NRS 428 Epidemiology Paper

Grand Canyon University NRS 428 Epidemiology Paper-Step -By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University NRS 428 Epidemiology Paper assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NRS 428 Epidemiology Paper

Whether one passes or fails an academic assignment such as the Grand Canyon University NRS 428 Epidemiology Paper depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NRS 428 Epidemiology Paper

The introduction for the Grand Canyon University NRS 428 Epidemiology Paper is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NRS 428 Epidemiology Paper

After the introduction, move into the main part of the NRS 428 Epidemiology Paper assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NRS 428 Epidemiology Paper

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NRS 428 Epidemiology Paper

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Requirements

Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.
Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected.Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?
Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.

Sample Answer for NRS 428 Epidemiology Paper

There is a significant impact that communicable diseases, such as tuberculosis, HIV/AIDS, and influenza, have on the population of the entire world. The rate of transmission and the severity of communicable diseases are both significantly influenced by factors such as globalization. For instance, the status of human interactions is always shifting, which can have an impact on the way infectious diseases are disseminated across the world. The primary responsibility of reducing the incidence and severity of communicable diseases in their respective populations falls on the shoulders of nurses and other healthcare professionals. They utilize primary, secondary, and tertiary health promotion methods in order to empower those who are affected and those who are at risk to make changes to their lifestyles and behaviors. In addition to this, they choose interventions that are examples of best practices and improve care outcomes in terms of factors such as safety, quality, and efficiency. As a result, the epidemiology of HIV/AIDS is the topic that will be investigated in this paper.

Description of the Communicable Disease

In NRS 428 Epidemiology Paper, HIV/AIDS is the main infection/illness that will make the major part of this discussion. The viral infection known as HIV/AIDS is caused by the human immunodeficiency virus. It makes the immunological system of the body its main target. In the absence of therapy, it is possible for the virus that causes acquired immunodeficiency syndrome to progress (AIDS). Those who have HIV or AIDS encounter a wide range of symptoms throughout the stage of the illness known as the symptomatic phase. There are a range of symptoms associated with HIV/AIDS, and they can differ depending on the stage of infection. Early symptoms may include fever, rash, fatigue, enlarged lymph nodes, and sore throat (Dumais, 2017). As the infection progresses, people may develop more severe symptoms such as fevers that don’t respond to medication, significant weight loss, recurring infections, and problems with the nervous system. AIDS is the most advanced stage of HIV infection, and can lead to debilitating illnesses and death. Patients often include fast weight loss, pneumonia, skin rashes, and neurological conditions including depression and memory loss.

HIV is most commonly spread through sexual contact and the exchange of physiological fluids containing the virus, such as semen, vaginal fluid, or blood. It can also be spread through contact with infected mucous membranes, such as the inside of the mouth or rectum. HIV can be spread from mother to child during pregnancy, labor and delivery, or breastfeeding as as shown in NRS 428 Epidemiology Paper. It can also be spread through needle sharing among intravenous drug users. And finally, it can be acquired through a blood transfusion or organ transplant if the donor is infected with HIV. While bringing the pregnancy to term and again after the baby is born, the mother may directly transmit the virus to the growing fetus. A history of STDs, injecting drugs, a large number of sexual partners, and participating in sexual activity without using protection are all risk factors for HIV and AIDS. There are many issues that are related to HIV/AIDS. This group of illnesses includes pneumocystis pneumonia, cryptococcal meningitis, CMV, toxoplasmosis, candidiasis, and tuberculosis. Along with frailty, liver disease, renal disease, diabetes, and malignancies unrelated to AIDS, patients are also more likely to have these conditions (Capriotti, 2018; Dumais, 2017). Currently, there is no HIV/AIDS therapy or cure. On the other hand, antiretroviral drugs are used to treat patients and they lower the level of virus that is present in the body. Treatments for symptoms of illnesses including oral candidiasis, meningitis, and pneumonia are also used to stop further immune suppression.

The data that are now available show that HIV/AIDS is a problem for both national and international health. Statistics show that in 2019, there were 34 800 newly discovered cases of HIV/AIDS. It was an 8% drop from the incidence rate of the prior year. The age group with the greatest infection rate was 45 to 54 years old, followed by 35 to 44 year olds as the second highest age group. In the US, there are 1.2 million persons living with HIV/AIDS, of whom 13% are uninformed of their infection status. The demographics most affected by HIV/AIDS in the United States include those from underrepresented groups, such as homosexual men, bisexual men, and other males who have sex with other men (HIV.GOV, 2021). A sickness like HIV/AIDS must be disclosed. Healthcare institutions report cases of HIV/AIDS that have been clinically identified to the National HIV Surveillance System, which is maintained by the CDC, as well as to the health departments of the individual states. The instances are reported once the patients have been diagnosed.

Social Determinants of Health

The term “social determinants of health” refers to the factors that can be changed but still contribute to health disparities. Social determinants of health are things that are present in the environments in which people are born, where they live, where they work, and where they thrive. The HIV/AIDS epidemic is linked to a number of factors that determine health. Ethnicity is one of these factors (Hogan et al., 2021). The number of people living with HIV/AIDS is significantly higher in certain ethnic groups, including African Americans. A person’s socioeconomic status, as well as their level of poverty, is yet another social factor that influences their health. As a consequence of this, the prevalence of HIV and AIDS is high among people who come from families with low socioeconomic status. They are more likely to contract sexually transmitted infections, such as HIV/AIDS, due to certain risky behaviors, such as engaging in risky sexual activities.

Employment position is an additional social component that influences health in the case of HIV and AIDS. The work position of a person affects both their socioeconomic situation and their ability to get inexpensive health care. People who are unemployed are more prone than those who are working to participate in dangerous activities like drug use and prostitution, which increases their risk of contracting HIV. The HIV infection rate is often greater among the jobless as a result of this. The degree of education a person has is another crucial social factor of health when discussing HIV/AIDS. There have been reports of increased HIV/AIDS infection rates in communities where the average level of education is low (Friedman et al., 2018). The population’s degree of education has an impact on a variety of factors, including the population’s awareness, employment, and socioeconomic position. Another issue that adds to inequality among those with HIV/AIDS is access to care. Due to a lack of health insurance and inability to pay for treatment, it is expected that a large number of HIV/AIDS diagnoses will be recorded among communities with restricted access to healthcare. Delays in early diagnosis and treatment start are among the variables that contribute to poor outcomes in HIV/AIDS care. The population’s degree of awareness on how to limit the spread of HIV/AIDS has been proven to be impacted by low access to healthcare services (Santos et al., 2018). Because of this, it is crucial to implement interventions that focus on the socioeconomic variables leading to the spread of HIV/AIDS in order to enhance population health.

