Chickenpox is a communicable disease also known as Varicella. The disease is highly contagious and it is caused by a viral pathogen known as varicella zoster virus (VZV). Once an individual is infected, the virus is believed to remain dormant in the sensory dorsal root ganglia. Its reactivation has been associated with herpes zoster (HZ), a cutaneous disease that occurs in the dermatomes. The disease causes an itchy rush with minute fluid-filled blisters. Although people from all ages can be affected, chickenpox mostly affects children. Studies claim that treatment is not required as it can get better on its own. This paper will therefore comprehensively describe a communicable disease of public health concern, and the chosen disease is chickenpox. Various aspects of the disease will be covered including its symptoms, modes of transmission, treatment and complications. The social determinants of health and the epidemiological triangle will also be described as well as the role of a community health nurse. Finally, a national agency that addresses chickenpox and its global implications will be discussed.

Causes, Modes of Transmission and Symptoms of Chickenpox

As mentioned earlier, chickenpox is caused by the VZV virus, also known as the human (alpha) herpes virus 3. The virus is a member of the Herpes virus group. Being a highly contagious disease, chickenpox is transmitted through various modes that include direct contact (where a person gets infected by touching the rash), air transmission (where droplets are spread through coughing and sneezing). Indirect transmission involves contact with the vesicle fluids of the infected individual. The risk for contracting the disease is higher for particular individuals who have never received vaccination, or those who have never been infected. The incubation period istwo to three weeks and an infected person begins to show symptoms after this period. Chickenpox lesions may either crust or not, depending on whether an individual has been vaccinated. An infected person becomes contagious a few days (1-2days) before the onset of the rash (Bradford, 2018).

The initial symptoms include sore throat, runny nose, malaise, headache, anorexia, and fever. These symptoms resemble a common cold, and they appear a few days before the rash appears. The itchy chickenpox blisters appear 10-21 days after exposure to the virus, and the rush goes through three phases. The first phase involves the development of papules (red or pink bumps that are raised) which break over a few days. The second phase involves the formation of vesicles (small fluid-filled blisters) which form, break and leak within a day. The last phase involves the formation of crusts and scrabs to cover the broken blisters; these heal within a few days. The infected individuals remain infectious until all the broken blister have been clustered over. It is important to note that for healthy children, the disease is less severe. Severe cases of the disease involves lesions covering the whole body, including organs such as the vagina, anus, uterus, mucous membranes eyes as well as the throat (Bradford, 2018).

Diagnosis and Treatment

            Diagnosis of chickenpox is generally based on the rash. Confirmation can also be done through laboratory tests which include cultures for the lesion samples or blood tests. Blood tests are usually conducted to check for antibodies against chickenpox. The presence of antibodies means that an individual has protection against the disease. Those who lack antibodies however, have to be monitored closely for the development of chickenpox symptoms. The goal for chickenpox treatment is to ensure that the infected individual is comfortable hence promoting the immune system to fight the disease. Since the disease is characterized by an uncomfortable itching, oral antihistamines are usually prescribed to manage the itching. Also, oatmeal baths such as aveeno baths in lukewarm water are used to comfort the skin through the provision of a crusty feeling. Other substances that are used to minimize the itching are calamine lotion and sarna lotion. Lately, there has been the development of safe antiviral medications, which are usually prescribed as soon as the rush begins. The use of these medicines on children is however questionable since in most cases their costs may outweigh their benefits, especially on the children. The importance of these antiviral medicine however arises when the infected individuals has other infections such as eczema or asthma (Bradford, 2018).

Complications

Although the complications associated with chickenpox are common, they are rare in healthy people who get infected. Certain populations however have an increased risk for complications, and these include; infants, pregnant women, adolescents, people whose immune system is weakened (HIV infected individuals, cancer patients, people who have had transplants and individuals on immunosuppressive drugs such as steroids) and adults. The most common chickenpox complications include dehydration, bloodstream infections, hemorrhagic complications (bleeding), brain infections (encephalitis and cerebellar ataxia), lung infection (pneumonia) and soft tissue and skin bacterial infections (group A streptococcal infections). The complications may be severe such that they may require hospitalization, and in some instances, chickenpox may cause death (Bradford, 2018).

