Concepts in Community and Public Health
Florence Nightingale, a name most people know even if you aren’t a nurse, pioneered or ‘paved’ many of the ways of how we nurse today. She gathered her data and organized it in such a way to improve hospital conditions, and saved many lives, through pie charts, graphs and statistics. The data was proof that mortality rates were down, and sanitary conditions were improved in hospitals. In focusing on these trends, Florence Nightingale opened up the way for the populations in nursing and saved and improved many lives. Epidemiologic concepts are used to understand and explain how and why health and illness occur as they do in human populations. Florence Nightingale pioneered those statistics needed in epidemiology to learn over the human populations, differing from one client and their family.
Communicable diseases are an important trend to follow in the populations. Once thought, eradicated diseases through immunizations, like polio, may be on its way back in to the US. Varicella, or Chickenpox, is an acute communicable disease caused by varicella zoster virus (VZV). According to the CDC, Primary varicella infection was not reliably distinguished from smallpox until the end of the 19th century. “In 1875, it was demonstrated that the chickenpox was caused by an infectious agent by inoculating volunteers with the vesicular fluid from a patient with acute varicella.
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Clinical observations of the relationship between varicella and herpes zoster were made in 1888 by von Bokay, when children without evidence of varicella immunity acquired varicella after contact with herpes zoster. VZV was isolated from vesicular fluid of both chickenpox and zoster lesions in cell culture by Thomas Weller in 1954. Subsequent lab studies of the virus led to the development of a live attenuated varicella vaccine in Japan in the 1970’s. The vaccine was licensed for use in the US in March 1995.” (CDC, May 2012).
VZV is spread through the respiratory tract and conjunctiva. It’s believed to thrive at the site of entry for about 4 to 6 days after infection, then likes to travel on to other organs like the liver, spleen, and sensory ganglia. “Further replication occurs in the viscera, followed by a secondary viremia, with viral infection of the skin. Virus can be cultured from mononuclear cells of an infected person from 5 days before to 1 or 2 days after the appearance of the rash.” (CDC, May, 2012). The virus incubates for 14 to 16 days after exposure, with a range of about 10 to 21 days. In the immunocompromised patients, the incubation periods may be longer. When the pesky little rash is ready to present itself, adults may have a couple of days of aches, pains, and fever before the presentation.
The rash itches like the devil and progresses rapidly from macules to papules to vesicular lesions before they will crust over. It will usually appear first on the head, then trunk, and on to the extremities. Most of the lesions will be concentrated on the trunk of the body and present in several stages of the healing process. They usually measure 1-4mm in diameter and healthy kids can have as many as 200-500 lesions in succession. Kids usually have a little malaise, low grade fever, and scratch like the dickens, for what the CDC says for 2-3 days. Has it been that long that anyone has really been around a kid with a good case of chickenpox? The itching aspect is the last to go. “What Should You Do If Your Kid Develops The Chicken Pox? A Chicken Pox Survival Guide: “Some children have such a mild case that you don’t have to do anything,” says William Meyers, M.D., a Pediatrician with the Pediatric Group of New Rochelle, in New York. For others, a little TLC is in order.
Look at what’s bothering your child and make him as comfortable as possible,” advises Meyers, here are some other tips: Give your child a daily Aveeno oatmeal or baking soda bath to soothe itching. Don’t overdo or it will dry out the skin. Dab Calamine lotion on sores with a cotton swab. One mother allowed her child to ‘paint’ the lotion on with a clean paintbrush. Try oral antihistamine diphenhydramine and dose per package directions. Give the child plenty of fluids lost with any fevers and treat fevers with Acetaminophen as directed on package. Dress in loose clothing that doesn’t further irritate the skin. Avoid giving children aspirin because of its link to Rye Syndrome, which can damage liver and the brain. Trim your child’s fingernails to minimize scratching and, thus, the risk of scarring or infection. Give your child gelatin, ice cream, or other soft foods to eat if he has sores in his mouth or throat.—T.K.” (Kump, T. May, 1994).