Epidemiological Triangle

An epidemiological triangle is a technique that helps researchers better understand how infectious diseases spread among people. It clarifies the intricate connections between infectious disease pathogens, their hosts, and the settings they live in. The agent is the name for the microbe that is the cause of the illness. In the context of HIV/AIDS, a virus is the infectious agent that causes the illness. The most prevalent kind of the virus that may lead to HIV/AIDS is called HIV-1 (Gopalappa et al., 2017). HIV-2 is a rare virus with modest virulence with signs and symptoms similar to HIV-1. A variety of HIV-related variables have an impact on the virus’s capacity to infect a host. They include virulence, often referred to as pathogenicity, and dosage. A disease-causing microorganism’s pathogenicity refers to its ability to really cause illness. The HIV virus has a high degree of virulence since it may infect and spread throughout the host. A dosage is a measurement of a pathogen’s amount or concentration (a microbe that causes sickness) (Gopalappa et al., 2017). The majority of the time, HIV is present in high concentrations, which increases its ability to infect and spread throughout the host. HIV is spread from one person to another by direct contact between hosts and infectious fluids, such as blood, vaginal secretions, or sperm.

In the epidemiological triangle, the term “host” refers to the person who is carrying the disease. It is a reference to the people whose lives have been altered by HIV/AIDS. Their susceptibility to HIV infection and the subsequent progression of AIDS is influenced by a number of host factors. The state of one’s immune system is one of them. People with weakened immune systems have an increased likelihood of becoming infected with HIV. There is a high likelihood of viral invasion, further multiplication, and subsequent suppression. The individual behaviors of the hosts are another factor related to the hosts. The risk of the host being exposed to the agent is increased by behaviors such as having sexual contact without protection, having a large number of sexual partners, and injecting drugs while sharing needles, among other things (Mahdavi et al., 2021). Another host-related risk factor for HIV and AIDS is the possibility of becoming pregnant. Infected pregnant women have an increased risk of passing the virus on to their unborn children either through mother-to-child transmission, which can occur during delivery and breastfeeding, or through mother-to-baby transmission. People who already have a medical condition are at a greater risk of contracting HIV/AIDS than those who do not have a medical condition. Comorbidities that are already present in patients lower their immune status, which in turn increases their susceptibility to the agent. Patients receiving standard treatments for cancer are at an increased risk of contracting HIV due to the suppression of their immune systems caused by these treatments (Joas et al., 2018). Patients who are receiving blood transfusions and those who have been involved in car accidents are also at risk because of their contact with contaminated fluids.

The word “environment” describes the different external factors that affect the epidemiologic epidemic. Environmental elements, in addition to the host and the infectious agent, contribute to the spread of the illness. The environmental variables that contribute to the transmission of HIV/AIDS include places with a high frequency of sexually transmitted infections and poor levels of reporting (Dumais, 2017). Situations like this promote the spread of the HIV/AIDS pandemic. Socioeconomic variables, such as poverty, also contribute to the spread of HIV/AIDS since they make it harder to get the essential therapy. Another thing that deters people from enrolling in testing and treatment programs is when people with HIV/AIDS experience stigma or social isolation (Dumais, 2017). They are to blame for the increased pace of the disease’s population-wide spread as a direct consequence of this.

Role of the Community Health Nurse

Community health nurses have a number of roles in the epidemiological treatment and prevention of HIV/AIDS. One of the responsibilities involved is case discovery. The search for cases entails looking for those who have had HIV/AIDS as well as those who are at risk. The community health nurse conducts population screens in order to find the patients. She also outlines the susceptible groups, which might include those who are transgender, misuse alcohol or drugs, have several sex partners, or participate in unprotected sexual activity, such as those who work in the sex industry (Mottiar& Lodge, 2018). The nurse educates the vulnerable population on HIV/AIDS prevention strategies as well as the need of being screened and starting treatment for cases as soon as they are found.

A case that has been detected must also be reported to the proper authorities by the community health nurse. To correctly estimate the prevalence, incidence, and severity of HIV/AIDS in a specific community, data must be gathered and reported. The information is useful in figuring out how to best provide the people with resources linked to HIV/AIDS. The nurse is also in charge of gathering information on HIV/AIDS in the general community (Knettel et al., 2021). The information provided by the data provided insights on the severity, prevalence, and trends of the illness in the community. In order to provide a true picture of the illness pattern, distribution, and burden throughout the community, the nurse will do an analysis on the data that was gathered. The nurse will also share the studied data with the general public, healthcare professionals, and public health authorities in an effort to motivate individuals to take action. Presenting results to communities, publishing findings in journals, presenting findings at conferences, and creating new policies based on study findings are all examples of effective dissemination tactics. Additionally, the community health nurse is in charge of case follow-up. Follow-up is conducted to make sure infected individuals continue to take their medications as directed and to look for any additional needs that could affect the outcome of treatment (Knettel et al., 2021). As a consequence, community health nurses must play a crucial role in the epidemiological treatment of HIV/AIDS.

National Agency

A national organization called UNAIDS fights HIV/AIDS both in the US and in other countries across the globe. UNAIDS is a worldwide program that was started to spearhead efforts to eliminate HIV/AIDS by the year 2030 within the framework of the global Sustainable Development Goals. The organization takes special pride in its capacity to encourage leadership in the battle against HIV/AIDS at all levels—regional, global, national, and local (UNAIDS,2021). The organization acts as a global issue solution by integrating communities affected by HIV/AIDS in the decision-making process. Additionally, it carries out and keeps track of response activities in the war against HIV/AIDS. The group collaborates with other countries and communities to develop strategies that are successful in ending HIV/AIDS. It also campaigns for the adoption of policies to eliminate the political and legal barriers that prevent effective HIV/AIDS response.

