Communicable Disease: Chickenpox

Communicable Disease: Chickenpox

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Communicable Disease: Chickenpox

Chickenpox, also known as Varicella, is defined as “an extremely contagious viral disease, mainly of children, characterized by early fever, an eruption of papules and vesicles, and mild constitutional disturbances” (Chicken Pox, para.1, 2019). T. M. Rivers and W.S. Tillet first reported the chickenpox virus in 1924 (Chicken Pox, 2019). Chickenpox is deemed as a communicable disease. A communicable disease is defined as a disease “that is spread from one person to another through a variety of ways that include: contact with blood or bodily fluids; breathing in an airborne virus; or being bitten by an insect” (ACPHD, 2018).

Chickenpox is caused by the varicella-zoster virus (VZV). This virus is transmitted via an airborne route, by “breathing in the virus particles that come from the chickenpox blisters, and possibly through tiny droplets from infected people that get into the air after they breathe or talk” (CDC, 2018). Any person who has not received the available vaccine or had never contracted chicken pox before, has a higher risk of contracting the virus (CDC, 2018). The first to second day prior to appearance of a rash until the appearance of blisters that turn into scabs, are considered the contagious stage. Typically, symptoms become visible at about fourteen to sixteen days following the exposure and show as common cold symptoms such as a runny nose, fever, sore throat and fatigue. Shortly after the symptoms start, small, red spots begin to be visible and spread throughout the body surface, “usually beginning on the trunk and scalp and spreading outward” (Chicken Pox, 2019). In addition to the skin rash appearance, mucous membranes could be affected with spots in the nose and in the mouth. These spots will begin to develop into vesicles; “raised bumps with clear, teardrop-shaped blisters that turn rapidly to crusty lesions within six to eight hours” (Chicken Pox, 2019). In the healing stages, some spots will heal while others still develop. The skin crusts will begin to heal and disappear after about twenty days. (Chicken Pox, 2019). Another symptom of chickenpox is intense itchiness, also known as pruritus, throughout the skin. Often the immense urge to scratch is very overwhelming for the affected person. Complications such as cellulitis, a bacterial skin infection, or scarring of skin can be caused by the lesions on the skin (Chicken Pox, 2019). Other complications of chickenpox that are possible are; “pneumonia, infections such as invasive group A streptococcal, sepsis, and necrotizing fasciitis; Reye syndrome; and encephalitis” (Chicken Pox, 2019). Young children and people with a weak immune system are at increased risk on encountering such complications (CDC, 2018). The diagnosis of chickenpox is followed through the appearance of symptoms; often fever and a rash. The treatment of chickenpox is focused on the symptoms of the disease; itching and reducing fever, due to the fact that the “majority of cases are uncomplicated and resolve themselves within two to three weeks” (Chicken Pox, 2019). Treatment of the pruritus is provided with antihistamines such as Benadryl and topical treatment such as wet compresses. Fever will be maintained with either ibuprofen or acetaminophen intake. Oral antiviral drugs such as “acyclovir, valacyclovir, and famciclovir have been shown to be effective in decreasing the intensity of itching, hastening the healing of skin lesions, and generally shortening the duration of the disease” (Chicken Pox, 2019). It is recommended to start medication treatment within twenty-four hours of first onsite of symptoms. Increase of fluids and addition of electrolytes is important to prevent dehydration. To prevent the risk of skin infections, it is recommended to keep fingernails as short as possible and frequently take a bath.

In 1995 the vaccine Varivax was developed and approved by the US Food and Administration and is available for children over the age of one, and is found to be “90 percent effective in preventing chickenpox” (Chicken Pox, 2019). Along with chickenpox, the Varivax vaccine “protects individuals from developing shingles, an extremely painful rash that is caused by the varicella-zoster virus, which lies dormant in nerve tissue near the spinal cord and brain in individuals who have chickenpox and can be reactivated” (Chicken Pox, 2019).

The typical age range of chickenpox virus outbreak are seen in children under the age of 15 years, but reported by pediatricians to the Center of Disease Control are the age 1 to 4 years that marks the higher percentage in cases. (CDC, 2018). Before the vaccine for chickenpox, “varicella was a common childhood disease, causing about 4 million cases, including an average of 10,500 hospitalizations and 105 deaths, each year” (CDC, 2018). The incidence of outbreaks has decreased drastically and has had impact on the severity of some cases of chicken pox. The implementation of the “two-dose” vaccine recommendation schedule for children has decreased the number of cases dramatically (CDC, 2018). With this urge a recommendation was provided in 2003, that all cases of chicken pox outbreak should be reported and documented. “The three initial core variables recommended by CDC for case-based reporting included age, vaccination status, and severity of disease (based on number of lesions)”. A “varicella messaging guide” was developed to guide direct proper documentation that will be send to the CDC (CDC, 2018).

Healthy People 2020 defines social determinants of health as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (Heathy People 2020, 2018). “Complex, integrated, and overlapping social structures and economic systems, collectively referred to as social determinants of health (SDH), are now thought to affect disease morbidity and mortality” (Song, Hall, Harrison, Sharpe, Lin & Dean, 2011). Factors such as low income and not having medical health coverage have been discussed in the possibility of taking part in the development of chickenpox outbreaks in certain communities. It is part due to the less likelihood and inability of an individual and their family members to seek medical care on a regular base. Often lack of education in a language that is understood by an individual plays a significant role, as well as a shortage of the vaccine itself in some areas of the country. Chickenpox is highly contagious and social structures who have not received proper education, may not be aware of the important vaccine which puts them at a great risk of contracting the disease.

