Epidemiology – Infectious disease

Infectious mononucleosis (IM), or “mono,” is a communicable disease that is most commonly caused by the Epstein-Barr virus (EBV). EBV is one of the most common human viruses found all over the world, and most people will become infected with it at some point in their lives (Centers for Disease Control and Prevention [CDC], 2014a). However, not all people infected with EBV will develop IM. By understanding the epidemiologic triangle of IM and identifying how the determinants of health contribute its development, the community nurse canbetter u nderstand the scope of their role in helping to reduce or resolve its impact. IM is most commonly caused by EBV, which is a member of the herpes virus family.

Other viruses that can cause IM are HIV, hepatitis A, B, or C, toxoplasmosis, cytomegalovirus, rubella, and streptococcal pharyngitis (CDC, 2014b). IM is often called “the kissing disease” because EBV is primarily transmitted through saliva, but it can also spread through a cough or sneeze or by sharing a drink, food, cups, utensils, or toothbrushes with someone who has IM (CDC, 2014a; Mayo Clinic, 2015c).

EBV can also be transmitted just by shaking hands with someone who has the virus or by touching an infected utensil or an item that has the saliva of an infected child on it (CDC, 2014a; Mono Treatment, 2015a). While EBV and some of the other viruses that cause IM are most commonly spread through saliva, all of them can also be spread through semen and blood during sexual contact, organ transplants, and blood transfusions (CDC, 2014a). Typical symptoms of IM usually appear four to six weeks after you become infected with EBV; they may develop slowly and may not all occur at the same time (CDC, 2104b).

Most symptoms of IM can be hard to distinguish from other viruses, such as the flu (Cafasso, 2012). According to the CDC (2014b) and Mayo Clinic (2015d), the most common symptoms of IM are: ?Fatigue (can be extreme at times) ?Fever (may be very high) ?Sore throat or strep throat that doesn’t improve with antibiotics ?Adenopathy in the neck and axilla ?Headache and body aches ?General feeling of unwellness (malaise) ?Swelling of the tonsils ?Skin rash ?Swollen spleen and/or liver The possible complications of IM are more serious than the disease itself.

IM can cause enlargement of the spleen, which in very rare cases may lead to rupture (Mayo Clinic, 2015b). Complications with the liver may also occur, such as hepatitis and jaundice (Mayo Clinic, 2015b). The Mayo Clinic (2015b) lists rare complications to be: ?Anemia ?Thrombocytopenia ?Myocarditis ?Severe tonsillitis leading to airway obstruction ?Meningitis, encephalitis, Bell’s palsy, and Guillain-Barre syndrome (caused by EBV) There is no known cure or antiviral drugs for IM, and no vaccines for its prevention are available. IM is self-limiting, and will usually resolve on its own in about 2-4 weeks, but the fatigue may last longer (CDC, 2014b). Treatment is aimed at easing the symptoms.

The most important things are to drink plenty of fluids to stay hydrated and get plenty of rest, and also take over-the-counter medications for fever and pain and gargle with warm salt water to help relieve the sore throat (CDC, 2014b; Mayo Clinic, 2015d). Antibiotics may be required to treat a secondary infection, such as strep throat or tonsillitis, and corticosteroids may also be prescribed to reduce throat or tonsil swelling (Mayo Clinic, 2015d).

Any activity that may cause bluntabdom inal trauma should be avoided for at least a month after infection to prevent splenic rupture (Cafasso, 2012). The only way to prevent transmission is to avoid transfer of saliva by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who currently or was recently infected with IM.. IM commonly affects teenagers and young adults, especially college students. Because IM is not a reportable disease, demographic statistics are not often readily available or vary depending on the source. According to Balfour, et al.

(2013) “incidence and risk factors for acquisition and correlates of severity of primary EBV infection are incompletely understood [and] the prevalence of EBV antibodies varies widely by age and geographic location” (p. 80). According to the CDC (2014b), at least 25% of teenagers and young adults who contract EBV will develop IM, where Mono Treatment (2015b) lists this statistic at 35-50%. In the study by Balfour, et al. (2013) 143 EBV-naive college freshmen living in the dormitories were voluntarily tested for EBV antibodies over four years which yielded an incidence of 89%.

Generally, EBV causes IM 90% of the time it’s contracted, but the severity differs so that some cases show no symptoms at all, especially among young children (Mono Treatment, 2015b). Because most Americans have been exposed to EBV at some point during their lives they have built antibodies against it and will not develop symptoms. Secondary infections that may occur with IM include strep throat, tonsillitis, and sinus infections, and splenic rupture is a possibility even a month after infection. People rarely die from IM, and it’s usually from its complications. In 2004 there were a total of 78 recorded deaths caused by IM (as cited in Mono Treatment, 2015b).