UNAIDS can help patients with HIV and AIDS in a variety of ways. First, it encourages individuals who are afflicted by the illness and those who are at risk of developing it to have access to treatment and preventative services (UNAIDS,2021). Increasing patient access to antiretroviral drugs for the treatment of HIV/AIDS would be an excellent illustration of this. In the battle against HIV, UNAIDS also defends the rights of the patients. It ensures that their needs will be given top consideration in the formulation and application of policy. Additionally, it supports initiatives aimed at enhancing the quality of life for HIV patients, including as social and gender-based rights protections and educational initiatives.

Global Implication

Globally, the expansion of HIV/AIDS has a detrimental impact. According to estimates, there are over 38 million persons living with HIV/AIDS worldwide. It contributes to the spread of illness since the vast majority of persons affected globally lack access to treatment or preventative programs. A reduction in quality of life is experienced by HIV/AIDS patients and those who are important to them. Patients with opportunistic infections must stay in the hospital for extended periods of time, which may be difficult for both the patient and their loved one (Navon, 2018). As a direct consequence of having to visit the hospital often and being admitted, the productivity of the patients and their families is negatively impacted.

Due to HIV/AIDS, the world’s nations are also suffering severe financial consequences. For instance, the US spent more than $34.8 billion on HIV/AIDS prevention and treatment initiatives in 2019. (KFF, 2021). Dieleman et al. (2018) report that from 1995 to 2015, the annualized rate of healthcare expenditure per person related to HIV/AIDS grew. From 1995 to 2015, there was a rise in this. Both upper-middle income countries and low-middle income countries saw the greatest rates of growth. As a result of the rise, $9.1 trillion was spent on healthcare globally to combat and cure HIV/AIDS.

Another cause of death that contributes significantly to global mortality is HIV/AIDS. For instance, a study released by UNAIDS estimates that since the start of the epidemic, 47.8 million individuals have died as a consequence of HIV/AIDS-related infections. Additionally, 680000 people died in 2020 as a result of HIV-related diseases. n.d. (UNAIDS). UNICEF (2021) estimates that 330 children would die from diseases associated with HIV/AIDS per day in the globe in 2020. A number of causes contributed to the majority of child fatalities, with inadequate access to HIV treatment and prevention being the most important. Several nations have put different initiatives into place to fight HIV/AIDS. One of the methods that has been put into practice in the majority of nations is expanding access to treatment by making antiretroviral medications free to use. Having access to therapy increases the overall quality of life and longevity of those who are afflicted (Chenneville et al., 2020; Mandsager et al., 2018). Furthermore, there are no fees involved with being tested for HIV/AIDS. Both free HIV testing and health education programs are available to the general population. In order to alleviate dietary inadequacies, the population also gets help in the form of nutritional aid.

Conclusion

The HIV/AIDS pandemic has a considerable impact on worldwide disease burden. The presence of the host, the infectious agent, and environmental elements that contribute to its worldwide spread are revealed via analysis employing epidemiological methodologies. In the battle against HIV/AIDS, the community health nurse is in charge of a number of tasks. You will be in charge of locating cases, gathering information, running analysis, sharing it, and keeping in touch with patients in this position. Numerous problems that are linked to HIV/AIDS add to the increased urgency with which confirmed individuals must be treated. To reduce the possibility of the illness spreading among such communities and its harmful impacts, vulnerable people should be given priority when making choices concerning public policy. Organizations like UNAIDS play crucial supportive roles in the battle against HIV/AIDS. National governments and international organizations should collaborate to implement policies that will reduce the incidence and prevalence of the illness in order to enhance public health and stop the spread of HIV/AIDS.

References

Capriotti, T. (2018).HIV/AIDS: An Update for Home Healthcare Clinicians.Home Healthcare Now, 36(6), 348–355. https://doi.org/10.1097/NHH.0000000000000706

Chenneville, T., Gabbidon, K., Hanson, P., & Holyfield, C. (2020).The Impact of COVID-19 on HIV Treatment and Research: A Call to Action.International Journal of Environmental Research and Public Health, 17(12), 4548. https://doi.org/10.3390/ijerph17124548

Dieleman, J. L., Haakenstad, A., Micah, A., Moses, M., Abbafati, C., Acharya, P., Adhikari, T. B., Adou, A. K., Kiadaliri, A. A., Alam, K., Alizadeh-Navaei, R., Alkerwi, A., Ammar, W., Antonio, C. A. T., Aremu, O., Asgedom, S. W., Atey, T. M., Avila-Burgos, L., Awasthi, A., … Murray, C. J. L. (2018). Spending on health and HIV/AIDS: Domestic health spending and development assistance in 188 countries, 1995–2015.The Lancet, 391(10132), 1799–1829. https://doi.org/10.1016/S0140-6736(18)30698-6

Dumais, N. (2017). HIV/AIDS: Contemporary Challenges.BoD – Books on Demand.

Friedman, E. E., Dean, H. D., &Duffus, W. A. (2018). Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Public Health Reports, 133(4), 392–412. https://doi.org/10.1177/0033354918774788

Gopalappa, C., Farnham, P. G., Chen, Y.-H., &Sansom, S. L. (2017).Progression and Transmission of HIV/AIDS (PATH 2.0): A New, Agent-Based Model to Estimate HIV Transmissions in the United States.Medical Decision Making, 37(2), 224–233. https://doi.org/10.1177/0272989X16668509

HIV.GOV. (2021, June 2). U.S. Statistics. HIV.Gov. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

Hogan, J. W., Galai, N., & Davis, W. W. (2021).Modeling the Impact of Social Determinants of Health on HIV.AIDS and Behavior, 25(2), 215–224. https://doi.org/10.1007/s10461-021-03399-2

Joas, S., Parrish, E. H., Gnanadurai, C. W., Lump, E., Stürzel, C. M., Parrish, N. F., Learn, G. H., Sauermann, U., Neumann, B., Rensing, K. M., Fuchs, D., Billingsley, J. M., Bosinger, S. E., Silvestri, G., Apetrei, C., Huot, N., Garcia-Tellez, T., Müller-Trutwin, M., Hotter, D., … Kirchhoff, F. (2018). Species-specific host factors rather than virus-intrinsic virulence determine primate lentiviral pathogenicity. Nature Communications, 9(1), 1371. https://doi.org/10.1038/s41467-018-03762-3

KFF. (2021). U.S. Federal Funding for HIV/AIDS: Trends Over Time. 6.

