Epidemiology of Chickenpox
Karissa N. Martinez
Grand Canyon University: NRS-427V
05/16/2014

Epidemiology of Chickenpox
This essay was written to explain the epidemiology of chickenpox and allow the reader to develop a better understanding of the disease. The author intended for the reader to become informed about the causes, symptoms, mode of transmission, complications, treatment and mortality and morbidity rates. Also, the reader will become familiar with the determinants of health and contributing factors to develop varicella, the relation of the epidemiologic triangle, the role of the community health nurse, as well as identify a national organization that reduces the impact of the disease on the community.
Chickenpox also known as varicella is a highly infectious disease caused by the varicella zoster virus. Varicella zoster can cause two illnesses, the first is chickenpox and the second illness is herpes zoster also known as shingles. Transmission of this highly infectious disease is spread through droplet exposure and contact with fluid from blister like vesicles. Examples of exposure through droplets are sneezing, coughing and oral secretions inhaled causing infection to the new host. Chickenpox is easily spread two to three days before the rash appears and is contagious until all the vesicles are scabbed over (WebMD, 2013). Symptoms tend to develop fourteen to sixteen days after exposure; around day ten after the first symptom is when the blisters crust over (WebMD, 2013).
Chickenpox can occur in both children and adults but is more common in children under the age of ten years. Generally, healthy children acquire a mild infection that spontaneously expires. Between the months of March and May children are more likely to acquire chickenpox, but are still susceptible anytime of the year. In children the first symptom is a rash that becomes itchy and spreads throughout the body. The red itchy spots can be found on the child’s face, scalp, ears, abdomen, chest and extremities. The spots can develop blisters called vesicles that contain clear fluid. The child can also acquire ulcers in the mouth that can be very painful and complain of headache and suffer from low grade fevers (Gould, 2014). Complications in the healthy child can be a secondary bacterial infection of the lesions and dehydration related to loss of appetite and thirst (Gould, 2014).
Though chickenpox is a mild condition in healthy children, the disease is more severe for adults. Adults are at a higher risk for complications and the symptoms tend to be more severe than for a child. Symptoms for adults can be nausea, myalgia, headache, general malaise and low grade fevers. Some cases even require a hospital admission due to complications like pneumonia, and effects on the neurological system (Gould, 2014). Examples of neurological complications are cerebellitis, meningoencephalitis, transverse myelitis, and even stroke ( Khandelwal & Kumawat, 2008). Additionally, individuals whom have a weekend immune system are at higher risk along with pregnant women, and infants. Some examples of immunocompromised person can be a cancer patient and a HIV infected patient. Complications for an immunocompromised patient can also include the neurological complications discussed above along with pneumonia, and also visceral disseminations. Visceral dissemination is a varicella infection of the internal organs that leads to hepatitis, encephalitis and intravascular coagulopathy (CDC, 2014). A pregnant woman who fosters varicella in the first and early second trimester puts the unborn child at increased risk for developing congenital varicella syndrome which can cause scarring on the skin, low birth weight, and abnormalities in the brain, limbs and or eyes (CDC, 2014).
Treatment for chicken pox is usually symptom related. For instance calamine lotions and oatmeal baths can be used to help soothe the itching resulting in a lower chance of acquiring a bacterial infection from scratching the lesions (Gould, 2014). Also a non-aspirin medication can be used to help reduce fevers and cold drinks to help soothe the painful mouth sores. For patients who are at high risk for complications an antiviral can be prescribed called acyclovir. Acyclovir can help reduce symptoms in the early stages; twenty four hours after the rash appears (Gould, 2014). Mortality and morbidity rates are higher for adults and those how are immunocompromised ( Khandelwal & Kumawat, 2008). Centers for Disease Control 2014, has revealed that the number of chickenpox outbreaks in the United States has decreased significantly since the vaccination was introduced. If the disease is still acquired after vaccination symptoms are mild resulting in fewer lesions and low or no fever (CDC, 2014). Centers for Disease Control, 2014 state that four million people would be infected by chickenpox in the United States alone, 10,600 people hospitalized and 100 to 150 deaths before the vaccination was initiated.
