NRS 428 Epidemiology Paper Assignment

January 17, 2022

NRS 428 Epidemiology Paper Assignment

NRS 428 Epidemiology Paper Assignment

NRS 428 Epidemiology Paper Assignment

Epidemiology Paper

Description of the Disease

The widespread of the Human Immunodeficiency Virus (HIV) is with more than 50% of the populations of the African populations. By 2004, the World Health Organization had already estimated that 40 million people were infected with the disease. The disease affects the human immune system making it unable to fight subsequent infections.  People with HIV/AIDS are vulnerable to infections. The CD4 cells activate other immune cells in the body to respond against infections. People with HIV infections have low CD4 count and this means that the ability of their body defense mechanisms to respond to infection is highly compromised. The opportunistic infection arises in people with the disease because of their lowered defense mechanism. As a result, antiretroviral therapy (ART) are drugs that help in reducing the multiplication of the virus in the body thus reducing its pathogenicity. HIV is a retrovirus, meaning that it converts its structure from RNA to DNA to multiply in the body. The antiretroviral therapies hinder the ability of the virus to integrate its DNA molecules into the host system and so blocking the lifecycle. Over 35 million individuals diagnosed with HIV reside in resource-limited settings (RLS) (Labrique et al., 2016) use the ARTs.  The population of people using ARTs was 17 million in 2016 and this was anticipated to rise to 20 million in 2020. The rate of infectivity and spread of HIV/AIDs reduced with the introduction of ARTs which helps in keeping the viral loads low. However, greater concerns have been on the children who are born with the disease. More than 2.2 million children under the age of 15 years have the virus (Labrique et al., 2016).

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Causes, Symptoms, and Mode of Transmission of HIV/AIDS

HIV is mainly transmitted through sexual intercourse and contact with the infected blood, semen, or vaginal fluids. The risk of contraction increases with the viral load of the infected individuals. Mostly, the diseases of transmitted through sexual intercourse and that is why the WHO advocates for the protected sexual practices which reduce the risk of transmission. People sharing needles especially drug dealers are also at high risk of contracting the disease in case they use a needle with the virus. Greater concerns are on the transmission from mother to children during birth or breastfeeding. Children are supposed to be on exclusive breastfeeding for six months after which they can be weaned. On the other hand, the fact that HIV is intracellular means that it cannot survive outside the body and so this limits the possibility of the virus being spread through the contacts such as sharing of glasses with infected individuals. Furthermore, the risk of transmission through kissing is also low unless one has ulcers in the mouth that could give the virus an entrance point in the bloodstream.

The clinical manifestation of the virus varies. At the incubation stage, the infected individuals do not show any serious signs and symptoms and so many people are likely to experience flu-like symptoms. On the other hand, some of the early signs and symptoms of the disease include skin rash, headache, malaise, swollen glands, and muscle pains among others. The severity of the symptoms also depends on the individual’s immunity (Laurencin et al., 2018). The symptoms mostly appear with the first two weeks of the infection. The body produces an immune response to the infection and this could lead to the clearing of the virus, a condition known as sero-reversion. As a result, the infected individuals may not present the symptoms for many years after which, they may reappear. The symptoms worsen as the disease progresses in the body system. At the advanced stage, the victims may develop skin conditions such as Kaposi’s sarcoma and Cryptococci meningitis. Therefore, early detection of the virus in the system is needed to initiate treatment interventions that will reduce its multiplications in the blood system. The CDC recommends HIV tests for all people as part of routine screening to reduce the burden of the disease in society. The frequency of testing depends on the risk classification of the populations. The general population should screen at let once a year. However, the high-risk populations including people with more than one sexual partner should screen after every three months.

Complications, Treatment, and the Demographic of Interest

HIV disease causes various complications in the body. The increased multiplication of the virus in the human system results in severe immune weakening and so exposing one to opportunistic infections. The common opportunistic infection among HIV patients includes tuberculosis, cytomegalovirus, and many other infections. Tuberculosis is among the leading killers of people with HIV/AIDS disease. Furthermore, the patients may also experience poor gastrointestinal functioning characterized by diarrhea.   At the advanced stage, the patients develop Kaposi sarcoma or cancer of the blood vessel walls (Laurencin et al., 2018). The common symptoms of Kaposi sarcoma include dark purple lesions on the skin and mouth. The condition is also linked to problems in the digestive tract, lungs, and other internal organs. Furthermore, HIV/AIDs patients may develop lymphomas, a condition characterized by swollen lymph nodes.

