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Epidemiology Paper

Epidemiology Paper

Sample Answer 

Epidemiology Paper

Communicable Disease – Tuberculosis (TB)

Introduction

Communicable diseases are illnesses that spread from person to person in myriad ways, including physical contact with infected objects, surfaces, individuals, bites from animals or insects, or through the air. Throughout history, several communicable diseases (such as leprosy) have come and gone, while others have stayed with humanity until today (such as influenza and polio). In recent years, especially with the discovery of deadly diseases such as HIV, coronavirus, and Ebola, medical experts have devised ingenious ways of controlling the spread and progression of these novel infections to epidemic and pandemic levels, costing governments billions of dollars (Suhrcke et al., 2011). Reporting incidences of communicable diseases has been imperative in controlling the subsequent spread, virulence, and impact.

In the U.S., identifying critical social determinants of health and using an epidemiologic triangle have been largely used by the government and social workers to identify the point of contact and intercept the spread chain. Today, community health nurses (CHNs) have an integral part to play in not only advocacy and education but also in coordinating the care needs of patients as well as ensuring equity in the distribution of health care resources, especially among the most vulnerable. This paper, therefore, specifically explores the case of tuberculosis (TB), from its specifics (such as causes, symptoms, treatment, and so on), determinants of health influencing its development, the epidemiologic triangle, role of community nurses in stopping its spread, the concerned national agency, to the global implication.

Description of the Communicable Disease – Tuberculosis

Definition, Causes, and Risk Factors

Tuberculosis, which is commonly shortened as TB, is a respiratory illness caused by a bacterium (Mycobacterium tuberculosis) and mainly affects the lungs but sometimes other parts of the body, including the brain, spine, and kidney. Although uncommon in developed nations, the cases of tuberculosis started rising in 1985, especially in the U.S., following the emergence of the Human Immunodeficiency Virus (HIV) – which is a pathogen that causes Acquired Immunodeficiency Syndrome (AIDS). Specifically, HIV functions by weakening an individual’s immune system, allowing other opportunistic diseases like TB to take advantage of the body’s reduced defense structure. In the United States, the incidence rates of TB started falling in 1993 after the government intensified its fight through comprehensive, nationwide programs.

HIV is one of the greatest risk factors for TB, with WHO (2020) estimating that HIV victims are 19 times more likely to develop tuberculosis than those without. The risk is also higher among people with underlying illnesses that compromise their immunity, people suffering from undernutrition (who are three times more likely to), as well as elderly people. WHO (2020) also estimates that approximately 95 percent of all deaths and cases occur in developing countries, meaning that poverty is as well one of the greatest contributors. Tobacco smoking and alcohol use disorder also amplify the risk by a factor of 1.6 and 3.3, in that order. On the global scale, about 0.83 million new cases in 2003 were attributed to alcohol use disorder, while 0.86 million were associated with smoking.

Mode of Transmission

Tuberculosis primarily spreads from person to person through the air. The bacteria are first suspended in the air when an infected individual (either throat or lungs) sings, speaks, or coughs. People around get infected by inhaling these air-suspended bacteria, which then settle in their lungs before starting to multiply. From the lungs, the bacteria usually spread via the blood to different sections of the body, including the brain, spine, or kidney. Whereas tuberculosis bacteria in the lungs are infectious, the Mycobacterium in other body parts is non-infectious. According to the CDC (n.d.), the spread of TB is high between sick patients and their family members, schoolmates, coworkers, and friends because they spend more time together.

Symptoms and Diagnosis

The common signs and symptoms of tuberculosis (especially active lung) include night sweats, fever, weight loss, weakness, chest pains, as well as cough with sputum, which is sometimes accompanied by blood. For most countries, the diagnosis of TB is still reliant on sputum-smear microscopy. Highly qualified lab technicians observe sputum slide samples under an electron or light microscope for the presence of Mycobacterium tuberculosis bacteria. However, since 2010, perhaps because of the incapacity of microscopy to detect drug-resistance TB bacteria, the application of rapid diagnostic tests (Xpert MTB/RIF) has increased significantly. According to WHO (2020), this method simultaneously detects tuberculosis and resistance to rifampicin drug.

Demographic of Interests – Mortality, Morbidity, Incidence, and Prevalence

Globally, approximately 1.5 million deaths from tuberculosis in 2018 were reported, including about 251,000 with the HIV/AIDS virus (CDC, 2020). TB is classified as one of the top ten causes of death, as well as the single infectious agent leading cause. The CDC also estimates that 10 million people were infected in the same year globally, including 1.1 million children (205,000 deaths), 3.2 million women, and 5.7 million men. Countries with the highest-burden included South Africa, Bangladesh, the Philippines, Indonesia, India, Nigeria, and Pakistan. The CDC (2020) also estimated that multi-drug resistance tuberculosis poses the highest public health security threat, including a total of 484,000 new cases that were resistant to the rifampicin drug. The CDC (n.d.) also reported a total of 9,025 cases in the United States, representing a decrease of about 0.7 percent from 2017. The countrywide incidence rate was roughly 2.8 cases/per 100,000 individuals, which dropped 1.3 percent from 2017.

