Epidemiology of Cholera: Understanding the Epidemiology Triangle and Communicable Diseases, Exams of Nursing

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NUR 340 Public Health Nursing Classroom Group Assignment 4 Answer the following questions, please give complete answers. Please provide a resource book (Textbook Stanhope Chapters 6, 9, 26 and 27; ATI (7.0) pgs. 7-9 & 63-65 and ATI (8.0) pgs. 15-16 & 23-26, etc. with page number) for the answers.

1. Complete the Incidence/Prevalence Calculations (See Attached Sheet) (Individual Assignment)
2. Use the Epidemiology Triangle or Triad to describe the following Disease: ( Follow the assignment ) Diseases (for question # 2): Group A (1 and 2)
   1. Zika
   2. West Nile
   3. Malaria- done
   4. Lyme disease- done Group B (3, 4, 5 and 6)
   5. Varicella
   6. Hepatitis A
   7. Hepatitis C
   8. Smallpox Group C (7, 8, 9 and 10)
   9. Influenza
   10. Pertussis
   11. Tuberculosis
   12. HIV Group D (11, 12, 13 and 14)
   13. HPV
   14. Syphilis
   15. MRSA
   16. Gonorrhea **Epidemiology
3. What is epidemiology?** (ATI Pg 23 Chp 3 )

Epidemiology is the study of health- related trends in population for the purpose of disease prevention, health maintenance, and health protection.

4. Who is the best-known epidemiologist of the 19th^ century and what did he investigate? (Stanhope Pg 149) One of the most famous studies using a comparison group is the mid-19th-century investigation of cholera by John Snow, whom some call the “father of epidemiology”. By mapping cases that clustered around one public water pump during a London cholera outbreak, Snow was able to show how the water supply and cholera were associated. He observed that cholera rates were higher among households supplied by water companies whose water came from downstream than among households whose water came from farther upstream, where it was subject to less contamination. Snow conducted a “natural experiment,” as seen in Table 9.1, and documented that foul water was the vehicle for transmission of the agent that caused cholera. 5. What are epidemiological calculations, name the different types, describe how they are used? (AT Ch3 Pg 24) Incidence and prevalence rates are used to measure the existence of a particular disease and allow the nurse to compare the rate of disease in one population to another, even though there can be different numbers of people in a given population. Incidence : Number of new cases in the population at a specific time / population total x 1000 = _______ per 1000 Prevalence : Number of existing cases in the population at a specific time / population total x 1000 = ______ per 1000

6. What is the epidemiological triangle? Give an example of how to use it (using a disease process). Resource: ATI pg 23 The triangle involves the study of the relationships among an agent, host and environment. Their interaction determines the development and cessation of communicable diseases. Ex: g Disease: Smallpox Levels of Prevention: Host: Humans Primary: Education regarding immunization of vaccine Agent: Variola Virus Secondary: Health fair telling early diagnosis Environment: Low temp and low humidity Tertiary: Management of symptoms
7. Describe the epidemiological process, name the components. Resource: ATI pg 23 The epidemiological process is a systematic method of targeting specific health needs with the goal of improving health. It provides a broad understanding of the spread, transmission, and incidence of disease and injury. The components are the agent, host, and environment.

Communicable Diseases/Bioterrorism

8. Define communicable disease. ATI pg 24 The degree to which an organism is able to cause disease is referred to as the virulence, or degree of communicability. 9. What populations are at risk for communicable diseases and why? ATI pg 24 ● Young children ● Older adults ● Immunosuppressed clients ● Clients who have a high-risk lifestyle ● International travelers ● Health care workers 10. Describe the different modes of transmission and how they can be prevented. ATI pg 25 Airborne: particles transmitted by air to susceptible hosts via droplets or particles. ● Measles [airborne isolation precautions] ● Chickenpox [airborne isolation precautions] ● Tuberculosis (pulmonary or laryngeal) [airborne isolation precautions] ● Pertussis [droplet isolation precautions] ● Influenza [droplet isolation precautions] ● Severe acute respiratory syndrome (SARS) [droplet isolation precautions] Foodborne ● Food infection (bacterial, viral, parasitic infection of food) ◯ Norovirus ◯ Salmonellosis ◯ Hepatitis A ◯ Trichinosis ◯ Escherichia coli (E. coli) ● Food intoxication : toxins produced through bacterial growth, chemical contamination, or disease-producing substances. ◯ Staphylococcus aureus ◯ Clostridium botulinum Waterborne: fecal contamination of water ● Cholera ● Typhoid fever ● Bacillary dysentery ● Giardia lamblia Vector-borne: via a carrier, such as a mosquito or tick ● West Nile virus ● Lyme disease ● Rocky Mountain spotted fever ● Malaria

