Public Health focuses on the preservation and improvement of health in the general population through preventive measures. Epidemiology, being a basic science of public health works on probability, statistics and comprehensive research methods in a given hypothesis, in the aim of promoting public health. Through epidemiological methods and studies hazards and risk factors of various diseases are identified. Nurses play a major in the objectives of public health, they assist with the development, promotion, and management of public health initiatives. In the mid-19 th century, awareness and knowledge provided to the local communities about diseases led to the implementation of important changes in sanitation that led to reduced spread of infectious illnesses. Currently, public health nursing (PNH) is tackling the ever increasing complex factors that influence health and those that contribute to illness. As such, this paper discusses on the epidemiology of chickenpox.
Chickenpox is a viral infection caused by the varicella-zoster that causes itchy rashes with blisters full of fluid. It is a highly contagious infection especially to the people who have not been vaccinated against it and also to those that have not had the disease. The virus is acquired either by inhaling the particles originating from chickenpox blisters or by touching any surface that the particles had landed on. Additionally, the virus can also cross the placental barrier and result in fetus infection. The symptoms of chickenpox occur in two stages; pre-rash stage and the post rash stage. Before the rash appears on the body there is the general feeling of unwell, loss of appetite, aching muscles, and fever. After a rush appears, there is the development of clusters from rash spots and the development of blisters. Although chickenpox has no cure, it resolves within a week or two through self-treatment. The doctor can only prescribe medication for reducing the severity of symptoms or administer vaccines to help prevent it.
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The vaccine is commended for young children, unvaccinated older children, and unvaccinated adults, however, it is not approved for people allergic to antibiotic neomycin, pregnant women and those with a deteriorated immune system. In occasional cases, chickenpox can be serious and can result to serious complications that include pneumonia, dehydration, encephalitis, toxic shock syndrome, sepsis, death, and Reye’s syndrome especially in teens and children using aspirin during chickenpox. The people at a higher risk of chickenpox complication are pregnant women, adults, people who smoke, those under other medication and people with weak immune systems. Comprised immune systems and older ages are the significant risk factors linked with the mortality and severity of chickenpox (Gould, 2014).
In the early 1990s, chickenpox was very common in USA.an estimate of around 4 million people had varicella whereby the preschool-aged children were the most affected. 100 to 150 passed away each year and 10,500 to 13,000 were hospitalized. After the licensing of varivax vaccine in 1995, 100 deaths, at least 3.5 million cases of chickenpox and around 9,000 hospitalizations have been prevented annually. Ever since the mortality rate has greatly decreased due to the high vaccination rates. Varicella is a reportable disease, through the National Electronic Disease Surveillance System (NEDSS) cases associated with the disease are reported to the National Notifiable Diseases Surveillance System (NNDSS).
Health is not just the absence of sickness but rather a state of complete social, mental and physical well-being. Consequently, there are five factors that determine or contribute to a person’s health status. They include biology and genetics, social environment, physical environment, individual behavior, and health services. The social determinants of health are complex, integrated and overlapping social structures and economic systems that are accountable for most health questions. They are the conditions in which people are born in, live in, work or age with. These social-economic systems are shaped by the distribution of money, power, and resources at local, national or international levels, therefore, the health disparities. Examples include language barriers, quality of education, public safety, social support, and social-economic conditions (Berkman et al., 2014).
Accessibility to vaccination is a crucial determinant of health for people at risk of developing chickenpox. Some countries, especially in Africa, do not fully support the vaccination projects for all the children. These countries rather recommend the vaccinations to high-risk populations of which is contrary to the United States or other nation that commonly recommends the vaccine for children. Irrespective of the vaccine recommendation, over the past 20 years, the rates of VZV infection have decreased globally due to the availability of the vaccine. In the United States, access to VZV vaccine to its citizens has no disparities in terms of race or ethnicity nor any socioeconomic factors that can hinder the administration of the vaccine.