Knettel, B. A., Fernandez, K. M., Wanda, L., Amiri, I., Cassiello-Robbins, C., Watt, M. H., Mmbaga, B. T., &Relf, M. V. (2021). The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania.Journal of the Association of Nurses in AIDS Care, 32(6), 682–692. https://doi.org/10.1097/JNC.0000000000000267

Mahdavi, F., Shams, M., Sadrebazzaz, A., Shamsi, L., Omidian, M., Asghari, A., Hassanipour, S., &Salemi, A. M. (2021). Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis.Microbial Pathogenesis, 160, 105202. https://doi.org/10.1016/j.micpath.2021.105202

Mandsager, P., Marier, A., Cohen, S., Fanning, M., Hauck, H., & Cheever, L. W. (2018).Reducing HIV-Related Health Disparities in the Health Resources and Services Administration’s Ryan White HIV/AIDS Program.American Journal of Public Health, 108(S4), S246–S250. https://doi.org/10.2105/AJPH.2018.304689

Mottiar, S., & Lodge, T. (2018). The role of community health workers in supporting South Africa’s HIV/ AIDS treatment programme.African Journal of AIDS Research, 17(1), 54–61. https://doi.org/10.2989/16085906.2017.1402793

Navon, L. (2018). Hospitalization Trends and Comorbidities Among People With HIV/AIDS Compared With the Overall Hospitalized Population, Illinois, 2008-2014. Public Health Reports, 133(4), 442–451. https://doi.org/10.1177/0033354918777254

Santos, V. da F., Pedrosa, S. C., Aquino, P. de S., Lima, I. C. V. de, Cunha, G. H. da, &Galvão, M. T. G. (2018). Social support of people with HIV/AIDS: The Social Determinants of Health Model.RevistaBrasileira de Enfermagem, 71, 625–630. https://doi.org/10.1590/0034-7167-2017-0346

UNAIDS.(2021). Global HIV & AIDS statistics—Fact sheet. Retrieved December 17, 2021, from https://www.unaids.org/en/resources/fact-sheet

UNAIDS.(n.d.-b). Homepage. Retrieved December 17, 2021, from https://www.unaids.org/en/Homepage

UNICEF.(2021). HIV Statistics—Global and Regional Trends.UNICEF DATA. https://data.unicef.org/topic/hivaids/global-regional-trends/

Sample Answer 2 for NRS 428 Epidemiology Paper

Influenza is a highly contagious respiratory disease caused by influenza viruses. It is commonly referred to as flu. It is a cause of pandemics and epidemics, although it is not so contagious as the common cold. There are many influenza viruses, each causing its disease; some are very similar but different. The symptoms include fever, cough, sore throat, and coryza. Influenza can cause mild to severe illness in people of all ages. The condition, which is particularly quick and vigorous, has been observed to catch people during the fall and winter frequently. Reports indicate that millions of cases are reported worldwide during an epidemic season each year. Therefore, there is a need to prevent the disease. Vaccination is the most appropriate strategy to handle this health challenge. It helps to prevent the spread of the disease during its reach. Hence, according to the local healthcare department’s recommendation, people should seek vaccination yearly. This paper aims to describe influenza in terms of specific demographics, how various determinants of health contribute to its development, and the epidemiology triangle. Similarly, it will focus on the community health nurse’s role, the importance of demographic data, the national organization that works to address the disease, and the global implication.

Comprehensive Description of a Communicable Disease and the Demographic of Interest

Influenza is caused by influenza viruses infecting the upper respiratory tract. The viruses are classified as influenza A and B (Darricarrère et al., 2021). Each type causes distinct disease patterns, but both are capable of causing severe illness and death in young children, older adults, and people with other underlying health conditions who lack immunity to the virus (Kim & Chang, 2018). Influenza A viruses are further divided into subtypes based on the genetic makeup of their hemagglutinin (HA) and neuraminidase (NA) protein subunits (Kim & Chang, 2018). Hemagglutinins comprises H1 and H3 on the surface of the virus. These proteins help the virus bind to sialic acid molecules on host cells, thus allowing the virus to attach to them and enter through the cell membrane. Once inside a cell, the virus replicates and infects another cell by attaching itself to sialic acids on this new host cell. The H1 protein is responsible for causing symptoms such as fever, chills, coughing, sneezing, and sore throat (Kim & Chang, 2018).

The H3 protein does not have these symptoms; however, it helps spread infection from one person to another through coughing or sneezing. Influenza B viruses are further divided into subtypes based on the genetic makeup of their PB1 and PA protein subunits (Kim & Chang, 2018). Influenza is a highly contagious disease that spreads quickly from person to person, household to household, school to school, and workplace to workplace. In general, influenza is spread through direct contact with respiratory secretions such as coughing, sneezing, or droplets expelled from a sick person (Boktor et al., 2021). It can also be transmitted from objects and surfaces contaminated with infected respiratory secretions, such as doorknobs and phones. Also, it occurs through touching things like toys and books that have come into contact with infected surfaces. Most people recover from influenza within a week. However, some people develop complications such as pneumonia or even death if they contract influenza while they have underlying health problems such as asthma or diabetes. Preventing flu is more accessible than treating it once it spreads (Kim & Chang, 2018). Vaccination can prevent infection with many types of flu virus; nevertheless, not all flu vaccines work equally well for everyone (Mameli et al., 2019). Also, vaccination should be done early in the season when the highest risk exists for developing severe illness from flu virus infection.

Influenza is a reportable disease for the U.S. Public Health Service (PHS). It is when one can be tested for influenza and reported to the local or state health department or hospital as appropriate (Morabia, 2020). A person who has had an influenza-like illness and presents to the health care provider with a fever, cough, or other respiratory symptoms should report within 24 hours after the onset of symptoms. If the patient cannot contact a health care provider or hospital within 24 hours, it is necessary to call a local or state health department or hospital at once and ask them to accept the report (Morabia, 2020). Also, the patients should contact their public information office to confirm if they would accept reports from a specific area code phone number.