Direct contact: transmission of infectious agent from infected host to susceptible host via direct contact ● Sexually transmitted infections: HIV/AIDS, chlamydia, gonorrhea, syphilis, human papilloma virus (HPV), genital herpes, hepatitis B, C, D ● Infectious mononucleosis ● Enterobiasis (pinworms) ● Impetigo ● Lice, scabies PREVENTION AND CONTROL ● Prevention and control of communicable disease helps eliminate a disease from a specific location, or completely eradicates the existence of a particular disease. ● Nurses can create community programs that monitor individuals’ adherence to treatment regimens to help minimize the spread of disease. This strategy also reduces the risk of complications for individuals, which can reduce the overall burden of disease on a community. ● Public health nurses can use the core functions to target communicable disease. For example, a nurse can identify cases of a disease (assessment), develop a program for city or county government to spray insecticide (policy development), and ensure proper follow- up for individuals who have tuberculin skin testing (assurance).

11. Describe the Portals of Entry and Exit using an example of an infectious agent. Portal of entry: nose, eyes, mouth, insertion of medical devices. Portal of exit: vomiting, diarrhea, saliva, sexual contact, secretions from coughing, sneezing, or talking, open wounds. 12. What is Communicable Disease Surveillance? Name the Nationally Notifiable Diseases as identified by the CDC? ATI pg 26

The community health nurse engages in communicable disease surveillance, which includes the systematic collection and analysis of data regarding infectious diseases Identified at the CDC website and include the following. ● Anthrax ● Botulism ● Cholera ● Congenital rubella syndrome (CRS) ● Diphtheria ● Giardiasis ● Gonorrhea ● Hepatitis A, B, C ● HIV infection ● Influenza-associated pediatric mortality ● Legionellosis/Legionnaires’ disease ● Lyme disease ● Malaria ● Meningococcal disease ● Mumps ● Pertussis (whooping cough) ● Poliomyelitis, paralytic ● Poliovirus infection, nonparalytic ● Rabies (human or animal) ● Rubella (German measles) ● Salmonellosis ● Severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV) ● Shigellosis ● Smallpox ● Syphilis ● Tetanus/C. tetani ● Toxic shock syndrome (TSS) (other than Streptococcal) ● Tuberculosis (TB) ● Typhoid fever ● Vancomycin-intermediate and vancomycin-resistant ● Viral hemorrhagic fever ● Staphylococcus aureus (VISA/VRSA)

13. What are the Health Care Goals for communicable diseases? ATI pg 26

Reductions in ● Infections caused by pathogens often transmitted through food ● New HIV diagnoses among adolescents and adults ● New AIDS cases among adolescents and adults ● Number of perinatally acquired HIV and AIDS cases ● Deaths from HIV infection ● Vaccine-preventable diseases (reduction or elimination) ● Number of antibiotic courses for ear infections in young children Increases in ● Consumers who follow food safety practices ● Surviving more than 3 years after a diagnosis of AIDS ● Adolescents and adults who have been tested for HIV in the past 12 months ● Testing for HIV in adults who have TB ● Substance use treatment facilities that offer HIV/AIDS education, counseling, and support ● Sexually active persons who use condoms ● Immunization rates among young children ● Immunization rates among adolescents

14. Name the levels of Prevention for Primary, Secondary, and Tertiary for communicable diseases. ATI pg 26 Primary prevention ● Prevent the occurrence of infectious disease. ● Educate the public regarding the need for immunizations, and federal and state immunization programs. ● Counsel clients traveling to other countries about protection from infectious diseases. Refer clients to the health department for information about mandatory immunizations. ● Educate the public regarding prevention of disease and ways to eliminate risk factors for exposure (hand hygiene, universal precautions, proper food handling and storage, use of insecticides, use of condoms). Secondary prevention ● Increase early detection through screening and case finding. ● Refer suspected cases of communicable disease for diagnostic confirmation and epidemiologic reporting. ● Provide post-exposure prophylaxis (hepatitis A, rabies). ● Quarantine clients when necessary. ● Use partner notification and contact tracing to identify and screen individuals who have been exposed to a communicable disease. Tertiary prevention ● Decrease complications and disabilities due to infectious diseases through treatment and rehabilitation. ● Monitor treatment compliance, including directly observed therapy (DOT). ● Identify and link clients to needed community resources.

