Chickenpox and Community Health
Chickenpox is often thought of as merely a nuisance, yet fatal cases of the disease occur each year. While not as deadly as many other infectious pathogens, it greatly affects the quality of life for many children at a very young age when they cannot understand what is happening to them. Furthermore, the virus can lie dormant in the body and develop into a more severe condition later in life. This paper will delve into the epidemiology of chickenpox as well as what can be done to lessen the condition’s rates of morbidity and mortality.
Chickenpox is a highly contagious condition caused by the varicella zoster virus (VZV). Its primary symptom is the appearance of red, itchy blisters on the skin, starting with the stomach and then spreading across the entire body. Secondary symptoms such as tiredness and fever also occur. The condition lasts for approximately one week and the number of blisters can rise to anywhere between 250 and 500. VZV is not necessarily eradicated in the body and it can go dormant in nerve cells to reemerge later in life as a painful condition known as shingles (Centers for Disease Control [CDC], 2016).
Chickenpox is spread easily through direct or indirect contact either with the blisters themselves, the pus from the blisters, or through droplets when an infected person sneezes or coughs. For this reason VZV is considered highly contagious and anyone encountering someone with chickenpox is at risk for infection if they have not already had the condition and have not been vaccinated. One of the most common ways the disease is spread is from people scratching the irritating blisters and then transmitting the virus to others under their fingernails. People remain contagious from 1 to 2 days before developing the rash to the time all of their blisters have formed scabs. This period is usually between 5 and 7 days. (CDC, 2016).
According to the CDC, between 100 and 150 people died in the United States each year from chickenpox related illnesses before 1995 when vaccination was implemented in the country. The CDC, World Health Organization (WHO), and a search of relevant literature all failed to yield current rates of mortality for the condition, though the CDC claims that as many as a hundred lives a year are currently being saved due to the vaccine. All people who have not been vaccinated or previously had the condition are susceptible to infection. The effects of chickenpox are usually benign albeit irritating, and the condition can run its course without risk of complication or serious health concerns. Secondary bacterial infections of the skin can occur. In certain situations, a patient can develop sepsis, encephalitis, and pneumonia as a result of VZV. Furthermore, the virus has a more potent effect on adolescents and adults, causing the painful condition known as shingles in which more serious blisters appear on the skin. Infants are also at a higher risk than older children for serious complications from the disease (CDC, 2016).
One of the most important determinants of health for people at risk of developing chickenpox is access to the vaccine. According to Papaloukas, Giannouli, and Papaevangelou (2014), the United States has included the chickenpox vaccine as a commonly recommended vaccine for children. Some countries do not recommend it for all children and instead choose to use it on only high risk populations. Regardless, globally, the rates of VZV infection have decreased over the past 20 years do to the vaccine being made available. Additionally, the study claims that the VZV vaccine is easily accessible for most people and there has been not noticeable different in race or ethnicity for people receiving the vaccine in the United States. While socioeconomic factors often greatly affect access to health care, they do not seem to play as large a role in this particular instance.
Another determinant of health that is not social, but rather biological, is age. Adults over 20 have a risk of death that is 25 times higher when compared to children between ages 1-4. In adults who have not had chickenpox or who have been infected with VZV and had it hide in their nerve cells, the virus causes a different, more dangerous, condition known colloquially as shingles and medically as herpes zoster. Though not truly chickenpox, for the purposes of this paper it is worth noting that the two conditions are related and that vaccination is the same for both (Papaloukas, Giannouli, & Papaevangelou, 2014).
Chickenpox is a disease in which the host is the same as the reservoir, it is carried by humans and infects humans. The environment is any place interaction is high among humans at risk for infection. Since only those acting as hosts can transmit the disease, it is commonly seen to cause outbreaks among young children. Since children regularly gather at school, schools and daycares are the most common environment to see chickenpox. The CDC (2016) has a separate page on their website dedicated to educating school children about the risks of chickenpox, how VZV is spread, what they can do to lessen risks, and what they can expect if they develop chickenpox.
The vector, as has been discussed, is the varicella virus, which a contagion in the herpes family of viruses that causes lesions in the skin but can also access the nervous system and lie dormant there. The virus is highly contagious through direct contact, its ports of exit and entry being the mouth, nose, and open skin wounds. The method of transmission is both direct and indirect as the virus can survive on surfaces outside the body for a sufficient amount of time to infect another host (CDC, 2016).
The community health nurse can make an impact in combating VZV infection rates by advocating for the varicella vaccine. The varicella vaccine is not 100 percent effective and those receiving it can still develop chickenpox or shingles. However, the rate of infection is significantly decreased which has a compounding effect by lessening exposure to the condition and thus further lowering infection rates in a population. The vaccine is under scrutiny, as many vaccines currently are, and some people fear the vaccine or consider it ineffective.
Community health nurses can track the effectiveness of chickenpox treatments by gathering accurate data from medical facilities on not the reported incident numbers as well as the numbers of VZV associated deaths. While these are rare, finding the ones that do occur is important for understanding what conditions lead to death and for assessing the effectiveness of treatments. As has been mentioned, in researching this paper, the author could find no current data on the mortality rates of chickenpox in the United States. Community health nurses would be vital in researching and establishing such statistics.
Beyond data collection, community health nurses can analyze data to find trends. Data is readily available according to the CDC (2016) since reporting of outbreaks to active surveillance sites has been common since the introduction of the vaccine in 1995. Data analysis needs to be more than merely establishing current rates, but also determining trends by comparing rates in different locations and across time to better understand the various factors that may affect the spread of the illness and increase patient risk for complications.
The National Foundation for Infectious Disease (NFID) is an organization dedicated to raising awareness of infectious diseases and advocating for vaccination where possible. The organization manages a website dedicated to adolescent vaccination which lists VZV as one of the viruses it is important for which to be inoculated. Since the disease is preventable and the mortality rate low, especially in children, the NFID focuses on lowering the risks for adolescents and adults. The vaccine is readily available in the United States, therefore funding, policy change, and providing resources are not the goal of the NFID. Instead the organization focuses on the education of at risk populations and the parents in why receiving the vaccine is important for combating the illness in the population (NFID, 2016).
While the chickenpox vaccine has been a significant help in managing the disease, work can still be done to improve education on the illness and how it can affect people. Specifically, at risk adults who have not had the disease and have not been vaccinated can be taught of the dangers of VZV and their risk for developing shingles. The community health nurse plays an important role in tracking the disease and correlating data to determine risk factors, as well as for advocating for the vaccine and educating members of the community on its availability and safety.
Centers for Disease Control and Prevention. (2016, April 11). Chickenpox (Varicella). Retrieved May 15, 2016, from http://www.cdc.gov/chickenpox/index.html
National Foundation for Infectious Disease. (n.d.). Chickenpox (Varicella). Retrieved May 15, 2016, from http://www.adolescentvaccination.org/vpd/chickenpox-varicella
Papaloukas, O., Giannouli, G., & Papaevangelou, V. (2014). Successes and challenges in varicella vaccine. Therapeutic Advances in Vaccines, 2(2), 39-55. doi:10.1177/2051013613515621