Currently, there is a cure for the disease and so people have to depend on the ARTs to reduce the disease progression. People with good adherence to the medication have a chance of surviving many more years. On the other hand, poor adherence is associated with negative outcomes in patients with HIV/AIDs (Laurencin et al., 2018). HIV/AIDs is highly infectious and that is why people should exercise precaution in terms of their sexual lifestyle. People who are already infected should take the drugs accordingly to avoid treatment failures.

HIV/AIDs screening involves the testing of the antibodies produced against the virus. The disease is reportable and the reporting procedures are usually linked to the high-risk populations. For epidemiological purposes, reporting the burden of the disease by regions also directs the government efforts to fight and eradicate it. Over the years, the management of HIV/AIDS has been characterized by continuous research processes and reporting of the research outcomes to the public and the healthcare institutions. Also, given that the disease is a global problem, there is always the need to report the outcomes of various research processes.

Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Topic 2: Epidemiology and Communicable Diseases


  1. Apply the principles of epidemiology to community health nursing.
  2. Explain the value of demographic data in community health.
  3. Apply the epidemiology triangle to a communicable disease occurring at a global level.
  4. Evaluate the communicable disease chain model.
  5. Discuss the impact of global health issues on public health systems.
  6. Explain how social determinants of health contribute to the development of disease.

Communicable Disease Selection

  • Chickenpox
  • Tuberculosis
  • Influenza
  • Mononucleosis
  • Hepatitis B
  • HIV
  • Ebola
  • Measles
  • Polio
  • Influenza

Epidemiology Paper 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
    NRS 428 Epidemiology Paper Assignment

    NRS 428 Epidemiology Paper Assignment

    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.

A minimum of three peer-reviewed or professional references is required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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Measles, also referred to as Rubeola, is an acute and highly contagious disease that mainly affects children. Measles is a major cause of child mortality in developing countries. However, measles can affect individuals of all ages. At least 90% of measles secondary infection rates occur in susceptible domestic contacts. This paper discusses measles, including causes, symptoms, transmission, complications, treatment, and demographics, and how social determinants contribute to the disease. The paper will also explore the role of the community health nurse and agencies in addressing measles and the global implication of the disease.


The Measles virus causes measles. It is a single-stranded, negative-sense enveloped RNA iris belonging to the genus Morbillivirus in the Paramyxoviridae family (WHO, 2019). The virus is highly infectious, and almost all infected persons develop clinical illness.


The symptoms of measles depend on the nutritional status of the patient. The onset of measles symptoms occurs 7-14 days after exposure to the virus (Odei, 2018). The first clinical manifestation is a high fever of above 1040 F that usually lasts for 4-7 days (WHO, 2019).  The prodromal phase present is characterized by fever, malaise, anorexia, and the classical triad of conjunctivitis, coryza, and cough (Odei, 2018). The characteristic manifestation of enanthem occurs 2-4 days after the start of the prodromal phase and lasts for 3-5 days, marked by Koplik spots inside the cheeks. Exanthema occurs 1-2 days after the occurrence of Koplik spots and is associates with mild pruritus (WHO, 2019). It is marked by a rash that begins from the face and upper neck and spreads to the extremities, chest, and abdomen after 24 hours. The skin rash in measles is characteristic and matches from one region of the body to another in a systematic pattern.

Uncomplicated measles usually occurs in well-nourished or slightly underweight children. It presents with fever, conjunctivitis, rhinitis, cough, koplik spots, stomatitis, and skin rash (Odei, 2018).  On the other hand, complicated measles occurs in malnourished and underweight children. It presents with nasal flaring, tachypnea, dyspnea, hoarse voice, barking cough, inspiratory stridor, skin rash, anorexia, vomiting, diarrhea, keratitis, photophobia, convulsions, and ear discharge.

Mode of Transmission

The Measles virus is transmitted by a sneeze- or cough-produced respiratory droplets. The virus spreads through invisible droplets secreted from the respiratory tract of an infected person. Respiratory droplets remain active and contagious for almost two hours (WHO, 2019). It spreads very easily and fast infecting the skin and the layer of cells that line the lungs, eyes, mouth, throat, and gastrointestinal tract (Odei, 2018). Besides, the measles virus weakens a person’s immune system for many weeks after the onset of the illness, putting one susceptible to other infections.