Determinants of Health and Explanation of How Determinants Contribute to Disease Development

The social conditions in which one is born lives, and ages significantly impact the spread of influenza. These social determinants are responsible for how the disease affects the body and the people’s health experiences (Seligman etal., 2021). These factors include access to health care services, public safety, and the availability of resources that satisfy everyday needs, such as safe housing and food (Social Determinants of Health, 2018). Besides, they include the availability of resources and the patient’s capacity to access medical care, and many other circumstances might improve one’s health, including but not limited to employment, education, and social support.

Like many other diseases, social factors in health influence the frequency of influenza-related mortality and the harm that impacts economic growth. Researchers have discovered a connection between the improvement of social elements and the prevention of influenza outbreaks. For instance, if the economy were to improve, more people would have access to vaccinations, which would help reduce disease prevalence (Fell et al., 2017). Additionally, it would be beneficial in providing researchers with more adequate resources to undertake studies to comprehend the nature of the disease and stop its spread. Therefore, strengthening the economy is essential to easing the burden of this illness on the population. Lack of educational possibilities may also affect how the disease is handled because it is more likely to cause adverse conditions if people are unaware of how to take it (Fell et al., 2017). Given that the infected persons might not be aware of the associated symptoms and the use of preventive actions, it could be fatal because it would spread exceptionally quickly.

Epidemiologic Triangle (Host Factors, Agent Factors, and Environmental Factors

According to Fell et al. (2017), the four components of the epidemiological triangle are time, host, environment, and agent. The numerous influenza virus strains related to the illness are linked to the illness’s epidemiological triangle and attack the upper respiratory system. Fell et al. (2017) reveal that influenza viruses use animals as carriers and have a quick mutation rate. This aspect demands that new vaccines be continuously produced each year. The most susceptible individuals to this illness are those with immunological deficiencies (Tanner et al., 2021). Because there are not enough environmental health determinists, health professionals are also at risk of contracting the disease. The sickness’ causal agent, moisture from infected individuals, is responsible for its transmission. According to Fell et al. (2017), influenza has an incubation and a symptomatic period between 5 and 7 days. After this period, there is the likelihood that the disease will stop being infectious to the host. However, the host may experience the symptoms for up to 14 days.

Role of the Community Health Nurse and Importance of Demographic Data

Community health nurses should contribute to researching influenza. They are responsible for collecting and reporting influenza statistics to CDC, just like many other communicable illnesses (Grohskopf et al., 2018). This information is essential for the CDC to accurately assess the sickness and develop workable tactics to stop its spread. Community health nurses also help the general public’s awareness of the illness. They can develop public relations strategies, campaigns, and studios to increase awareness. Through a greater understanding of the illness and its risks, these initiatives may seek to reduce the spread of the disease (Grohskopf et al., 2018). In addition, community health nurses can be at the forefront of promoting and advertising the program in society during immunization campaigns to ensure it reaches the public.

Similarly, nurses are responsible for providing patients with medical care to encourage healthy lives and stop the spread of disease. In addition to providing medical care to the ill, they can provide educational programs with advice on how to stop the spread of the illness by choosing healthy lives (Grohskopf et al., 2018). Community health nurses can assist the health departments in setting up screening procedures and immunization cases of influenza outbreaks. Also, they can offer the general public personal protective equipment to keep them from catching the disease.

National Agency or Organization That Works to Addresses Communicable Disease

Over the years, World Health Organization (WHO) has been at the forefront of addressing the effects of influenza. According to Ly et al. (2017), WHO was established on 22^nd July 1946 as a United Nations office focusing on solving global influenza and other medical issues. It has successfully reduced the flu through practical measures, a significant contributing component. The group focuses on changing some of the mechanisms that regulate all pandemics caused by the disease. Because of its dedication to improving public health and wellbeing, the organization has conducted extensive research on preventing sporadic influenza outbreaks and spreading the virus from animal to human. One instance was the 2009 H1N1 influenza A test conducted in Mexico. The introduction of a Pandemic Influenza Control (PIP) structure in the same year led to significant advancements in treating the condition. The system was intended to increase availability and significantly respond to the influenza epidemic. WHO works with its administrative bodies to create organizations for delivering impact populace training programs. The organization released the Global Influenza Strategy 2019–2030 on 11th March 2009 to protect the entire world’s population from influenza (Ly et al., 2017). According to Ly et al. (2017), the organization suggested using flu antibodies throughout the Northern Hemisphere’s 2019–2020 flu season. In addition, it has the Global Influenza Program, which aims to provide strategic direction, activity coordination, and technical support based on the threat from all types of influenza.

Global Implication

Influenza is a leading cause of global mortality and morbidity rates today. According to Ly et al. (2017), besides death, the disease has significant effects that cause major burdens towards the limited resources in the world. Therefore, the global implications of influenza are far-ranging and impact many industries. The economic costs of the pandemic have been staggering, with estimates placing them at $11.2 billion in the United States alone (Putri et al., 2018). These costs can be attributed to lost productivity, increased medical care expenses, travel disruptions, and even death. Similarly, in the last few decades, influenza viruses have evolved to overcome many antiviral drugs used to treat them. It has led to an exploding number of cases, with about 5-10% of adults and 20-30% of children worldwide becoming ill (Ly et al., 2017). These statistics contribute to between 3 and 5 million cases of influenza and nearly 1 million fatal cases worldwide (Ly et al., 2017). The World Health Organization (WHO) estimates that more than 200 different types of influenza A virus are circulating globally at any time. Vaccines or antiviral drugs do not recognize the majority of these types. Each year, the WHO publishes recommendations for countries on preparing for and responding to pandemic influenza outbreaks. These recommendations include using vaccines and antiviral drugs as their countries’ healthcare systems require. On the other hand, the influenza B virus is an endemic species to specific regions and does not spread globally. According to Ly et al. (2017), influenza B cases are reported in India and China.