Demographic of Interest

Children who are below 15 years old have a high risk of acquiring the disease with most cases occurring in children between the age of one and four years. Prior to the development of chickenpox vaccine, the disease was regarded as the most common childhood illnesses, with over four million cases and more than 10, 000 cases of hospitalization. Moreover, the annual childhood deaths associated with chickenpox were more than 100. The median age for chickenpox in 1995 was 3-5 years, for the children already vaccinated, and 5-6 years for the children who were yet to be vaccinated. Statistics show that an approximate of 95% Americans acquire chickenpox at some time in their lives. However, after the vaccine was developed, the incidence and prevalence of chickenpox reduced as severe cares of the disease could be prevented (Bakker, Martinez-Bakker, Helm, & Stevenson, 2016). Currently, children have a two-dose vaccine schedule, which has led to a reduction in the number of chickenpox cases, thereby reducing the associated public health burden as well as the burden on communities, schools and families.Varicella disease incidence is known to be high among middle school, high school and college students(Bakker et al., 2016).

Chickenpox is a reportable disease, and the varicella vaccination program which began in 1995 was accompanied by the establishment of active surveillance sites, for monitoring the disease. Deaths associated with chickenpox became notifiable in 1999, and the reporting for individual cases in states began in 2005. Case-based reporting is determined by three variables, that include age, vaccination status and disease severity. Additional standard information that is included in reporting for the disease are epidemiological, clinical and demographic data. Case outcomes are also reported and all his information is reported to the Center for Disease Control and Prevention (CDC). Additionally, chickenpox outbreaks are reported through the collection of case-based data(Bakker et al., 2016).

Social Determinants of Health 

According to the HealthyPeople.gov(n.d), social determinants of health are environmental conditions that affect the health of individuals. Such conditions include where an individual is born, where they live, their place of worship, their recreational practices, and their age. All these factors affect the health and wellbeing of individuals, as well as their overall health outcomes and the risk for acquiring infections. There is a wide range of social determinants for health some of which include public safety, culture, availability of resources, educational access, exposure to violence and crime and access to healthcare. Therefore, disease development I not only a product of personal behavior and genetic facts, but rather a complex interaction of a wide range of factors, which determine the morbidity and mortality of a disease.

Inequitable distribution of resources (money, health care resources and educational resources) affect the ability of individuals to receive quality healthcare services that can reduce the susceptibility of individuals to chickenpox. For instance, in individuals with adequate resources, frequent visits to the health care facilities ensure that healthcare professionals do not miss any signs associated with varicella disease. Age is also a significant determinant of health with children below the age of 10 being more susceptible to disease development. Worship practices, cultural practices and personal beliefs are the most important social determinants affecting the development of chickenpox. Development of the disease highly depends on whether an individual was vaccinated or not. The two-dose varicella vaccine schedule has been shown to significantly reduce chickenpox outbreaks among children populations. Vaccination refusal on cultural and religious grounds is however an emerging concern, that has seen most parents refuse to adhere to the vaccination schedules(Pelčić et al., 2016). The result of this is increased susceptibility of children to the virus, and hence ease of disease development.

The Epidemiological Triangle

In epidemiology, it is critical to understand the processes involved in the spread of diseases. With this information, it is easy to understand the susceptibility of populations to a disease, the spread of the disease through the population, and the factors contributing to the disease survival within the population. The understanding of these factors make disease prevention by healthcare professionals easily manageable; and this understanding can be achieved through the epidemiological triangle. The epidemiological triangle is a traditional infectious disease causation model that explains the organism causing given disease and factors contributing to its survival and spread (Engard, 2017). The knowledge obtained from the epidemiological triangle establishes the infection chain link which then allows a discovery of the weak link within the triangle. Elimination of the threat associated with this link leads to the control of the disease hence eliminating the associated long and short term health effects, treatment and management costs as well as the risk for death.

