EPIDEMIOLOGY AND THE NURSE’S ROLE IN COMMUNICABLE DISEASE 8
Plague is a communicable illness caused by Yersinia pestis (CDC,2015). The disease spreads easily and is deadly when not treatedimmediately. Both humans and other mammals are at risk of gettingplague. Transmission to humans happens following a bite by a rodentflea carrying the bacterium. Transmission may also happen throughhandling an animal that is already infected. The first epidemic ofthe plague refers to “The Black Death” because it resulted in thekilling of almost 200 million individuals in the middle ages (CDC,2015).
Common signs and symptoms include chills, body aches, fever,headache, sore throat, abdominal pain, cough, stiff neck, seizures,nausea and general feeling of sickness among others (Stenseth et al,2008). The signs and symptoms are dependent on manner of exposure tothe bacteria. The illness takes dissimilar clinical forms, howevermost frequent are pneumonic, bubonic and septicemic. In pneumonicplague, sick individuals depict signs of a fast advancing pneumoniain line with shortness of breath, headache, pain in the chest, bodyweakness and cough (Stenseth et al, 2008). This type of plaguedevelops following inhalation of infectious droplets or could arisefrom untreated septicemic or bubonic plague, once the bacteriaspreads to the lungs. In bubonic plague, sick persons suddenlydevelop swollen and aching lymph nodes referred to buboes. The buboesdevelop in the area where an individual has been bitten by aninfected flea (Stenseth et al, 2008). The septicemic plague symptomsmainly involve bleeding, causing the skin and different tissues tobecome black and numb, specifically toes and fingers (Stenseth et al,2008).
Diagnosis is possible when a patient has an apparent bubo. Doctorstake blood or tissue samples from the sick persons suspected ofhaving plague. The samples undergo laboratory testing, and followingthe detection of plague, treatment commences with immediate effect.Diagnosis may also happen through a chest X-ray when the doctorsuspects that the plague may be pneumonic (CDC, 2015).
Treatment begins with patient isolation to prevent infection toothers. There are patients that may require breathing assistance bygiving them oxygen. Patients are given antibiotics while underinspection. Administering antibiotics is the first step to treatmentto enhance the possibility of killing the bacteria. Examples ofantibiotics are streptomycin sulfate with a combination oftetracycline (CDC, 2015).
Prognosis – persons infected with the disease could developmeningitis, septic shock, bleeding, death of tissues and swelling inthe region around the heart, which have a high chance of resulting infatality (Cunha, 2015). The death rate is close to 13% for personswith bubonic plague. Septicemic plague results in 40% chance offatality, while the fatality rate is 100% in pneumonic plague (Cunha,2015).
Host – above 200 diverse rodents and different species act as the hosts (Perry & Fetherston, 1997). These are rodents, domesticated cats, dogs, rabbits, sheep, camels, and deer among others. The vector is the rat flea. Once the flea bites the infected host it transmits the bacteria to humans through a bite.
Environment – plague is most common in urban areas with high rat infestations, causing the agent to cycle amid rats and their fleas (Perry & Fetherston, 1997). In rural areas, people are most likely to contact animals bitten by the host flea due to forests and grasslands that are home to different hosts (Perry & Fetherston, 1997). Transmission also occurs when an individual breathes in plague-infected organisms released to the air, resulting in pneumonic plague. Persons with pneumonic plague further transmit plague by cough droplets. Other individuals that contact the infected droplets become infected.
Agent – the agent is a bacterium Yersinia pestis. The bacterium circumvents the defenses of its host via injecting in host cells several virulence factors, which inhibit response to the immune system (Perry & Fetherston, 1997).
Impact of the Disease
Epidemics of plague have happened in Asia, America and Africa.However, the most common incidences from the 1990s have been inAfrica. There are between 1,000 and 2,000 epidemics of plaguereported to the WHO on a yearly basis, yet the incidence andprevalence might be higher specifically in developing nations(Medscape, 2015). This is because diagnosis and reporting isnot reliable. Mortality rate is approximated at 8 to 10% with ahigher possibility of more deaths specifically is plague prevalentregions. Countries such as Congo, Madagascar, India, China, Tanzaniaand Zimbabwe report above 100 cases of the disease (Medscape,2015). In America, several plague foci are situated in California,Utah, Arizona, New Mexico and Colorado. There were 13 cases reportedin 2006 amid individuals from California, New Mexico, Texas andColorado. A mean of 10 to 15 cases are reported on a yearly basis inAmerica (Medscape, 2015). The most recent reporting of plaguewas in Colorado in 2014, following a man’s contact with an infecteddog, which further resulted in the infection of three otherindividuals. The effect of plague is that there is a high mortalitypossibility and transmission to other people. Depending on the typeof plague, untreated pneumonic plague results in 100% mortality rateand 50% when treated. Untreated bubonic plague leads to 50-90%mortality and 10-20% when treated. The mortality rate for septicemicplague is 20-25% when treated (Medscape, 2015).