Other diseases in several African nations exhibit symptoms similar to those of influenza. Due to the disease’s limited surveillance, they become confused (Ly et al., 2017). High poverty levels and weak health systems are present in various African nations, especially in the Sub-Saharan region. Similarly, the countries face significant obstacles brought on by illnesses like HIV and malaria, which change the focus of financial issues (Ly et al., 2017). The world must work together to address these issues and raise the region’s health standards. For instance, the CDC has significantly contributed to reducing malaria in Kenya through various programs.

Conclusion

Influenza is a contagious disease that spreads through contact with respiratory secretions, doorknobs, phones, and toys that have come into contact with infected surfaces. Vaccination can prevent infection with many flu viruses, but not all vaccines work equally well. A person with influenza-like symptoms should contact a health care provider or hospital within 24 hours. They can also get their public information office to confirm if they would accept reports from a specific area code phone number. The social conditions in which one is born lives, and ages significantly impact the spread of influenza. These social determinants include access to health care services, public safety, and the availability of resources that satisfy everyday needs, such as safe housing and food. The four components of the epidemiological triangle are time, host, environment, and agent. Influenza viruses use animals as carriers and have a quick mutation rate, and the most susceptible individuals are those with immunological deficiencies. Community health nurses are responsible for collecting and reporting influenza statistics to the CDC, helping to develop public relations strategies to increase awareness of the illness, and providing medical care to patients to encourage healthy lives and stop the spread of disease. The World Health Organization is a United Nations agency that works to address infectious diseases. It has successfully reduced the flu through practical measures and created organizations to deliver impact training programs. Influenza is a leading cause of global mortality and morbidity rates today. It has significant effects that cause major burdens towards the limited resources in the world and has cost the United States $11.2 billion. The WHO estimates that more than 200 different types of influenza A virus are circulating globally at any time. It recommends that countries use vaccines and antiviral drugs as their healthcare systems require. African nations face significant obstacles due to illnesses like HIV and malaria, which change the focus of financial issues. The world must work together to address these issues.

References

Boktor, S. W., Hafner, J. W., & Doerr, C. (2021). Influenza (Nursing).

Darricarrère, N., Qiu, Y., Kanekiyo, M., Creanga, A., Gillespie, R. A., Moin, S. M., … & Nabel, G. J. (2021). Broad neutralization of H1 and H3 viruses by adjuvanted influenza HA stem vaccines in nonhuman primates. Science Translational Medicine, 13(583), eabe5449. doi: 10.1126/scitranslmed.abe5449

Fell, D. B., Bhutta, Z. A., Hutcheon, J. A., Karron, R. A., Knight, M., Kramer, M. S., … & Savitz, D. A. (2017). Report of the WHO technical consultation on the effect of maternal influenza and influenza vaccination on the developing fetus: Montreal, Canada, September 30–October 1, 2015. Vaccine, 35(18), 2279-2287. https://doi.org/10.1016/j.vaccine.2017.03.056

Grohskopf, L. A., Sokolow, L. Z., Broder, K. R., Walter, E. B., Fry, A. M., & Jernigan, D. B. (2018). Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 influenza season. MMWR Recommendations and Reports, 67(3), 1. doi: 10.15585/mmwr.rr6703a1

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Sample Answer for NRS 428 Epidemiology Paper

Epidemiology Paper: Chicken Pox

Also referred to as Varicella, chicken pox is viral condition that has high levels of contagiousness. The condition is particularly prevalent in children and manifests through early eruption of the papules and vesicles. Further, the condition also produces fever and mild constitutional disturbances. Physicians were only able to differentiate chicken from smallpox in the 19^th century. Nevertheless, chicken pox was first described in the 16th century by a physician called Giovani Filippo. Following the description, William Heberden formulated a differentiation of small pox and chicken pox varicella in the year 1767 (Presti et al., 2019). Further research was conducted by Von Bokay, who reported in the year 1875 that the causative agent of the condition was an infectious agent. Moreover, in the year 1909, Von Bokay made a maiden observation of the differences between the two diseases. The causative agent of chicken pox was isolated in the year 1954 by Thomas Weller, whereas Michiaki Takahashi proceeded to create a maiden attenuated vaccine in the year 1972. The present paper will thus examine the epidemiological aspects of chicken pox.

Chicken Pox Description

The varicella-zoster virus (VZV) is a causative agent for the chicken pox diseases, which is airborne in nature. The transmission of the condition occurs through person-to-person means via coughing or sneezing, as well as inhalation of the particles by an unaffected person. Moreover, viral particles that have been shed from a sick person’s body can transmit the disease via contact or inhalation (Yu, Ashworth, Hughes, & Jones, 2018). As such, even indirect means of transmission such as items that had direct contact with active blisters. Incidentally, unvaccinated individuals who have never contacted the chicken pox are at high risk of developing the disease. Experts consider the varicella zoster virus as contagious in 1-2 days upon whose end a person develops rashes and scrubs that emanate from the blisters. However, the incubation period for the condition is 14-16 days after which period the symptoms manifest (Presti et al., 2019). The original symptoms of the disease have commonalities with common cold and they include sore throat, malaise, running nose, and fever. The red spot will start having a presence around the body immediately it begins manifesting. Normally, the spots would appear on the trunk and scalp, which precedes spreading outwards. Moreover, the mucus membrane is also affected in the manner that the spots will be noted on the mouth and along the nasal cavities. The spots will then graduate into vesicles in the form of elevated lumps that have lucid teardrop shaped blisters, which will the quickly turn to crusty lesions within 8 hours (Gray & Cathie, 2019). Novel spots will undergo continual development as the old ones disappear after healing. Researchers opine that it will take a total of five days for the development of new lesions to stop. On the other hand, the crusts will take up to twenty days to start disappearing from the body.

Moreover, intense itching is also amongst the symptomatology of the condition and it gives a person the irresistible urge to scratch, which phenomenon may result in certain complications including cellulitis. According to Cassidy and McBrien (2019), the cellulitis is a skin infection that results from bacteria. Additional symptoms that may be caused by chicken pox entail encephalitis, necrotizing fasciitis, sepsis, invasive group A streptococcal infection as well as Reye syndrome. People whose immune systems are poor or have been compromised are the ones that develop the above complications. The diagnosis of the condition is confirmed based on the presence of symptomatology such as fever and rash. In the event that a physician would be interested in the confirmation of the condition, a specimen in the form of lesion fluid is taken to the laboratory and cultured within 5-10 days.