Complications of measles occur more in individuals below five years or older than 30 years. Complications occur in various body systems, including the respiratory, neurological, gastrointestinal, eyes, and ear-nose-throat (Odei, 2018). The most common complications of measles are pneumonia, croup, and encephalitis, which are the common cause of measles-related death. Patients also develop gastroenteritis, convulsions, meningitis, conjunctivitis, and otitis media (Odei, 2018).  A patient can also develop Xerophthalmia, which is an ophthalmic condition characterized by dryness of the conjunctiva ad cornea.


There are no Antiviral drugs available for the treatment of measles. Treatment of measles involves supportive care (WHO, 2019). Persons with uncomplicated measles are usually managed on an outpatient basis, whereas those with complicated measles are treated as inpatients. Supportive management involves maintaining hydration, and replacement of fluids lost through emesis and diarrhea (WHO, 2019). For children, the caregiver should be advised to provide the child with adequate fluids and light, nutritious diet. IV rehydration is given in patients with severe dehydration. Paracetamol is administered to relieve pain and fever. Children with complicated measles should be admitted and be provided with a balanced diet to improve their nutritional status. They should be weighed to assess the nutritional status, and the caregiver should be instructed to bring the child to the clinic daily for follow up.

Vitamin A should be administered to speed up recovery of measles and prevent complications such as Xerophthalmia. The recommended Vitamin A doses for children diagnosed with measles include: Infants below six months should be administered with two doses of 50,000 IU per day; 6-11 months two doses of 100,000 IU per day, and above one year two doses of 200,000 IU per day (Odei, 2018). Besides, children with clinical signs of Vitamin A deficiency should be administered with the first two doses as per the age then a third dose based on the child’s age after 2-4 weeks.

Demographic Of Interest

Malnourished and non-immunized children below three years are at high risk of contracting measles. The severity of measles is related to the viral load one gets from the source. Children who live in overcrowded dwellings and are in close contact with the index case for the whole infective period obtain a high dose of the virus (WHO, 2019). These children develop severe measles with high case fatality rates. Unvaccinated males and females have equal susceptibility rates to infection by the measles virus (WHO, 2019). However, high mortality rates secondary to acute measles has been observed among females. Measles affects people from all racial groups.

Morbidity and mortality rates are high in individuals with malnutrition, immune deficiency disorders, vitamin A deficiency, and inadequate vaccination. Mortality rates are higher among children below five years. The highest mortality rates are among children between 4 to 12 months, and in immunocompromised children due to HIV infection or other conditions (WHO, 2019). Post-exposure prophylaxis with Measles virus vaccine or human immunoglobulin is recommended in unvaccinated persons.

Case Reporting

Immediate reporting of any suspected case of measles is required in the United States (US). Health care providers are required to report the case to the local or state department of health. Since endemic measles transmission has been eliminated in the US, measles cases should be reported within 24 hours by the state health department to the Centers for Disease Control and Prevention (CDC) through telephone or e-mail. The state health department should electronically report notifications of confirmed cases to the National Notifiable Diseases Surveillance System (NNDSS). The US CDC clinical case definition for reporting a susceptible measles case requires the presence of a generalized rash that has lasted for three days or longer; a temperature of 1010F or higher; and presence of cough, conjunctivitis, or coryza (CDC, 2019). When reporting to the CDC, measles cases should be classified as either Suspected, Probable, or Confirmed.

How Social Determinants of Health Contribute to the Development of Measles

Social determinants of health (SDOH) refer to complex conditions in which individuals are born, raised, work, play, worship, and age. SDOH comprises of five key areas, which are health and health Care and Neighborhood, social and community context, economic stability, education, and built environment. Individuals not immunized against measles virus have the highest susceptibility to infection. SDOH has the possibility of affecting measles immunization programs globally (Gastañaduy et al., 2019). Therefore, it is essential to explore the types of SDOH affecting immunization efforts in a country for the state to address them, thus preventing the spread of measles and lower mortality rates.

SDOH, such as housing and community design, contribute to the spread of measles in individuals living in congested areas such as slums. People living in overpopulated areas are likely to be infected with measles since it is airborne, spread very fast, and can result in outbreaks (Rivadeneira, Bassanesi & Fuchs, 2018). Individuals from low-income countries have a high likelihood of contracting measles due to inadequate health care facilities and inconsistent vaccine supply (Rivadeneira, Bassanesi & Fuchs, 2018). Families that travel for long distances to a health facility and those that lack transportation services often fail to take their children for immunization.