The epidemiological triangle is composed of three points; susceptible person or host, environment, and causative agent (Maurer & Smith, 2013). “Analyzing the natural history of a disease involves the use of the epidemiological triangle” (Maurer & Smith, 2013). As one analyzes and gains knowledge of the chain of infection and the given links between the individual factors, it will give an insight on how to prevent the spread of this communicable disease. It is important to discover the weakest link in this triangle to gain control of this disease and eventually remove the threat. “Control efforts include prevention activities and efforts to reduce the seriousness of an illness as measured by the severity, the length of illness, the cost of treatment, the short- and long-term effects, and the risk of death” (Maurer & Smith, 2013). With the example of the chickenpox virus, the human presents as the host for this virus and the agent is the Varicella Zoster virus. Chickenpox is transmitted through sneezes or coughs, and often occurs “by respiratory contact with airborne droplets or by direct contact or inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster” (CDC, 2018). Studies present seasonal fluctuations in temperate regions with an increase in cases in the winter months and early spring time (CDC, 2016). But for the United States, “incidence is highest between March and May and lowest between September and November” (CDC, 2018). To prevent further transmission of the disease, it is important for the community health nurse to notify the parents of the child as well as community members.

“Community health nurses must be familiar with basic information about communicable diseases, including causative organisms, incubation period, mode of transmission, symptoms, protective measures, and the necessary treatment” (Maurer & Smith, p. 209, 2013). Having knowledge of this information increases a focus on care and reduction of symptoms. It also aids in prevention of transmission of diseases. The community health nurse plays an important role in community education of the disease process, as well as the transmission and prevention of the spread of disease. Through community involvement, the nurse is able to screen cases and is able to identify risk factors. Education is very imminent to individuals infected with this virus to protect themselves and others from spread of the disease. It is important to teach about personal hygiene, proper hand washing, disposal of contaminated tissues and how to cough and sneeze without spreading disease further. Through the CDC, proper reporting guidelines for medical personal to follow were establish. These data need to be properly collected and reported. Analyzes of current cases and follow up on previous cases are important, as this will provide better outcomes for future cases. “Community/public health nurses are often involved in investigating and treating communicable disease, performing contact investigations and filing follow-up reports to local and state health departments and the CDC” (Maurer & Smith, p.150, 2013).

Examples of well-established agencies to provide resourceful information are the Centers for Disease Control and Prevention (CDC) and the WHO (World Health Information. Through the CDC website information of common signs and symptoms of chickenpox, the transmission process as well as prevention and treatment options can be found. Photos of examples of the disease and ‘child-friendly fact sheets’ for parents to aid in the explanation of the disease to their children is provided. The WHO has similar information within their website, but also inform about travel risks and what to consider during travel outside the country. Both provide great resources of current research in communicable diseases and the newest treatment options.

“Varicella (chickenpox) is an acute, highly contagious viral disease with worldwide distribution” (WHO). The ‘Universal Childhood Vaccination Program’ was introduced in the United States in 1995 with guidelines to follow a series vaccination schedule. The varicella vaccines are available throughout the world, “the varicella vaccines have been recommended as a universal childhood immunization in only a small number of countries including Canada, Germany, Australia, Korea and Japan, where high coverage rates have been attained, and vaccination has resulted in a significant decline in varicella-related incidence, morbidity and mortality” (Songtao, Mukai, Huanying, Haiyan, Meng, Jianhui, & Wenbo, 2016). Due to the absence of “varicella vaccination programs in most countries”, varicella continues to be a worldwide epidemic (Songtao, 2016). The global varicella disease burden includes “4.2 million severe cases and 4200 deaths annually” (Songtao, 2016).

An abundance of cases of chickenpox cases were reported before the introduction of the vaccine in 1995 and has shown a decrease of approximately 90 percent in cases in the years 1995 and 2005 (Chicken Pox, 2019). The vaccine has proven to have a beneficial benefit on health and the community health nurse has an important role to educate families and community members. Education should include ways to obtain vaccine, prevention of transmission of disease, and proper treatments including ways to seek treatment. National agencies are great resources and can provide effective ways to promote education of communicable diseases, such as chickenpox, on a national and global level.

References

ACPHD. (2018). Communicable Disease. Retrieved from http://www.acphd.org/communicable-disease.aspx

Chicken Pox. (2019). Funk & Wagnalls New World Encyclopedia, 1p. 1.

Centers for Disease Control and Prevention (June, 2018). Chickenpox (Varicella). Retrieved from http://www.cdc.gov/chickenpox/index.html 

Healthy People 2020. (2019). Social Determinants of health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health?topicid=39

Maurer, F., Smith, C. (2013). Community/Public Health Nursing Practice, 5th Edition. [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-1-4557-0762-1/

National Foundation for Infectious Disease. (n.d.). Retrieved from http://www.nfid.org/info

National Shingles Foundation. (n.d.). Retrieved from http://www.vzvfoundation.org/ #Chickenpox

Song, R., Hall, H. I., Harrison, K. M., Sharpe, T. T., Lin, L. S., & Dean, H. D. (2011). Identifying the impact of social determinants of health on disease rates using correlation analysis of area-based summary information. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150132

Songtao, X., Mukai, C., Huanying, Z., Haiyan, W., Meng, C., Jianhui, Z., & … Wenbo, X. (2016). Nationwide distribution of varicella-zoster virus clades in China. BMC Infectious Diseases161. doi:10.1186/s12879-016-1863-x

World Health Organization. (n.d.). Varicella. Retrieved from http://www.who.int/ith/diseases/varicella/en/