VZV is the causative get for chickenpox and the host for the visas is the human body. Once the virus enters the body, the host may carry it without any symptoms showing. As mentioned earlier, it is believed that the virus remains dormant in the sensory dorsal root ganglia. The host is susceptible to the virus due to wide range of factors including a weakened immune system, age, host genetics, antiretroviral and cancer therapy. The main external factor that influences the spread of the disease is temperature, with the disease incidence increasing in temperate areas. Other external factors include access to healthcare and cultural norms. Also, the spread and occurrence of chickenpox is high during spring and winter. Chickenpox is highly contagious and as such, children with symptoms of chickenpox should be excluded from school settings up until all the lesions have scabbed.

A visual representation of the epidemiological triangle

Host: Weakened Immunity, therapy, age, susceptibility

                                          Chickenpox

Agent: Dormancy                                                             Environment: Social norms, limited access to healthcare, temperature

The Role of the Community Health Nurse

The responsibility of community health nurses is to improve the health and wellbeing of communities. To sufficiently fulfill this role, community health nurses are required to be familiar with relevant information on communicable diseases. Community health nurse should be able to determine the causative agents of a disease, its incubation period, how the disease is transmitted, diagnosis and treatment options available, as well as preventive measures. Having such substantial knowledge can significantly improve the ability of a nurse to identify the symptoms of a disease and thereby implement prevention strategies (Mechcatie, 2018).

Through community education programs, the nurse can educate community membersin important healthcare facts such as the precautionary warning signs for chickenpox and the importance of adhering to vaccination schedules. Also, through their knowledge the community health nurse can identify community members at a higher risk for acquiring the disease. The nurse should be conversant with the disease reporting and follow up guidelines outlines by the CDC. It is the responsibility of community health nurses to collect information on the disease within the community setting, analyze it and present is too the relevant bodies. This helps ensure better patient outcomes within the community as case reporting and demographics data provides the full picture of the impact of the disease within the community(Mechcatie, 2018).This thereby allows clear mapping for disease prevention and community health promotion.

National Agencies that Address Chickenpox

Various organizations and agencies have been put in place to address communicable disease such as chickenpox. Two such agencies are CDC and the World Health Organization (WHO). CDC is a national organization that provides relevant information to the public about various diseases including chickenpox. The information provided by CDC include the signs and symptoms for chickenpox, modes of transmission, its complications and preventive measures as well as information regarding vaccination.WHO is an international organization that provides relevant chickenpox information, similar to that provided by the CDC; however, WHO provides additional information about global travel risks. Through this information, the two organization ensures that people have knowledge on how they can avoid being infected on the disease and hence reducing its impact. The National Foundation for Infectious Diseases (NFID), and the National Shingles Foundation are two examples of no-profit organizations that are essential to the prevention of chickenpox. NFID focuses on health education, not only for the public but also for the healthcare professionals. Through education, health literacy is improved, and hence leading to improved quality of life through disease prevention. The National Shingles Foundation focuses on research and education, through which information is obtained which can help fight against VZV.

Global Implication of the Disease

Chickenpox is a highly contagious disease, whose effects are global and through the efforts of various organization, a worldwide varicella vaccine was introduced which became popular in the United State in 1995. The vaccine is standard management practice for varicella disease in most countries. The vaccine is a universal childhood immunization that is available in several countries which include Korea, Japan, Germany, Australia, andCanada. Global adherence to the vaccination program has resulted in reduced incidences, morbidity and mortality for varicella disease (Xu et al., 2016). The lack of varicella immunization programs in a majority of countries however has contributed to the increasing global burden of the disease, with approximately 4200 global deaths being recorded annually, as well as millions of cases (Wutzler et al., 2017).

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