Roles of Professional Nursing
Case finding – when a patient presents with signs similar to thoseof someone with the plague disease, the nursing professional issupposed to screening the individual to ascertain whether they haveplague or not (Morse, 1995). Once a patient tests positive to plague,the nurse interviews the individual to ascertain the host. Forinstance, the nurse may ask a patient about the environment wherethey live, if they have had any pets that have passed away, and whomthey have contacted. By tracing possible contacts, it becomespossible to stop further spread of the disease by isolating thosehighly susceptible, especially in the case of pneumonic plague (Fritzet al, 1996). Contact tracing is both direct and indirect. Directcontacts are people that have had one-on-one contact with a suspectcase of plague (Morse, 1995). Tracing contacts may be done throughinterview of all suspects, possible and confirmed incidences. Anotherrole includes investigating the contacts to be certain if they havethe illness or not. When screenings indicates that the patient hasplague, the nurse screens all other patients to identify possibleinfection following exposure. Following the identification of anoutbreak, a working case for investigation might include anindividual with fever or cough, which evolves as more information onexposure is acquired.
Reporting – plague has a high mortality rate following the delayof treatment, hence, nurses are encouraged to report immediately anyincidence of plague. Nurse’s role in reporting can be throughtelephone or online communication, and in most instances reportingusing the fastest means possible. Immediate reporting enhances theprevention of rapid spread of plague, makes it possible to isolatepersons that are infected and those that may have contact to thedisease. The CDC has a Plague Case Investigation Report, which isaccessible to all nursing professionals, and which they use to reportany suspected case (Lombardo &Buckeridge, 2012). The investigation report informs in detainthe profile of the individual, location, their concurrent conditions,signs and symptoms as well as their initial onset, localized signsand treatment and an epidemiologic investigation. In addition, is aplague case status, which helps to determine if the individual isconfirmed to have the illness, what possibility the individual hasplague or when there is no case of plague. The CDC also has a“Nationwide Notifiable Diseases Surveillance System” which is acountrywide collaboration, which makes it possible for nurses,whether global, state, local, federal or territorial, to exchangehealth information (Lombardo &Buckeridge, 2012). Sharing information makes it possible tomonitor, regulate and avoid the incidence as well as spreading ofstate-reportable or nationally notifiable illnesses.
Data collection and analysis – the nurse should use different datasources to collect and analyze during plague surveillance. The WorldHealth Organization identifies specific sources of data forsurveillance. These are epidemic reports, environmental information,mortality reports, reports on specific case investigations, anysurvey that the nurse has conducted and reports on epidemicinvestigations (Lombardo &Buckeridge, 2012). Such information makes it possible for thenurse to monitor the population, in the incidence of a new plaguecase. After collecting the information, the nurse then analyzes theinformation collected. The intention is to determine any new trends,which makes it possible to monitor the disease. Monitoring can be bydetermining the incubation period, speed of mortality and how fastthe disease is spreading. When collecting data, it is the role of thenurse to determine who has the disease, people that have been incontact with the illness, where the outbreak happened, the possibletime when the first person became ill and what measures are beingtaken or are to be taken to avoid further spreading of plague. Datacollection and analysis is important because other healthprofessionals depend on the information from the nurse in undertakingprevention measures. The media may use the information to alert thepublic about the epidemic, while health agencies use the informationfor outreach to avoid further spread.
Follow-up/evaluation – after identifying the epidemic of plague ina specific population, the nurse’s role additionally involvesfollow-up. This is necessary in determining whether the interventionsthat were used have been effective. The most common treatment forplague is antibiotics. Follow-up entails the nurse determining if theantibiotics used were effective in treating and controlling furtherspread of any plague outbreak. The nurse is also responsible fordrafting measures, which will apply in the prevention of plaguewithin a given location or state. Following the identification ofpersons with plague and commencement of treatment, the nurse mustfollow-up with the patient. This is to ensure that patients adhere totreatment, if isolation was necessary that they remain isolated toavoid spread of the disease to other people, and determine how thepatient is responding to treatment. The nursing professional as wellfollows-up after the occurrence of plague to be certain that thereare no new incidences, that spread of the disease has dropped and thepossibility of new occurrences is possible to control.
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Cunha, J. P. (2015). Plague disease prognosis. Emedicinehealth.Retrieved from: http://www.emedicinehealth.com/plague/page6_em.htm
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Lombardo, J. S., & Buckeridge,D. L. (2012). Diseasesurveillance: a public health informatics approach.John Wiley & Sons.
Medscape. (2015). Plague epidemiology. Retrieved from: http://emedicine.medscape.com/article/235627-overview#a6
Morse, S. S. (1995). Factors in theemergence of infectious diseases. Emerginginfectious diseases, 1(1),7.
Perry, R. D., & Fetherston, J. D. (1997). Yersinia Pestis– Etiologic agent of plague. Clinical Microbiology Reviews,10(1), 35-66.
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