The treatment of the condition focuses on managing the symptomatology associated with infectious conditions including fever and itchiness reduction. The reason for this preference is that most Chicken pox infections are not easy and they may resolve themselves only after 2-3 weeks. Antihistamines such as Benadryl and Atarax are principally recommended when it comes to the management of the pruritus (Shin et al., 2017). Moreover, topical treatment and wet compresses may be used to offer the patient immediate relief from blister pain. Ibuprofen and acetaminophen as non-steroidal inflammatory drugs are used to handle the fever. Owing to the viral nature of the condition, pharmacological agents inclusive of acyclovir, famciclovir, and valacyclovir as antiviral agents are used to manage the condition. The antiviral agents work by reducing the itching intensity and increasing the healing process by shortening the infection period. In order for the pharmacological agents to offer maximum therapeutic impact, a patient should start on using them within the first 24 hours of contracting the disease (Duncan, 2019). However, non-pharmacological inte4rventions such as adequate amount of electrolytes and fluids to cushion a patient against dehydration from the infection should also be incorporated into the therapy. Hygienic behaviors such as having short nails and taking frequent baths form part of the recommended prophylactic measures in the management of the condition.

Chicken pox also has a vaccine known as Varivax that was created and approved by the FDA in the year 1955. The vaccine is effective in children that are more than a year. The vaccine has 90% effectiveness (Reisinger et al., 2019). The vaccine’s effectiveness is also manifested in the mild symptoms that appear after one develops the condition after receiving it. Moreover, Varivax also protects individuals from other diseases including shingles. Shingles is a severely painful rash that is influenced by varicella-zoster. In order to cause shingles, the varicella-zoster virus has a dormant period around the spinal cord and the brain of individuals who may have suffered from chickenpox which dormancy can undergo reactivation.

The prevalence of chickenpox is high amongst the teenage population that are 15 years and below with most it being registered in children between ages 1-4. Prior to the development of the Varivax, the disease affected nearly 4 million children annually with average mortality of 105 and over 10 500 hospitalizations (Senders, Bundick, Li, Zecca, & Helmond, 2018). The CDC reveals that over 95% US adults contract the disease at least once in their lifetime. Nevertheless, Varivax managed to successfully reduce the mortality and morbidity of chicken pox with only mild symptoms manifesting in a few people. Therefore, the adoption of the two-dose Varivax for all children has dramatically decreased incidences of the disease.

The United States of America recommended that all infections related to chicken pox should be reported since the year 2003. The CDC offered guidelines that consisted of a three core variables including patient vaccination status, disease severity, and age (Reisinger et al., 2019). Moreover, the CDC recommended the reporting of clinical, epidemiologic, and demographic data alongside the data related to patient infection. Also, the CDC established guidelines related to varicella messaging so as to aid in information documentation concerning the chicken pox infection by the respective respondents.

Social Determinants of Health

The Healthy People 2020 offered the social determinants of health definition as the conditions in the environment that individuals are given birth in, raised, play, work, learn, age and worship, which impact numerous functioning facets of life, health and overall quality, alongside their outcomes and associated risks (Luyten & Beutels, 2016). In regards to chicken pox, social determinants such as education, access to health care, resource availability, cultural beliefs, and public safety play an integral role in the prevalence of the disease. According to research, genetic factors and personal behaviors cannot comprehensively offer an explanation concerning infectious disease disparities as standalones. Further, overlapping, complex, as well as integrated economic systems and social structures require reviews so as to fully explain mortality and morbidity related to a certain infectious condition. Individual living in poverty such as the ones lacking medical cover or those with low income have a higher predisposition to the disease since they do not seek medical attention or fail to do so regularly due to cost implications. On the other hand, distribution shortages in minority populations and language barriers may also influence the development of the disease condition. The illiteracy factor may also influence the development and spread of chickenpox since the victims may have less knowledge regarding the vaccine in lieu of vaccination time, and the preventative measures when one of them is infected (Keefe, Lane, Heyman, & Congress, 2018). Due to the contagious nature of the disease, social structures inclusive of education as well as public awareness are preferred so as to ensure that community members are equipped with knowledge on preventative measures including personal hygiene so as to cushion the population against viral spread.

The Epidemiologic Triangle

The epidemiologic triangle consists of three principal tenets: the host or susceptible person, the environment within which the person stays, and the causative agent for a disease. The epidemiological triangle plays an integral role when it comes to assessing the natural history related to a certain condition. The information contained in the epidemiologic triangle is important when it comes to the prevention of the advancement of a contagious disease (Hanson & Weinstock, 2016). It helps stakeholders to identify the triangle’s weak points so as to address the threat. The achievement of the above occurs via the execution of preventative activities alongside enhancement of the efforts to reduce disease seriousness via considerations such as death risks, disease severity, costs, the disease’s long- and short-term impacts, as well as the length of the illness. Thus, the epidemiologic triangle aids in the connection of the linkage between the varicella-zoster virus and humans, who function as the principal hosts. The triangle further shows transmission modes including coughing and sneezing, which predispose people to the viral particles that result in infection via inhalation.

Moreover, the triangle also offers an association between the period of the year when the prevalence of the condition is high (Smith, 2019). For example, the outbreak of the condition undergoes fluctuations in the United States with prevalence being the highest during early spring period as well as the winter period. Specifically, between March and May, the United States registers the highest cases of chickenpox while the incidences become lowest in September all the way to November (Conway et al., 2018). The above information makes it significant for members of a community to receive notifications if an outbreak of the disease occurs so as to cushion themselves using appropriate modalities.

Role of the Community Health Nurse

The role of the community health nurse in the prevention and management of communicable diseases such as chicken pox cannot be underestimated. All of them must possess rudimentary knowledge on communicable conditions, alongside a lucid comprehension of the causes, incubation time, transmission modes, symptomatology, preventative interventions, available care plans and treatment modalities. By possessing such information, a community health nurse will place their focus on managing the disease symptoms while simultaneously cushioning the population against its spread. Further, community health nurses also need to undertake patient as well as community awareness around the significance of the vaccination of the disease, its transmission, symptom management, and prevention of disease spread amongst community members. The community health nurse is also required to identify the risk factors associated with chicken pox and other communicable diseases and then devise strategies that will cushion community members (Joyce et al., 2018). The high contagiousness of the diseases means that community nurses are required to frequently formulate reports based on the disease management guidelines offered by the CDC so as to examine disease progress and similarly formulate recommendations that would limit its morbidity. Equipped with adequate information, it becomes easy for the community health nurse to examine the pharmacotherapies used for the management of the condition as well as their effectiveness based on the feedback acquired from community members. For this reason, the posterity of the management of the condition will only involve the reinforcement of productive methods so as to reduce disease burden.

