Running head: Epidemiology Research Paper 1

Epidemiology Research Paper

Jessica R. Evans

Grand Canyon University: NSG440

7 April 2019
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Abstract

Despite the availability of the vaccine, varicella continues to remain a public health issue

globally. Varicella is a virus that is more commonly known as the chickenpox. It is caused by the

varicella-zoster virus, which is in the herpes virus group (Center for Disease Control 2019). After

contracting the disease, the virus stays in the body. Programs on vaccinating children in infancy

started approximately ten years ago in the United States. Epidemiological data is still being

collected by nurses that help inform health care on decision-making for vaccine use in other

countries. Many countries participate in vaccination against varicella while others do not, making

their prevalence high in those countries (Wutzler 2017). There can be serious complications to

varicella if contracted in infancy, adolescence, or adulthood. Additionally, if the individual is

pregnant or immunocompromised. Some serious complications that can arise from varicella are

bacterial infections, pneumonia, cerebellar ataxia, encephalitis, viral pneumonia, and

hemorrhagic conditions (Center for Disease Control 2019). These complications go beyond a

pruritic rash and fever and require hospitalization. In the end, varicella is a global issue as it

remains present, especially with lack of information about it and vaccine usage decreasing.
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Epidemiology Research Paper

Currently, infectious diseases affect millions of people globally. An infectious disease is

also known as a communicable disease because it is communicated and transmitted to person to

person directly or indirectly. These types of diseases invade the body and fight against its natural

defenses. As a nurse, in the community or not, it is important to understand how infectious

diseases work and how to prevent its spread. There are a multitude of communicable diseases

that nurses are responsible to report and treat. For instance, varicella is an infectious disease that

affect people worldwide. In the end, it is imperative to understand how varicella works, its

epidemiology triangle, impact globally, current and new prevention programs, and a nurse’s duty

in surveillance.

Describe the Clinical Description of Varicella

Varicella, or more commonly known as the chickenpox, is an acute infectious disease that

is caused Varicella-zoster virus (VZV). Once an individual is primarily infected, the virus stays

in the body as a latent infection. If an individual is infected secondarily from the virus, it

becomes shingles. Varicella has an incubation period of fourteen to sixteen days after exposure.

The classic symptom is a rash that becomes pruritic, fluid-filled blisters that eventually crust

over. It is first seen on the chest, back, and face and heavily concentrated on the chest and back.

This typically lasts for four to seven days. Additional symptoms that can appear one to two days

before the rash is a fever of 102 degrees Fahrenheit, malaise, loss of appetite, and headache

(CDC 2019). For Varicella to be diagnosed, most physicians diagnose based on the classic sign

of the rash, however, it can be diagnosed through laboratory tests such as: blood work and

samples from the lesions (Mayo Clinic 2019). These confirm the presence of the varicella-zoster

virus. Since Varicella is a virus, there are no antibiotics to give, so the infected individual must
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let the virus take its course. However, there are remedies to help with symptom management. For

instance, calamine lotion, cool bath with baking soda, and uncooked oatmeal can help with the

itching. Scratching is discouraged because of the possible skin infections, so it is important to

keep fingernails short and trimmed during this time. Additionally, over-the-counter medication

such as Tylenol, is useful to help treat the fever associated with the disease (CDC 2019).

However, the best way to treat Varicella is to prevent it. A vaccine has been made available to the

population and deemed safe and effective. While there are cases of those who have been

vaccinated still contracting the disease, the symptoms show to be much milder.

Furthermore, Varicella is considered a benign childhood illness, however, serious

complications can arise. In 2014, the World Health Organization “estimated that approximately

4.2 million severe complications leading to hospitalization and 4200 related deaths occur

globally each year,” demonstrating that the prevalence and incidence of this disease is high

(Wutzler 2017). Additionally, this has been approximated after the vaccine has been created. In

the pre-vaccine days, the number was much higher and more concerning, especially in adults

since the disease became more severe the older an individual was. Varicella has shown to have

multiple complications such as bacterial infections in children and pneumonia in adults,

however, most cases are less severe. On average, many infected individuals recover in a week. In

the end, Varicella is a considerable health burden and affect millions globally.

Provide an Epidemiological Description of Varicella Through the Epidemiologic Triangle.

Include and Label a Diagram.

Because communicable diseases are a big part of the healthcare community, it is

important for healthcare professionals to understand infectious diseases. For instance, it is

essential to learn about how the infectious disease spreads, what makes populations susceptible
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to them, how exactly they move through the population, and what allows the disease to survive

and spread (Engard 2017). An effective way to learn more about infectious diseases is to use a

tool called the epidemiology triangle. This model helps professionals understand the disease by

looking the relationships of the agent, host, and environment (Engard 2017). For Varicella, the

epidemiology triangle consists of a host, agent, and environment. The agent for Varicella is the

varicella-zoster virus because it causes the disease. The host for varicella consists on average

individuals under fifteen. However, anyone who has not had the disease is susceptible to it. It is a

more severe case if the individual is an infant, adolescent, adult, pregnant, or

immunocompromised because they are more susceptible to the complications that can arise.