Furthermore, access to education opportunities contributes to the development of measles since persons with high education levels understand the importance of immunization. As a result, they adhere to immunization guidelines while individuals with low educational levels fail to take children for vaccination due to ignorance on the importance of vaccination (Rivadeneira, Bassanesi & Fuchs, 2018). SDOH, such as availability of resources to meet daily needs, for example, healthy food, determine the nutritional status of an individual (Rivadeneira, Bassanesi & Fuchs, 2018). Individuals with inadequate access to healthy food often end up malnourished, which makes them susceptible to measles.

The Epidemiologic Triangle As It Relates To Measles

Humans are the only natural hosts of the measles virus with no known animal reservoirs. The virus is this spread from person to person. Host factors that increase the risk of infection include infants with diminished passive antibody before they reach the age of measles immunization (Odei, 2018). An immunocompromised state caused by corticosteroid therapy, HIV/AIDS, alkylating agents, or leukemia despite the immunization status. Besides, host factors such as malnourishment, pregnancy, vitamin A deficiency, and underlying immunodeficiency put one at risk of severe measles and complications (WHO. 2019). Environmental factors that favor the spread of the measles virus include temperate weather during spring and late winter.

Notifications should be done in schools for if a patient is a school-going child since measles is highly contagious. Besides, school-going children are at a high risk since they have not received the second dose of the measles-mumps-rubella (MMR) vaccine (Odei, 2018). It should also be done in the community in situations where no history of contact with a known case can be identified, and if the patient mostly contracted measles from community institutions such as churches.

The Role of the Community Health Nurse and the Importance of Demographic Data in the Health of the Community

The community health nurse (CHN) has the role of conducting case finding by collecting information on the transmission setting such as school or household, the likely source of infection, travel history, and the number of contacts without evidence of immunity (Gastañaduy et al., 2018). The nurse carries out vaccination and recommends quarantine of susceptible contacts without presumptive evidence of immunity.  Efforts are also made to establish the source of infection for every confirmed case of measles. The nurse asks the patient or caregiver about contact with other known cases. In cases where no history of contact with a known case can be identified, the nurse identifies opportunities for exposure to unknown cases (CDC, 2019). For instance, exposures may occur in schools, during travel, or through contact with recent travelers or foreign visitors.

The CHN has the role of reporting any suspected, probable, or confirmed case of measles to the state department of health. The CHN provides demographic information, reporting sources including state and county, the clinical symptoms, and the outcome of the case, whether the patient survived or died (CDC, 2019). In addition, the CHN collects information on the number of susceptible individuals with no probable immunity. The nurse then analyzes the data to establish what information is available and what still needs to be collected, referred to as information tracking (Gastañaduy et al., 2018). This is easily achieved by constructing a line listing of cases that enables ready identification of known and unknown data and ensures complete case investigation. Lastly, the CHN follow-up patients and their contacts to assess disease prognosis and evaluate the development of complications.

Demographic data are necessary to the health of a community since it helps identify the population at risk of infection, for example, unvaccinated preschool-age children, patients who visited a particular hospital, or students who have received one dose of measles vaccine. The data also help public health officials identify where measles transmission is occurring or likely to occur. This includes households, daycare, schools, health facilities, churches, and institutions. Furthermore, demographic data helps identify individuals at the highest risk of infection or transmission, such as unvaccinated children, immunocompromised persons, pregnant women, students, health care personnel, or infants below 12 months (Gastañaduy et al., 2018). The data is used to establish the scope of the investigation and the potential for spread.  It also guides in identifying appropriate interventions using public health judgment to guide investigation and control efforts.

National agency/ Organization that addresses Measles

The CDC is a health protection agency in the US that addresses measles by helping in reducing the occurrence of the disease and the impact it has on Americans. CDC offers both scientific and technical support to partners and countries in the US and other parts of the world to lower measles and rubella deaths (CDC, 2019). The agency played a vital role in partnership with the Pan American Health Organization (PAHO) to create a regional measles elimination strategy in 1996. This contributed to the elimination of measles and rubella in the Western Hemisphere by 2016. It helps reduce the burden of measles by assisting in planning at macro-and micro-levels, implementing, monitoring, and evaluating measles and rubella vaccination campaigns in target areas to eliminate measles and rubella (CDC, 2019). Besides, the CDC conducts operational research to present evidence for recommendations that enhance and guide measles- and rubella-control activities at local, regional, and global levels.