Prevention

According to the CDC (n.d.), although a majority of individuals with a latent infection of tuberculosis never develop the disease, those populations classified as high-risk have a higher chance of developing it, such as children, seniors, those with HIV, drug abusers, as well as those with compromised immunity. The WHO recommends that people with latent infection can lower the progression of the infection from latency to TB by taking drugs such as rifampin, rifapentine, and isoniazid. Other preventive measures include avoiding contact with patients reported to have tuberculosis, especially in enclosed and crowded environments, including hospitals, clinics, homeless shelters, and so on (CDC, n.d.).

Treatment and Complications

Treatment of tuberculosis can take two routes: treatment for latent infection and treatment for tuberculosis disease. As discussed above, the treatment of the latent condition primarily occurs before the disease progresses to TB and entails stopping the spread to vulnerable populations with the highest risk of infection, especially those with HIV or other immune-compromising underlying conditions. Rifampin, Rifapentine, and Isoniazid are the preferred drugs for latent TB, with NTCA (National Tuberculosis Controllers Association) and the CDC recommending the use of a nine-month isoniazid monotherapy or a three-to-four-month rifamycin treatment for people aged over six years. These regimens can also be used as first-line drugs for treating TB. A combination of these drugs can be used to treat drug-susceptible TB (isoniazid/rifampin/ethambutol/pyrazinamide), drug-resistant TB, as well as extensively drug-resistant TB.

During the treatment of both latent infections and TB disease, patients can experience different symptoms and signs of severe drug reactions, such as blurred/changed vision, bleeding/easy bruising, fever, fatigue, weakness, abdominal tenderness, numbness, tingling, burning of feet or hands, as well as unexplained jaundice, vomiting, nausea, or loss of appetite. Specifically, according to the CDC (n.d.), rifapentine and rifampin can cause orange urine discoloration as well as other body fluids.

Social Determinants of Health

Social determinants of health, which are usually shortened as SDOH, refer to the social and economic elements that create individual, group, or community health differences. The Healthypeople.gov (n.d.) defines social determinants of health as the key environmental conditions/factors with which people, populations, communities, or groups are born, learn, play, work, worship, interact, live, and age– meaning that they influence a wide range of health outcomes, such as the quality of life and the day-to-day operations of people. ‘Place’ is one example of an SDOH and includes things like neighborhood, workplace, church, school, hospital, and many others. Some of the major social determinants of health include language literacy, access to technology and mass media (internet, cell phones, social media, and so on), residential segregation, presence/absence of social support, transportation options, social attitudes and norms (racism, discrimination, and so on), socioeconomic conditions (poverty), public safety, as well as the presence of community-based resources. The others include quality of training and education, access to healthcare services, availability of resources to meet day-to-day needs (like food and safe housing), access to a job, economic, and education opportunities, as well as exposure to social disorder, and violent crime.

A set of these SDOH factors have been reported to influence the spread, incident rates, prevalence, prevention, treatment, and mortality rates of tuberculosis. Some of these factors are responsible for the observed health outcome disparities in the U.S. as well as in other parts of the world. For example, a study conducted by (Ali, Karanja, & Karama, 2017) using a sample of 385 patients with TB from seven tuberculosis trials consortium in Somalia established that the level of education was positively related to the percentage of TB patients (no education = 28.6%, primary education = 21.6%, and secondary education 16.6%). The study also found that knowledge about TB significantly influenced the health outcomes of the patients and their attitudes toward medication and prevention, including drug adherence. Other factors that were found to influence the health outcomes of TB patients included physical accessibility of TB health facilities, frequency of accessing anti-TB drugs, presence of TB support, availability of nutritional support, TB training and awareness, as well as the presence of health educational tools for reading. The presence of TB programs, poverty, and inequity in the distribution of resources are other critical social determinants of health that impact the prevalence, prevention, treatment, and management of tuberculosis. In the United States, for instance, a dismantling of TB control programs in the 80s resulted in a nationwide surge in the incidence rates (Millet et al., 2013).

Epidemiologic Triangle

The epidemiologic triad or epidemiologic triangle is a tool used in explaining and detailing the spread of a communicable disease in a community, with the intention of identifying the primary point of intervention to curb transmission and guide epidemiologic assessment. It entails identifying the infectious agent, susceptible host, reservoirs, port of re-entry, as well as means of transmission. In this case, the infectious agent is Mycobacterium tuberculosis, which is an aerobic, acid-fast, non-motile bacillus measuring 2-4 micrometers. It has a waxy, acidic cell wall comprised of mainly mycolic acid (Ozcaglar et al., 2012). In terms of host and reservoir, even though the Mycobacterium mainly colonizes or affects the respiratory systems of humans, it can also affect reproductive organs, joints, bones, kidneys, the brain, lymph nodes, and the pericardium. Tuberculosis primarily spreads from person to person through the air. The bacteria are first suspended in the air when an infected individual (either throat or lungs) sings, speaks, or coughs. People get infected by inhaling these air-suspended bacteria, which settle in their lungs before starting to multiply. From the lungs, the bacteria usually spread via the blood to different sections of the body, including the brain, spine, or kidney.