National Agencies and Organizations Handling Chickenpox

The Centre for Disease Control and Prevention and the World Health Organization form the two principal organizations that collate data and offer latest information concerning the condition. The Center for Disease Control and Prevention has offered adequate information regarding the presenting signs of chickenpox, its transmission, its causative agent, morbidity and mortality, prevention as well as complications in addition to others. Further, the CDC has also offered a kid-friendly fact sheet whose function is to offer information regarding the condition to the concerned stakeholders in a manner that is friendly (Presti et al., 2019). The WHO on the other hand ensures that it adds information on travel risks as well as preventative strategies when visiting chickenpox endemic regions to the information offered by the CDC (De Vito et al., 2017). The National Foundation for Infectious Diseases (NFID) and the National Shingles Foundation are the two foundations that address chickne pox issues. The former foundation is non-profit in nature and it was created to aid in public awareness creation and health care education concerning the prevalence, causes, treament and preventions associated with numerous communicable conditions including chicken pox. The organizarion purposs to use education so as to promote the health of various individualls globally. On the other hand, the National Shingles Organization also facilitates the fight agianst chicken pox using research undertakings and education.

The Global Implications of Chicken Pox

The World Health Organization states that chocken pox is a contagioius comdition, viral in nature and has wordlwide distribution. The chickenpox vaccine program for chindren that is available universally wa fomrulated in the United Statws in the year 1995 and implemented in the same year so as to prevent the chickenpox epdiemic in the country. The vaccone currently receives application worldwide but is only utilized in a few nations such as Korea, Geramnay, Australia and Japan wherein its usage has received extensive coverage (Gray & Cathie, 2019). The vaccine has been effective in the mentioned countries since it has greatly reduced morbidity and moratlity rates related to chickenpox. However, the vaccine is still premimum in most countries, especially developing nations, which implies that the disease still exists at epidemic levels worldwide. The worldwide burdne for the condition is still high with 4.2 million cases reported and 4200 annual deaths recorded.

Conclusion

The burden associated with chiekenpox disease was unbearable before the discovery of the Virivax vaccine in the uear 1995. However, this burden underwnt a significant reduction in the region of 90% from the year 1995 to the year 2005. Presently, only a few cases ae recorded in developed countriers but developing nations still expericne its ravaging effects. As such, comtinnuous public awanress and forumation of preventatiibe measures is necessary to manage the effects of the disease. More seriousnes is thus requried to address it at the global level.

References

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Conway, J. J., Toresdahl, B. G., Ling, D. I., Boniquit, N. T., Callahan, L. R., & Kinderknecht, J. J. (2018). Prevalence of Inadequate Immunity to Measles, Mumps, Rubella, and Varicella in MLB and NBA Athletes. Sports health, 10(5), 406-411.

De Vito, E., Parente, P., De Waure, C., Poscia, A., & Ricciardi, W. (2017). A review of evidence on equitable delivery, access and utilization of immunization services for migrants and refugees in the WHO European Region.

Duncan, D. L. (2019). Chickenpox: Presentation, transmission, complications and prevention. British Journal of School Nursing, 14(10), 482-485.

Gray, S. J., & Cathie, K. (2019). Fifteen-minute consultation: Chickenpox vaccine—should parents immunise their children privately?. Archives of Disease in Childhood-Education and Practice, 104(3), 120-123.

Hanson, B. M., & Weinstock, G. M. (2016). The importance of the microbiome in epidemiologic research. Annals of epidemiology, 26(5), 301-305.

Joyce, B. L., Harmon, M., Johnson, R. G. H., Hicks, V., Brown‐Schott, N., Pilling, L., & Brownrigg, V. (2018). Community/public health nursing faculty’s knowledge, skills and attitudes of the Quad Council Competencies for Public Health Nurses. Public Health Nursing, 35(5), 427-439.

Keefe, R. H., Lane, S. D., Heyman, J. C., & Congress, E. P. (2018). Health promotion and public health. Health and social work: Practice, policy and research, 89-104.

Luyten, J., & Beutels, P. (2016). The social value of vaccination programs: beyond cost-effectiveness. Health Affairs, 35(2), 212-218.

Presti, C. L., Curti, C., Montana, M., Bornet, C., & Vanelle, P. (2019). Chickenpox: An update. Medecine et maladies infectieuses, 49(1), 1-8.

Reisinger, K. S., Richardson, E., Malacaman, E. A., Levin, M. J., Gardner, J. L., Wang, W., … & Kuter, B. (2019). A double-blind, randomized, controlled, multi-center safety and immunogenicity study of a refrigerator-stable formulation of VARIVAX®. Vaccine, 37(38), 5788-5795.

Senders, S. D., Bundick, N. D., Li, J., Zecca, C., & Helmond, F. A. (2018). Evaluation of immunogenicity and safety of VARIVAX™ New Seed Process (NSP) in children. Human vaccines & immunotherapeutics, 14(2), 442-449.

Shin, Y. U., Kim, J., Hong, E. H., Kim, J., Sohn, J. H., & Cho, H. (2017). Varicella Zoster Virus–Associated Necrotizing Retinitis After Chickenpox in a 10-Year-Old Female: A Case Report. The Pediatric infectious disease journal, 36(10), 1008-1011.

Smith, E. (2019). The Effect of Potential Climate Change on Infectious Disease Presentation. The Journal for Nurse Practitioners, 15(6), 405-409.

Yu, J., Ashworth, J., Hughes, S., & Jones, N. (2018). Varicella-zoster virus necrotising retinitis, retinal vasculitis and panuveitis following uncomplicated chickenpox in an immunocompetent child. Case Reports, 2018, bcr-2017.