CDC offers technical assistance to undertake measles and rubella outbreak investigations, surveillance reviews, and routine vaccination program evaluations. It also helps develop and strengthen case-based measles-rubella surveillance systems that allow countries to identify, monitor, and promptly respond to measles and rubella infections (CDC, 2019). It serves as the global reference laboratory for measles and rubella and provides resources for national reference laboratories. Besides, the CDC offers technical assistance to global public health laboratories for the collection and transportation of clinical samples for measles testing using real-time polymerase chain reaction.

Global Implication of Measles and How It Is Addressed In Other Countries

Measles affects approximately 30 million children annually in developing countries and causes about a million deaths. It has been associated with 15000 to 60,000 cases of blindness every year globally. Although a safe and cost-effective vaccine is available, there were more than 140,000 measles deaths globally in 2018, primarily among children under the age of five (WHO, 2019). Countries are addressing the issue of Measles by introducing free immunization programs for children. Immunization has been the key public health strategy to lower measles death and eliminate measles. Countries have a routine immunization program that consists of two MMR vaccination doses (Gastañaduy et al., 2018). Countries with high case and death rates conduct mass immunization campaigns in addition to the routine measles-rubella vaccination.

Measles is not endemic in the US, and most cases result from international travel (Gastañaduy et al., 2019). However, Measles remains an endemic disease in many parts of the world, including Europe, Asia, the Middle East,  the Americas, and Africa (Gastañaduy et al., 2019). Countries with recent measles outbreaks include Thailand, Israel, Ukraine, Vietnam, Japan, the Philippines, DRC, Liberia, Madagascar, and Somalia.


Measles is a highly contagious disease caused by the Measles virus that spreads from person to person via respiratory droplets. It mostly affects children below five years but can also affect persons of all ages. Individuals highly susceptible to melees include those that are non-immunized, immunocompromised, pregnant, and malnourished. The typical symptoms of measles include fever, koplik spots, conjunctivitis, cough, and coryza. The characteristic rash of measles can be distinguished from other conditions in that it begins from the face and upper necks and then spreads to the trunk, abdomen, and extremities after 24 hours. Measles is associated with severe complications such as convulsions, severe dehydration, pneumonia, croup, and encephalitis.  SDOH, such as lack of access to health services, low-income countries, poor housing and neighborhood, and inadequate access to healthy foods, contribute to the development of measles.  A CHN has the role of conducting case findings and identifying contact individuals susceptible to developing measles as well as reporting suspected and confirmed cases of Measles to the state department of health. Measles has contributed to high blindness and mortality rates globally, and most countries are addressing this issue through immunization programs.

NRS 428 Epidemiology Paper Assignment

Epidemiology Paper SAMPLE INTRO

Since the beginning of time, populations of the world have been affected by numerous infections and diseases. Some of these ailments have had catastrophic effects on mankind and have threatened the survival of different groups of people. For instance, in the periods of Middle and Dark Ages, plagues were common and this led to mortality of millions of people in Europe (MacNeil et al., 2019). The high incident rates of morbidity and mortality reported during this time prompted scientific research in the field of medicine, which led to the discovery of vaccines and other solutions to combat these diseases. Despite these discoveries, there is always an infection that proves to be a menace to populations in the world. As key players in the field of medicine, nurses are expected to remain abreast with the patterns of disease occurrences to ensure that they provide effective care to patients (Harkness & DeMarco, 2016). Through epidemiology studies, nurses gain understanding on the spread of diseases and gain insights about the current preventive measures aimed at managing or controlling the spread of these ailments. As a case in epidemiology, tuberculosis (TB) provides the basis for this discussion.

According to Crepet et al. (2016), the condition is a major public health concern throughout the world as it competes with the human immunodeficiency virus (HIV) in causing deaths to patients. Since its discovery in 1882, TB has continued to cause misery and death with the vulnerable populations being the hardest hit across the world (Sulis et al., 2014). However, despite a regular declining trend in the incidences of TB over the last decades, new cases and deaths associated with the condition continue to soar when compared with other infectious diseases. As such, there is a need to explore the determinan

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