15. What are the agents of bioterrorism? ATI pg 75 CATEGORY A BIOLOGICAL AGENTS ● The highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates. ● Examples include smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (Ebola), and plague. CATEGORY B BIOLOGICAL AGENTS ● The second-highest priority because they are moderately easy to disseminate, and have high morbidity rates and low mortality rates. ● Examples include typhus fever, ricin toxin, diarrheagenic E. coli, and West Nile virus. CATEGORY C BIOLOGICAL AGENTS ● The third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates. ● Examples include hantavirus, influenza virus, tuberculosis, and rabies virus. **Environmental Health

16. What is Environmental Health? ATI pg 15** Environmental health relates to the quality of the air, land, water, and other surroundings with which people come into contact. 17. Name the environmental risks. Name some of the risks found in your community assessment. ATI pg 15 Toxins: lead, pesticides, mercury, solvents, asbestos, and radon Air pollution: carbon monoxide, particulate matter, ozone, lead, aerosols, nitrogen dioxide, sulfur dioxide, and tobacco smoke Water pollution: wastes, erosion after mining or timbering, and run-off from chemicals added to the soil Contamination: food and food products with bacteria, pesticides, radiation, and medication (growth hormones or antibiotics) 18. What is “I PREPARE” and how is it used in environmental health? ATI pg 15 The “I PREPARE” mnemonic is one method of determining current and past environmental exposures. I: Investigate : potential exposures P: Present work: exposures, use of personal protective equipment, location of safety data sheets (SDSs), hazardous materials brought home from work on clothing, trends R: Residence: age of home, heating, recent remodeling, chemical storage, water E: Environmental concerns : air, water, soil, industries in the neighborhood, waste site or landfill nearby

P: Past work : exposures, farm work, military, volunteer, seasonal, length of work A: Activities: hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines R: Referrals and resources: Environmental Protection Agency, Agency for Toxic Substances & Disease Registry, Association of Occupational and Environmental Clinics, SDS, OSHA, local health department, environmental agency, poison control E: Educate : risk reduction, prevention, follow-up

19. What are the National Health Care Goals for environmental health? ATI pg 16 REDUCTIONS ● Per capita domestic water use ● Blood lead levels in children ● Pesticide exposures requiring visits to a health care facility ● Indoor allergen levels ● U.S. homes with lead-based paint or related hazards ● Exposure to chemicals and pollutants ● Risks posed by hazardous sites ● Number of new schools near highways ● Global burden of disease due to environmental concerns INCREASES ● Use of alternative modes of transportation for work ● Number of days that beaches are open and safe for swimming ● Recycling of municipal solid waste ● Testing for presence of lead-based paint in pre-1978 housing ● Monitoring for diseases or conditions caused by environmental hazards ● Homes with radon mitigation (those at-risk) and radon-reducing features ● Schools with policies/practices to promote health and safety ● Presence/use of information systems related to environmental health

20. Name the levels of Prevention for Primary, Secondary, and Tertiary for environmental health. ATI pg. 16 ● Primary:
    • Individual: educate individuals to reduce environmental hazards
    • Community: educate groups to reduce environmental hazards, advocate for safe air & water, support programs for waste reduction & recycling, advocate for waste reduction & effective waste management ● Secondary:

• Individual: survey for health conditions that can be r/t environmental & occupational exposures, obtain environmental health histories of individuals, monitor workers for levels of chemical exposures at job site
• Community: Survey for health conditions that can be r/t environmental & occupational exposures, assess neighborhoods, schools, work sites, and the community for environmental hazards ● Tertiary:
• Individual: Refer homeowner to lead abatement resources, educate clients who have asthma about environmental triggers
• Community: Become active in consumer & health-related organizations & legislation r/t environmental health issues, support cleanup of toxic waste sites & removal of other hazards

21. What are the roles of nurses in environmental health? ATI pg. 15 & Stanhope pg. 102 ● Facilitate public participation in measure to improve the environment ● Perform individual & population risk assessments ● Implement risk communication ● Conduct epidemiological investigations ● Participate in policy development (Updated 2/21)