Determinants of health can be both social and physical factors that can either help avoid or put one at increased risk for development of a disease such as varicella. Some examples of social determinants of health can be quality of education, public safety, language barriers, culture, social support and socioeconomic conditions (Healthy People, 2013). These determinants can negatively impact the community, for instance if the population of focus is one of poverty level with low rates of quality education, and high incidence of crime this can make it difficult to obtain resources to help improve health. The community would be more at risk for being noncompliant with vaccinations and seeking medical attention and or resources when needed. Furthermore, examples of physical determinants that would increase the risk of varicella would be public settings like work and school, and also time of the year; late winter to early spring when chances of contracting varicella are more likely. These physical determinants are ones that can easily contribute to the development of varicella and are not so easily altered.
An epidemiologic triangle is a tool used to analyze and have a better understanding of the natural history of a health problem or illness (Maurer & Smith, 2009). The triangle consists of three categories the host, the agent and the environment. The agent in the case of chickenpox is the varicella zoster virus which causes varicella (Chicken pox) and herpes zoster (shingles) that can be spread through contact of droplets and contact with fluid from vesicles. Once infected with varicella the virus gains access to nervous system and can stay dormant there for years and can later be reactivated and cause shingles (Gould, 2014). When considering chickenpox the host is mainly children under the age of 10, but can also be adults and those who are immunocompromised as well. In cases where the host is an adult or immunocompromised the outcomes are at higher risk for complications. Chickenpox can also infect a host that has been vaccinated, but generally symptoms will be mild compared to the hosts that do not receive the vaccination. Varicella is commonly susceptible between the months of March and May, but can spread throughout any community worldwide. Since, chickenpox mostly infects children, a place that is a common environment would be public places like schools, daycares and parks where children have a tendency to come in contact with other children.
The role of a community health nurse is to focus on the community and or individuals and their family. The ultimate goal of the nurse is to prevent the spread of the communicable disease and in doing so the nurse should be highly aware of the basic information of the disease itself (Maurer & Smith, 2009). When preventing varicella it is extremely relevant to educate the community on prevention mechanisms like staying current with immunizations to help prevent the illness. The Centers for Disease Control, 2014 state that the best way to prevent varicella is to receive two doses of the vaccination. Also, the nurse should be able to educate the population at focus on the causes, signs and symptoms, mode of transmission, incubation periods, protective measures, treatments, and possible complications. It is highly important for the nurse to educate the population on who is at high risk for complications and deficits that can be resulted. Additionally, the nurse can provide instructions on proper isolation of infected host to help prevent the spread of the disease, when it is necessary to seek medical attention and to ensure that the population is compliant with treatment and follow ups. It is imperative for the nurse to evaluate the determinants of health regarding the community at hand so that areas of need can be a primary focus resulting in quality care as a whole. An organization that assists in reducing the impact of chickenpox is the Centers for Disease Control and Prevention [CDC]. This organization provides the community with information regarding the importance of vaccination in preventing the spread of varicella. Also, the CDC provides the community another resource by educating on the signs and symptoms, treatments and what to expect during the course of the infection. The ultimate goal of this organization is to make healthcare safer and save lives all around the world. References
Center for Disease Control and Prevention.(2014). CDC –Chicken Pox (Varicella).
Retrieved May 14, 2014, from http://www.cdc.gov/chickenpox/
Gould, D. (2014). Varicella zoster virus: chickenpox and shingles. Nursing Standard, 28(33), 52-58.
Healthy People. (2013). Social Determinants of Health. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx
Maurer and Smith. (2009). Community/Public Health Nursing Practice: Health for Families and Populations [VitalSouce bookshelf version]. Retrieved from http://pageburstls.elsevier.com/books/9781416050049/id/B9781416050049000081_u2050
Khandelwal, D. D., Sharma, C. M., Kumawat, B. L., Kumar, S., & Satija, V. (2008).
Neurological complications of chickenpox in adults. Annals Of Indian Academy Of Neurology, 11S146-S147
WebMD. (2013). Chickenpox (Varicella). Retrieved from
http://www.webmd.com/vaccines/tc/chickenpox-varicella-topic-overview