The epidemiologic triangle of chickenpox comprises the Varicella-Zoster virus as the agent. Chickenpox follows an early exposure to the virus through the VZV vaccine which results in its dissemination in immunocompromised children. It is a contagious and parasitic virus that is not dependent on its biological system for growth or development hence infecting the viable cells in the body for its survival. Subsequently, the host being an infected person may not be aware of the presence of chickenpox. In the onset of infection, the symptoms of the illness include fever, body aches, irritability, and fatigue but the actual symptoms which are blisters, appear after 2 days. The third vertex of the epidemiologic triangle is the environment. Chickenpox spreads simply through shared air with infected persons in case they cough or sneeze in households, workplaces or schools. Additionally, the disease is easily transferrable in situations where direct contact is involved with the infected person, and specifically the blisters.
Many countries including Ireland, USA, Australia and, Canada established the Community health nursing (CHN) in an aim of improving the quality of health care in their communities. It is a discipline incorporating evidence-based research in improving health. A community health nurse puts into focus both long-and short-term care for disease prevention and management of the spread of communicable diseases such as chickenpox. Again, the nurse focuses provides understandable information in the context of healthy living to families or communities. The community health nurse also collects data and uses sound evidence with the aim of executing positive changes for a better healthy living. Lastly, the community health nurses advocate for health care in order to get certain government-funded health facilities to provide affordable healthcare to surviving communities.
Population health data has proved to be effective and increasingly utilized tool in helping treat widespread health problems like communicable diseases. It has also played a crucial role in the plan and implementation of community-based health initiatives in the promotion of good and quality health practices. Demographic data provide assistance to health informatics professionals to better gauge the people being treated, kind of issues they are experiencing and how much the group is paying for the health care. Additionally, demographic data can be used to indicate health in different areas. For instance, places with higher mortalities rates indicate that the population living in that place is generally not healthy and hence the need for health interventions.
In 1991, the National Shingles Foundations was formed. It disseminates information and raises necessary resources for research on the varicella-zoster virus. The organization deals with both shingles and chickenpox as they are caused by the same virus and closely related in the sense that those people who were once infected with chickenpox are at high risk of getting shingles. Furthermore, the organization raises awareness of shingles and chickenpox vaccination.
Chickenpox (varicella) is a serious and highly communicable viral disease with a global distribution. The global burden associated with the disease is considered significant. Substantial evidence have been presented regarding the mobility associated with primary infection of the disease, both in high risk groups and children. Higher rates of death and complications are associated with increased adult prevalence of the disease in warmer countries, however this is not always the case in countries like South America. In the industrialized countries, the current varicella vaccine has been able to meet WHO guidelines, however the shortcomings in terms of storage and price (Wutzler et al., 2017).
In countries such as Germany, a first dose of the vaccine is administered to children aged 11-14 months and the second at the age of 15-23 months. In Australia the first dose administered at 18 months while the second between 10-15 years. However, in England the vaccine is not appreciated, the country has deemed the vaccine as not being cost-effective. After an experience of the illness, regardless of whether one is vaccinated or not, the virus remains under control due to the immune system. With aging the immune system wanes out causing the virus to reactivate of which results to shingles, a quite expensive illness to manage. Therefore England administers a shingles vaccine to adults in the range of 70 years. Even with the universal routine vaccination, chickenpox is still endemic in countries like Cyprus whereby the vaccination is administered in the private sector.
The epidemiological effect of childhood vaccination at different stages of coverage, period of protection against chickenpox minus natural exposure to the varicella-zoster virus, and the effect of vaccination of the elderly with a past of chickenpox, need to be properly understood. Epidemiology, public health and socioeconomic impact of chickenpox must also be taken into account by the decision-makers on matters regarding the chickenpox vaccination.
References
Berkman, L. F., Kawachi, I., & Glymour, M. M. (Eds.). (2014). Social epidemiology . Oxford University Press.
Gould, D. (2014). Varicella zoster virus: chickenpox and shingles. Nursing Standard , 28 (33).
Wutzler, P., Bonanni, P., Burgess, M., Gershon, A., Sáfadi, M. A., & Casabona, G. (2017). Varicella vaccination-the global experience. Expert review of vaccines , 16 (8), 833-843.