Varicella is usually a mildly acute disease, but can cause rare complications. Secondary bacterial infections of the lesions such as Staph or Strep, since these bugs are commonly everywhere to begin with, are the most common cause for a hospitalization. A secondary infection may cause serious illness and lead to death if not treated. Pneumonia is usually viral, but can be bacterial when it follows varicella. “Rare complications of varicella include aseptic meningitis, transverse myelitis, Guillain-Barre syndrome, thrombocytopenia, hemorrhagic varicella, pupura fulminans, glomerulonephritis, myocarditis, arthritis, orchitis, uveitis, iritis, and hepatitis.” (CDC, May, 2012). Immunocompromised patients are at a higher risk for serious complications and sometimes death. The CDC states that since 1996, the number of hospitalizations and deaths from varicella has declined more than 90%. Persistence of low income and rural urban communities in the Midwest regions of the US, continue to be a challenge for nurses and healthcare workers in bringing them up to date with immunizations and doctor visits.
“Varicella vaccine (Varivax, Merck) is a live attenuated viral vaccine, derived from the Oka strain of VZV. The vaccine virus was isolated by Takahashi in the early 1970s from vesicular fluid from an otherwise healthy child with varicella disease. Varicella vaccine was licensed for general use in Japan and Korea in 1988. It was licensed in the United States in 1995 for persons 12 months of age and older. The virus was attenuated by sequential passage in human embryonic lung cell culture, embryonic guinea pig fibroblasts, and in WI-38 human diploid cells. The Oka/Merck vaccine has undergone further passage through MRC-5 human diploid cell cultures for a total of 31 passages. The reconstituted vaccine contains small amounts of sucrose, processed porcine gelatin, sodium chloride, monosodium L-glutamate, sodium diphosphate, potassium phosphate, and potassium chloride, and trace quantities of residual components of MRC-5 cells (DNA and protein), EDTA, neomycin, and fetal bovine serum. The vaccine is reconstituted with sterile water and contains no preservative.” (CDC, May,2012).
Varicella and herpes zoster are global. Some studies suggest that varicella occurs more commonly in subtropical climates and more commonly in adults than in children. Varicella is a human disease, so no animal or insect vectors are known. The transmissions are through the respiratory tract as stated earlier and by direct contact of the skin lesions. Varicella does tend to occur most between March and May, and the least occurrences between September and November. Communicability extends from 1-2 days before the rash through days 4 and 5, or until they have formed the crust. The virus has not been isolated from the crusted lesions. Varicella is highly contagious and it has not been eradicated in the US. Extreme rural areas of low income families in the Midwestern US have cases of chickenpox reported. Anyone susceptible to this disease, which hasn’t had it before, has a 90% chance of contracting the virus. If contracted a good case of it, immunity is claimed. (CDC, May 2012).
“Epidemiologists and others can research possible connections with environmental factors. Within communities, nurses can use surveys to determine the biggest concerns and hazards that are identified by the community. A new tool in the public health armament is the Geographic Information System (GIS) (Choi et al., 2006). This is a term that refers to a number of computer programs that can link individual data units to a geographic location so that analysis of risk factors and health outcomes can be conducted. A map can also be created that provides a visual representation of the data. Primary prevention is the strategy for chicken pox vaccination in the communities. It’s the law in order for children to be in public school systems for children to be immune or have had the vaccination.” (Maurer & Smith, 2009). The community and public health nurses look for registry data, risk communication, advocacy with the responsibility of primary, secondary and tertiary preventions in mind.
Clark County, Washington State has the website for Public Healthcare Workers Immunization page and gives good information about who is susceptible in our community. Who needs these immunizations and why and how to get these immunizations at no or at low costs to our facilities.
References
Centers for Disease Control Epidemiology and Prevention of Vaccine Preventable Diseases. The Pink Book: Course Textbook-12th Ed Second Printing (May 2012) Accessed 06/15/2014 www.cdc.gov/vaccines/pubs/pinkbook/default.htm Clark County, Washington Public Health Healthcare Worker Immunizations, Retrieved 06/15/2014 from URL: http://www.clark.wa.gov/
Kump, T. Chicken Pox Survival Guide Parents (10836373) [serial online] May1994; 69(5)29-31 Available from CINAHL Complete, Ipswich, MA. Accessed 6-15-2014. Maurer and Smith. Community/Public Health Nursing Practice: Health for Families and Populations. 4th Edition. W.B. Saunders Company, 2009. VitalBookfile. Pageburst online
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