Lastly, this disease is highly contagious as it spreads from direct and indirect contact. This means

that the environment for varicella is in the soft tissue and fluid from the blisters. This is because

it can be spread through coughing and sneezing or direct contact of the fluid from the blisters

(CDC 2019). Additionally, outbreaks in the United States, are more common during the end of

winter during moderate temperatures.

Describe Separately the Agent, Host, and Environment of Varicella and Their Relationship.

For an epidemiology triangle to be understood and studied, it needs to consist of an agent,

host, and environment. These components of the epidemiology triangle help with the

investigation on how a disease spreads and strategies to combat it. For varicella, the agent is the

varicella-zoster virus and its host are those who are under fifteen or have not had the disease yet.

This disease transmits through coughing, sneezing, or direct contact of the fluid-filled blisters. It

thrives in an environment with moderate temperatures such as the end of winter (CDC 2019). It

is important to understand each component of the epidemiology triangle to accomplish breaking

one part of the triangle, so it stops the continuation the disease.

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The agent in the epidemiology triangle is the organism that actually causes the disease.

This is the agent that invades the body releases its toxins. Disease-causing agents are bacteria,

viruses, fungi, and parasites. Bacteria are single-celled organisms that replicate themselves.

Viruses are smaller and have genetic material with no way of reproducing without infecting cells

and using their materials. Fungi are made up of many cells similar to plants, however, they

cannot produce their own food, so they live off animals, humans, and plants. Parasites live off

other organisms (CDC 2019). For varicella, the agent is the varicella-zoster virus. This is a virus,

so it needs human cells to help it reproduce. By using antibiotics on bacteria, parasites, and fungi

and preventing viral infections, this component of the triangle can break and it will not invade

the host. It would disrupt the connection between the agent and host, thus stopping the spread of

disease.

Additionally, the host is the organism that is exposed agent and will harbor the disease.

The host can be an organism that gets sick or carries the disease with the ability to spread the

disease. The host can carry the disease for a period of time and be contagious before they even

experience the signs and symptoms. Furthermore, each host experiences the signs and symptoms

differently. For instance, the host for varicella are those who are under fifteen, but anyone who

has not been exposed to the disease can contract it (CDC 2019). A child can have varicella and

recover quickly, however, an adult can be infected with varicella and experience severe

complications. It is important to implement measures to protect and prevent varicella from hosts

because then the agent cannot infect them with the disease, even if the host and agent are within

the optimal environment.

For the environment, this is the favorable surroundings and conditions outside to the host

that allow the agent to be transmitted. For example, some diseases live best in dirty water or
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thrive in blood (CDC 2019). Additionally, some can survive in high temperatures while others

die from the heat. The optimal environment for varicella is in moderate temperatures at the end

of winter (CDC 2019). This is where the agent thrives and the host is most susceptible to the

disease because they are exposed to this environment. By improving the conditions of the

environment, the triangle connection between the envirnonment, host, and agent can be broken.

For instance, if a disease thrives best in dirty water, cleaning the water protects the host because

the agent cannot survive in its new environment. In conclusion, by taking measures that break

the connection between the environment, agent, and host, the spread of disease can be stopped.

Describe the Impact of Varicella Globally and its Effects Locally, State, National, and

International.

Varicella has been around for decades around the world. It is a common childhood illness

with lifelong immunity after recovery, however, it is not a universally notifiable disease. In the

United States, “approximately 30.9 out of 100,000 varicella cases were hospitalized and 0.41

cases per million were fatal,” in the prevaccination days (Wutzler 2017). Currently, the number

of cases that are hospitalized due to varicella has been cut in half and the death rate has dropped

after the vaccine was distributed. In Europe, “annual incidence rates from 300-1291 per 100,000

population has been reported” (Wutzler 2017). With varicella, the economic impact has been the

main impact. Children need their parents or caregivers to look after them during the varicella

virus. In Sweden, it was reported that “one in four needs to take time off from work to care for

children with varicella” (Wutzler 2017). Globally, the impact of varicella has been mild and

many countries see varicella has childhood illness that children contract.

Locally, in Arizona, the cases of varicella have dropped due to vaccine and high

temperatures. Varicella thrives in a moderate temperature and Arizona, generally, has an average
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higher temperature. Arizona does require the varicella vaccinations before entering elementary

school and many college programs require it as well (National Vaccine Information Center).

Nationally, The United States, has a lower incidence of varicella because the vaccine is available.

