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Epidemiology of Chickenpox

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Epidemiology of Chickenpox
Erica N. Huckaby
Grand Canyon University: NRS-427V
February 28, 2016

Epidemiology of Chickenpox Epidemiology is the study of the distribution and determinants of health related states or events in specified populations and the application of this study to control health problems (Farlex Partner Medical Dictionary, 2012). Epidemiology can be applied to any disease. It has helped to develop the methodology used in research and public health. For the purpose of this paper, we will explore the childhood illness chickenpox, the factors that contribute to it’s development, the epidemiological triangle, and the role of the community health nurse as related to reporting and follow-up of cases.
Description of Chickenpox Chickenpox, also known as varicella, is a highly contagious viral illness caused by the herpes virus, HHV3.4 or varicella zoster virus (Lowth, 2013). Chickenpox is mainly considered a childhood illness but can affect anyone at any age.
Symptoms
In children the illness generally begins with fever and malaise followed by development of papules on the skin. The day following the first fever a rash often appears on the face and scalp. Within the next 24 hours more papules appear as the first ones turn into vesicles. The rash generally will spread to the trunk, abdomen and limbs. Vesicles can be so few that they go unnoticed and leave the virus undiagnosed or they can cover the entire body including the mucous membranes. The course of the disease is generally seven to ten days from the initial fever to the crusting of the last vesicle.

Mode of Transmission The varicella zoster virus is spread by droplet contact when a person with chickenpox breathes, cough, sneezes, laughs, or even speaks. Droplets of saliva infected with the virus can be sent out into the air and are breathed in by others. Once the child or adult develop papules and the blisters pop, the fluid in the blister is also infected and can cause another person to contract virus through direct contact.
Complications
Chickenpox is considered to be a mild illness unless you are an adult, over the age of 50, or are pregnant. The risk of developing varicella pneumonia in these groups are much higher than in children. The course of illness is longer and they may feel more ill (PubMed Health, 2014). The most common complication of chickenpox is bacterial superinfection. When the lesions become infected, they are itchier and more likely to scar.
Treatment
Chickenpox is most often treated by symptom management. Medications to control fever and lotions, creams, or ointments that can be applied to lesions to reduce itching and to help papules and vesicle dry up. Adults that have been diagnosed with chickenpox generally are treated with an antiviral medication, acyclovir. Acyclovir reduces the length and intensity of the illness but only if the medication is started within the first 24 hours after rash appears. Once you have chickenpox, you are immune for life. It can only be contracted once.

Demographic of Interest
It wasn’t until 1998 that the Council of State and Territorial Epidemiologist (CSTE) recommended that deaths from varicella be placed under national surveillance. As of January 1, 1999, varicella related deaths became nationally notifiable to the Centers for Disease Control and Prevention (CDC) (Centers for Disease Control and Prevention, 2015). Since 1995 when the chickenpox vaccine became available the incidence of cases have decreased. According to the CDC (2015) in the early 1990s, an average of four million people got chickenpox, 10,500 to 13,000 were hospitalized, and 100 to 150 died each year. Yearly 3.5 million cases are prevented by the administrations of the varicella vaccine. Hospitalizations are decreased by 9,000 and the death has been reduced to roughly fifty a year.
Determinants of Health Having access to health care at any age is important. For infants and children having routine checkups ensure their growth and development are on track. Keeping vaccinations up to date as recommended by the immunization schedule can protect the young from serious diseases, such as chickenpox. As an adult it is even more important as the course of the varicella zoster virus can be much longer and with a greater number of complications. Chickenpox does not discriminate, anyone can be affected. For those with other morbidities, contracting varicella zoster can exacerbate those disease or conditions.
Epidemiological Triangle The epidemiological triangle is a model used to describe the factors involved in infectious disease. There is the host, the agent, and the environment. The host is any person susceptible to the agent, which in this case is the varicella zoster virus. The environment would be anywhere the susceptible person could be exposed to the virus. Due to the droplet transmission, the virus could be anywhere in the environment.
Community Health Nurse
The community health nurse must keep up to date on what can and should be reported to the CDC. The CSTE defines chickenpox as an illness with acute onset of diffuse maculo-papulovesicular rash without other apparent cause (CDC, n.d.). Laboratory confirmation of chickenpox is not recommended due to the virus’s highly contagious nature however, laboratory confirmation is required for all fatal cases. There are two types of classifications used when reporting cases: probable and confirmed. The National Electronic Disease Surveillance System electronically transfers data from healthcare system to public health departments to the CDC (CDC, 2015). The community health nurse can also assist with follow-up, mostly telephonic due to contagiousness, and ensure that all infants and children are receiving their vaccinations. They can also assist in identifying which older adults may need the vaccine as well.
National Agencies and Organizations
It is difficult to pin point any one agency or organization focusing on reducing the amount of varicella cases. The CDC along with the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists have developed a vaccination schedule that includes the varicella vaccine. Vaccination protects the person receiving it as well as the community.
Chickenpox is a highly contagious yet preventable illness. With the introduction of the vaccine in 1995, the number of cases, hospitalizations and deaths have dramatically decreased. Unfortunately health determinants such as poverty, transportation and access to healthcare make it difficult to get everyone vaccinated. Due to the person being contagious one to two days prior to fever we are unable to prevent exposure to an infected person. This is why the vaccine administration is so important.

References
Centers for Disease Control and Prevention. (2015, December 8). Conducting varicella surveillance. Retrieved from: http://www.cdc.gov/chickenpox/hcp/conducting-surveillance.html
Centers for Disease Control and Prevention. (n.d.). Varicella/Chickenpox 2010 case definition. Retrieved from: http://wwwn.cdc.gov/nndss/conditions/varicella/case-definition/2010/
Epidemiology. (n.d.). Farlex Partner Medical Dictionary. (2012). Retrieved from: http://medical-dictionart.thefreedictionary.com/epidemiology
Lowth, M. (2013). Chickenpox. Practice Nurse. Retrieved from: http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?sid=00c963d0-3305-4563-8982-d700d223ab69%40sessionmgr4001&vid=10&hid=4110&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=107953685&db=ccm
PubMed Health. (2014, June 30). Chickenpox: Overview. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072805/

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