Role of the Community Health Nurse (CHN) and Importance of Demographic Data

Community health nurses are very important front-line workers in preventing, controlling, and treating tuberculosis. They are integral in conducting case studies, data collection, data analysis, documentation of the findings, reporting of the results, as well as follow-up. Specifically, community nurses are responsible for identifying TB symptoms and isolating/separating infectious patients. They also offer health training and education to all community members, including school children, on tuberculosis identification and prevention. Community nurses also significantly contribute to TB research by assisting in supplying demographic data (based on age, race, gender, location, and so on) related to incident rates, prevalence rates, causes, risk factors, social determinants of health, distribution of the disease, as well as effective therapies. TB demographic data is not only meant to alert and inform the public on ways of preventing and treating TB but also to inform the process of policymaking. Population prevalence rates can aid policymakers in appropriating funds and budgets as well as allocating other resources like outreach programs, nurses, and so on. Furthermore, community nurses play an essential advocacy role by helping design, evaluate, and design community-wide outreach programs specifically aimed at detecting and treating TB patients, as well as promoting public health through training.

National Agency/Organization Working to Address the Communicable Disease – National Tuberculosis Controllers Association (NTCA)

The National Tuberculosis Controllers Association (n.d.), which is shortened as NTCA, is a nationwide organization established to address issues related to tuberculosis in the United States. The agency’s mission is to protect all Americans by promoting and advocating for the reduction of tuberculosis through the combined effort of territorial, local, and state programs. Specifically, the objectives of the organization include providing a collective voice for “Tuberculosis Controllers” to advocate and advance the control and eradication of TB in the country. Another target is to counsel task forces, committees, organizations, and agencies on problems and actions influencing tuberculosis control and eradication at territorial, local, and state levels. NTCA also aims to work with and support other institutions/agencies as well as advocate for laws, policies, positions, and ways to promote tuberculosis control and eradication.

Global Implication

Internationally, roughly 1.5 million deaths from tuberculosis in 2018 were reported, including about 251,000 with the HIV/AIDS virus (CDC, 2020). TB is classified as one of the top ten causes of death, as well as the single infectious agent leading cause. The CDC also estimates that 10 million people were infected in the same year globally, including 1.1 million children (205,000 deaths), 3.2 million women, and 5.7 million men. Countries with the highest-burden included South Africa, Bangladesh, the Philippines, Indonesia, India, Nigeria, and Pakistan. The CDC (2020) also estimated that multi-drug resistance tuberculosis poses the highest public health security threat, including a total of 484,000 new cases that were resistant to the rifampicin drug. Even though TB is present in every corner of the globe, the disease seems endemic in some regions, especially countries that are impoverished as well as those with low educational or literacy levels. In 2018, for instance, WHO (2020) estimated that TB was endemic to the South-East Asian region (which accounted for 44 percent of the new cases) as well as the African region (with 24 percent of new cases). In fact, eight countries alone from these two regions accounted for 75 percent of all the new tuberculosis cases, including Pakistan, South Africa, Nigeria, India, Bangladesh, Indonesia, China, India, and the Philippines.

References

Ali, M. K., Karanja, S., & Karama, M. (2017). Factors associated with tuberculosis treatment outcomes among tuberculosis patients attending tuberculosis treatment centers in 2016-2017 in Mogadishu, Somalia. The Pan African Medical Journal, 28, 197. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878850/

CDC. (n.d.). How TB spreads. Retrieved from https://www.cdc.gov/tb/topic/basics/howtbspreads.htm

Healthypeople.gov. (n.d.). Social determinants of health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Ozcaglar, C., et al. (2012). Epidemiological models of Mycobacterium tuberculosis complex infections. Mathematical Biosciences, 236(2), 77-96.

Millet, J., et al. (2013). Factors that influence current tuberculosis epidemiology. European Spine Journal, 22(4), 539-548.

National Tuberculosis Controllers Association. (n.d.). NTCA. Retrieved from http://www.tbcontrollers.org/ntca-2/

Suhrcke, M., et al. (2011). The impact of economic crises on communicable disease transmission and control: A systematic review of the evidence. PloS One, 6(6), e20724. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0020724

WHO. (2020). WHO. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tuberculosis

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Question 


Epidemiology Paper

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.

Epidemiology Paper

Epidemiology Paper

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 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 the 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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