the symptoms start. Then blisters form till they burst, dry and then crust over. Up to 7 days, there will be new spots daily. The process of the disease from symptoms till the crusting of the blisters is about 10 days (WebMD, 2013).
The mode of transmission is from human to human by airborne droplets, coming in contact with the fluid in the vesicle either through direct or indirect contact. Although the virus can be contracted by indirect contact, the time in the environment is believed to be a short survival time. The virus comes in through the respiratory system and the eyes. “The virus is believed to replicate at the site of entry in the nasopharynx and in regional lymph nodes. A primary viremia occurs 4 to 6 days after infection and disseminates the virus to other organs, such as the liver, spleen, and sensory ganglia. Further replication occurs in the viscera, followed by a secondary viremia with viral infection of the skin” (CDC, 2012, p. 1).
Chickenpox is usually mild and the lifetime is limited, but may have complications such as: bacterial infection of the sores, pneumonia, central nervous system manifestations, Reye syndrome, and death 1 in 60,000 cases (CDC, 2012). Groups at increased risk would include people that are 15 years and older and newborns up to 1 year of age, pregnant women and immunocompromised people.
Treatment of chickenpox composes of using; antiviral medications such as acyclovir, reducing the itching by using antihistamines, relieve the fever by using over-the-counter medication that is non-aspirin. The antiviral medication is beneficial if given within 24 hours of rash onset and may reduce the severity of the disease. Antiviral medications do not decrease the transmission of chickenpox. It is not recommended for routine treatment of the infants and children that are low risk for complications (CHICKENPOX, 2010). The person with the virus and anyone exposed to chickenpox needs to be isolated and tended to by someone who has had the virus or the vaccine. They will need to be in isolation for about 15 days or until all the blisters are crusted over. The nurse will need to provide educational materials regarding these issues and the vaccine.
Chickenpox occurs worldwide and the majority in children younger than the age of 15. In tropical areas the virus is more common in adults than children and the reason is unknown. “The best way to prevent chickenpox is to get the chickenpox vaccine. Before the vaccine, about 4 million people would get chickenpox each year in the United States. Also, about 10,600 people were hospitalized and 100 to 150 died each year as a result of chickenpox” (Chickenpox , 2011, p. 1). The mortality is less than 2 per 100,000 cases. Adults, neonates and immunosuppressant patients are high risk from dying from the disease (CHICKENPOX, 2010).
Certain health behaviors can increase the spread of chickenpox such as; overcrowded living conditions, lack of hand washing, lower education, smoking, and lower-income families (Fairley & Miller, 2014). Overcrowded living conditions and lack of hand washing can result in an increase in spread of the virus. For people who smoke the risk of varicella pneumonia are high. Lower income families may not be able to afford health care, vaccines or proper living conditions. Lower educated people may not know how varicella is spread or to be able to take precautions. They may not know that a vaccine is available or be able to afford the vaccine. They may not know how to treat the symptoms or to get medical treatment for higher risk patients. Lower educated people have a greater chance of having preterm babies, in which they high risk if contracting chickenpox. Educating people and removing or improving the health determinants is the key to reducing or even eradicating chickenpox.
The epidemiologic triangle is a model used to understand the disease process. The triangle has three corners called vertices. Each link represents steps in transmission of infection and each link has to be present and in order for an infection to occur. The agent or microbe that causes the disease is one part of the triangle. The host or organism harboring the disease is the second part of the triangle. The environment or the external factors that cause or allow the disease transmission is the third part of the triangle. The goal is to break at least one of the sides of the triangle to disrupt the connection between the environment, host and the agent thus stopping the disease (Maurer, 2013, p. 204).
The host for chickenpox is humans. It is transmitted from human to human by airborne droplets or coming in contact with the fluid in the vesicle. The agent is varicella virus and is a member of the herpes virus group. It is contagious 1 to 2 days before rash onset until the lesions have crusted. Environmental factors would be a person not being vaccinated, coming in contact with the virus either through direct or indirect contact, although the time in the environment is believed to be a short survival time. There is a distinct seasonal fluctuation of outbursts of varicella in the United States. The highest occurrences of chickenpox are in the winter and early spring. Between March and May being the highest incidence and September and November being the lowest. Less seasonality is reported in tropical areas.
The role of the community health nurse is a vital component to prevent and control infectious diseases such as chickenpox. When an infectious disease is detected the nurse needs to have an investigation to ascertain the source of the disease, identifies cases and others at risk, and determines control measures. The nurse needs to collect, analyze, interpret, and publish data regarding the disease that is detected. The public health nurse responsibility is then to start immunization clinics and provide education regarding the disease (Association of State and Territorial Directors of Nursing [ASTDN], 2008). “Varicella was removed from the list of nationally notifiable conditions in 1981, but some state continue to report cases to Centers for Disease Control and Prevention (CDC)”. The nurse should report probable and confirmed cases of varicella to the CDC. “In 2007, 34 states reported varicella cases to the National Notifiable Diseases Surveillance System (NNDSS)” (CDC, 2012, p. 1).
CDC is one national agency that addresses chickenpox by having strategies to control and investigate varicella outbreaks. It provides much information on their website regarding background, reporting, case definitions and classifications, laboratory diagnosis, recommendations, education, and vaccine information.
Chickenpox has been recognized since ancient times. Since then, there have been tremendous efforts to control and eradicate this disease through research and vaccination. When thinking of chicken pox it seems to be a normal childhood illness. In healthy children from ages one to fourteen it can be a benign irritable disease, but for those children that are not healthy or immunosuppressed and over or under those ages it can be a fatal disease. It is extremely important to break the chain in the epidemiologic triangle to stop this disease. As nurses we need to help eradicate the determinants of health and remember the little things, such as washing our hands to help eradicate this disease.
Association of State and Territorial Directors of Nursing. (2008). Report on a Public Health. Retrieved from http://www.phnurse.org/docs/PHN_to_Population_Ratio_2008.pdf
CHICKENPOX (Varicella). (2010). Retrieved from Utah Public Health website: http://health.utah.gov/epi/diseases/Chickenpox/plan/ChickenpoxPlan
Centers for Disease Control and Prevention (CDC). (2012). Vaccines and Immunizations. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html
Chickenpox (Varicella). (2011). Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/chickenpox/about/overview.html
Fairley, C. K., & Miller, E. (2014). Varicella-Zoster Virus Epidemiology-A Changing Scene? Retrieved from http://jid.oxfordjournals.org/content/174/Supplement_3/S314.full.pdf?origin=publication_detail
Health for Families and Populations (5th ed.). http://dx.doi.org/978-1-4557-0762-1
WebMD. (2013). Chickenpox (Varicella) - Topic Overview. Retrieved from http://www.webmd.com/vaccines/tc/chickenpox-varicella-topic-overview