The epidemiologic triangle of IM is as follows: IM is caused by EBV found in saliva (the biological agent) that is spread directly from person to person or indirectly by sharing items contaminated with an infected person’s saliva (the host) usually within dormitories or schools (the environment). Because IM typically affects teenagers and young adults, human behavior is a major factor in the transmission of this disease because individuals of this age group tend to have increased close personal and sexual contact with each other.

Teenagers and young adults who contract IM are usually found in dormitories and schools, illustrating how close proximity of the environment can contribute to its transmission. In a European study, Semenza (2010) stated that “intermediary determinants of health [such as] crowded living and working conditions, inadequate food availability, high-risk sexual behaviour, etc. shape differences in exposure and vulnerability” (para. 2). Therefore, college students living in close quarters on a tight budget may tend to share personal items, food, and utensils, and when this is combined with increasedph sical contact it can lead to the development and spread of IM at a faster rate.

The community health nurse plays an important role in communicable disease and epidemiology in case finding and reporting, collecting and analyzing data, and patient follow-up. According to the Minnesota Department of Health (2001), “Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions” and is used to identify changes in incidence and prevalence.

Case finding, the individualized form of surveillance, is a one-to-one intervention that locates and identifies families or individuals that are most at-risk for a specific disease and then gives them to information on risks and resources (Minnesota Department of Health, 2001). For example, a school nurse may evaluate a patient or a cluster of patients with symptoms of IM, and may then alert other students or their parents on what to look for and how to prevent transmission of the disease to others. Reporting new cases of major communicable diseases to local health authorities is required for the health and safety of others.

Although IM is a communicable disease, it does not need to be reported due to its short, self-limiting course and non life-threatening nature. Referral and follow-up are intertwined, and the community health nurse assists individuals, families, and communities to access resources in order to prevent or resolve problems or concerns (Minnesota Department of Health, 2001). However, making a referral without following up and evaluating its results is both inefficient and ineffective. The Mayo Clinic is a nonprofit worldwide leader in medical care, education, andresearc h.

Their website contains information for patients and clinicians on IM and all other diseases, communicable or not. Their mission is “To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research” (Mayo Clinic, 2015a).

Their website can be accessed at http://www. mayoclinic. org/ IM is a highly contagious disease that can be prevented by breaking a link in the communicable disease chain. Education on signs and symptoms of IM, modes of transmission, and high-risk behaviors can increase awareness and prevention. By indentifying high-risk individuals and groups, community health nurses can focus their efforts on education and prevention to help decrease the spread of IM. References Balfour, H. H. , Odumade, O. A. , Schmeling, D. O. , Mullan, B. D. , Ed, J. A. , Knight, J. A. &… Hogquist, K. A. (2013).

Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. Journal of Infectious Diseases, 207(1), 80-88. doi:10. 1093/infdis/jis646 Cafasso, J.(2012). Infectious mononucleosis.

Retrieved from http://www. healthline. com/health/mononucleosis Centers for Disease Control and Prevention. (2014a). About Epstein-Barr virus. Retrieved from http://www. cdc. gov/epstein-barr/about-ebv. html Centers for Disease Control and Prevention. (2014b). About infectious mononucleosis. Retrieved from http://www. cdc. gov/epstein-barr/about-mono. html Mayo Clinic. (2015a). Mission and values. Retrieved from http://www. mayoclinic. org/about- mayo-clinic/mission-values Mayo Clinic. (2015b). Mononucleosis: Complications.

Retrieved from http://www.mayoclinic. org/diseases-conditions/mononucleosis/basics/complications/con- 20021164 Mayo Clinic. (2015c). Mononucleosis: Definition. Retrieved from http://www. mayoclinic. org/diseases-conditions/mononucleosis/basics/definition/con- 20021164 Mayo Clinic. (2015d). Mononucleosis: Symptoms. Retrieved from http://www. mayoclinic. org/diseases-conditions/mononucleosis/basics/symptoms/con- 20021164 Mayo Clinic. (2015e). Mononucleosis: Treatment and drugs. Retrieved from http://www. mayoclinic. org/diseases-conditions/mononucleosis/basics/treatment/con- 20021164 Minnesota Department of Health.

(2001). Public health interventions: Applications for public health nursing practice. Retrieved from http://www. health. state. mn. us/divs/opi/cd/phn/docs/0301wheel_manual. pdf Mono Treatment. (2015a). What is mono? Retrieved from http://www. monotreatment. com/what_is_mono. html Mono Treatment. (2015b). Mono statistics. Retrieved from http://www. monotreatment. com/mono-statistics. html Semenza, J. C. (2010, July). Strategies to intervene on social determinants of infectious diseases. Eurosurveillance (15)27. Retrieved from http://www. eurosurveillance. org/ViewArticle. aspx? ArticleId=19611.

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