Introduction
Herpes zoster (HZ) or shingles is a common viral infection preventable through vaccination. Caused by the reactivation of the varicella-zoster virus after causing chickenpox, HZ produces rashes with blisters, pain/itching in the affected area, sensitivity to light, general weakness, and headaches (Centers for Disease Control and Prevention [CDC], 2020; Harpaz & Leung, 2019). Transmission modes are droplet/airborne transmission or direct contact with blister fluids, and possible complications are post-herpetic neuralgia, ophthalmic sequelae, and nerve disorders (CDC, 2020). Treatments include analgesic medications and topical creams, as well as antiviral medications, such as acyclovir (CDC, 2020; Harpaz & Leung, 2019). Concerning prevalence, around 33% of people are affected by HZ during their lifetime (CDC, 2020). Regarding mortality and morbidity/incidence in the U.S., there are four new cases per 1,000 people every year, causing no more than 100 complication-related deaths per year, and the risk of getting it is significantly higher in those older than 60 and immunocompromised individuals with tumors or HIV/AIDS (CDC, 2019; Harpaz & Leung, 2019). This paper examines HZ with attention to the determinants of health, the epidemiological triangle model, and the NP’s responsibilities.
Determinants of Health as Contributors to HZ
There are peculiar age-related and ethnicity-related factors contributing to HZ. Those born in the U.S. before the 1980s have contracted wild-type varicella-zoster virus infection almost without exceptions, which eventually increases the risks of the virus’s reactivation (CDC, 2020). Older age represents a specific contributor to HZ since cell-mediated immunity to the once-contracted varicella-zoster virus has been shown to decline with age, increasing the virus’s chances of reactivating and causing symptoms (Sullivan et al., 2019). Other crucial determinants are social in nature and contribute to HZ by limiting access to timely vaccination (Vogelsang & Polonijo, 2022). In older adults, being Hispanic or Black decreases the odds of getting vaccinated against shingles by 50%, which could stem from the economically disadvantaged groups’ distrust of the healthcare system, lack of access to vaccine safety information, or limited awareness of HZ (Vogelsang & Polonijo, 2022). HZ is relatively common, and the existing vaccines are effective in at least 90% of non-immunocompromised individuals (CDC, 2020; Vogelsang & Polonijo, 2022). Therefore, racial minorities can be more exposed to HZ due to the unstable access to vaccines, and aging reduces the body’s natural protection against HZ.
Epidemiological Triad Discussion
The development of HZ and the chances of contracting it can be described using the traditional triad model that explains infectious diseases with reference to agent-host interactions in specific environments. Regarding agent factors, the presence of the varicella-zoster virus in the body after the recovery from chickenpox predisposes the host to develop HZ even if the virus remains dormant for years. Aside from the history of chickenpox, host factors that are important to consider are being older than 60, no vaccination against shingles, and various conditions associated with the body’s suppressed immunity, for instance, autoimmune disorders, diabetes, HIV/AIDS, and malignancies, especially leukemia and lymphatic cancers (CDC, 2020; Sullivan et al., 2019). Certain environmental factors increase the host’s risks of first exposure to the varicella-zoster virus, for instance, being around infected individuals in crowded environments, the time of the year, for instance, early spring or winter, and working with pesticides and insecticides on a regular basis (CDC, 2019; Oxman, 2018; Parks et al., 2021). Under these circumstances, the agent’s chances of getting into the host’s body and causing HZ after the host’s recovery from chickenpox are increased.
The NP’s Role in Disease Management
The NP is actively involved in managing HZ and other contagious diseases and preventing their spread. According to the American Association of Nurse Practitioners, primary NP-initiated interventions should include patient education on immunization against HZ, immunization schedules, and disseminating vaccine-related resources; secondary interventions and surveillance incorporate screening for HZ symptoms in patients with a history of chickenpox (AANP, 2021). For the already infected patients, NPs can offer HZ transmission prevention education, including waiting for lesions to become dry and using correct wound covering (CDC, 2019). NPs’ role in infectious disease management incorporates health status assessments, treatment, and education (AANP, 2019). Thus, NPs’ responses to infectious diseases enable the integration of the patient-centered holistic health model.
Next, the NP’s role in the implementation of tertiary interventions can incorporate wound care patient education to relieve discomfort, pharmacological therapy education, or making referrals to dermatologists or other specialty doctors to examine any complications. Reporting and data collection roles may vary across the U.S.; in some states, HZ is a reportable disease, so healthcare practitioners, including NPs, can be required to report data on new HZ cases to their state’s health department within one day, especially in underage patients or disseminated HZ cases (Minnesota Department of Health, n.d.). NPs’ data analysis responsibilities are not specified with regards to HZ, and follow-up appointments are frequently used to ensure normal healing and the absence of severe complications.
Conclusion
In summary, HZ represents a relatively common contagious disease, with the patient’s older age and being part of low-income ethnic groups serving as the relevant determinants of health to contribute to its development. HZ’s progression is linked to the interaction between the varicella-zoster virus and the host susceptible to HZ in high-risk environments. The NP’s role in managing the condition involves prevention, early detection, treatment, and reporting.
References
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