However, with the refusal to vaccinate, varicella cases have increased. Furthermore,

internationally, many countries have the vaccine available to them and it is used, however, there

are countries who do not participate because of cost and perception of varicella (Wutzler 2017).

In the end, varicella has been around for many years and it will continue to be around. Those

who are susecptible to severe complications need to utilize the vaccine to prevent the contraction

of the disease.

Assess and Evaluate Current Public Health Education and Prevention Programs by

Identifying Gaps and Areas of Opportunity. Propose a New Intervention or Program that

Will Improve Client Outcomes.

For varicella, many prevention programs are focused on the vaccine. The vaccine is

advertised and encouraged by medical professionals as safe and effective, especially for children.

The vaccine is recommended to be given at twelve to eighteen months and four to six years old.

Two doses of the vaccine are shown to be more effective. Additionally, since varicella is highly

contagious, individuals who contract the disease need to be kept away from others while they are

recovering to limit the number of people they infect. There are not many education programs on

varicella because the vaccine has been made available (Wutzler 2017). When a case has been

identified, often of times, parents or families are given a letter of what signs and symptoms to

look out for and what to do if one becomes infected.

Ultimately, a new program that needs to be invented is a program for new parents about

vaccinations. Many have the wrong idea of them and choose not to vaccinate their children. If
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parents are given the opportunity to learn more about vaccinations, how they work and what is in

them, more parents can decide to vaccinate because they have been educated on vaccines by a

medical professional. This program helps increase the number of those who are vaccinated

against varicella, thus preventing them from contracting it or the symptoms are much milder. In

the end, this new program that educates individuals about vaccines and helping them decide to

vaccinate helps decrease the prevalence of diseases like varicella and its impact.

Describe the Following Roles of the Nurse in Regards to Surveillance: Case Finding,

Reporting, Data Collection and Analysis, and Follow-up/Evaluation.

Much like traditional nursing, surveillance of disease is similar to the nursing process.

The nurse assesses the problem by gathering cases and reports, plans, diagnoses, and intervenes

with data collection and analysis, and then evaluates by following up. Nurses can help the

population with surveillance of disease because it serves as an early warning system for

impending health emergencies, documentation of the disease’s impact and treatment progress,

and monitor health problems and educate the public about health policy and strategies. The role

of the nurse when they are case finding are to screen, go door-to-door, and finding contacts that

may have been infected, exhibit risk factors for contracting the disease, and then assessing them

further and making recommendations for follow-ups. For reporting, the nurse reports the

communicable disease to the State Health Department (Stanhope 2016). In fact, reporting to the

health department is mandated by law and regulations.

Furthermore, the nurse then collects data by using statistical measures for trends. The

nurse is gathering the “who, what, when, and why,” of a disease. From here the nurse analyzes

all aspects of the diseases and its occurrence and spread while providing feedback to the public.

Lastly, the nurse evaluates the interventions that were taken during the spread of the
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communicable disease (Stanhope 2016). The nurse is answering the questions whether the

interventions control the problem or what measures are needed for prevention. In the end, it is

important to watch over infectious diseases so it does not spread wildly and hurt many

individuals.

In conclusion, infectious diseases are a part of the world. However, by utilizing the roles

of nurses in surveillance, techniques to break the connection of the epidemiological triangle, and

understand how certain diseases work, the diseases can spread less and epidemics or pandemics

are not a concern anymore. For varicella, it is important to understand what it is, how it spreads,

and prevention programs so it does not have to be a common childhood illness and severely

complicate those who are susceptible.

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Appendix A

HOST
Individuals under fifteen.
However, anyone who has not
contracted the disease is
susceptible

Epidemiology Triangle for

Varicella

ENVIRONMENT
AGENT
This disease is transmitted through
coughing, sneezing, or direct contact
Varicella-zoster Virus
with fluid-filled blisters. The virus
thrives in late winter with moderate
temperatures
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References

Center for Disease Control. (2019). Chickenpox (Varicella). Retrieved from

https://www.cdc.gov/chickenpox/about/index.html

Center for Disease Control. (2019). Understanding the Epidemiological Triangle Through

Infectious Disease. Retrieved from

https://www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf

Engard, B. (2017). What is the Epidemiologic Triangle? Retrieved fom

https://online.rivier.edu/epidemiologic-triangle/

Mayo Clinic. (2019). Chickenpox. Retrieved from https://www.mayoclinic.org/diseases-

conditions/chickenpox/diagnosis-treatment/drc-20351287

Stanhope, M. (2016). Public Health Nursing: Population-Centered Health Care in the

Community. Retrieved from

https://pageburstls.elsevier.com/#/books/9780323321532/cfi/6/2!/4/4@0.00:0.00

World Health Organization. (2019). Public Health Sureviellance. Retrieved from

https://www.who.int/topics/public_health_surveillance/en/

Wutzler, P. (2017). Varicella Vaccinnation: A Global Experience. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739310/