Vulnerable populations are “those with a greater than average risk of developing health problems by virtue of their marginalized socio-cultural status, their limited access to economic resources, or personal characteristics such as age and gender” (De Chesnay & Anderson, 2008). Infants and young children are vulnerable to a host of healthcare problems, they are susceptible to viral infection especially respiratory infection such as Respiratory Syncytial Virus. In this paper, the author will define and describe epidemiological triangle as it relates to respiratory syncytial virus (RSV), types of epidemiology, and levels of prevention of RSV.
Epidemiology Definition Epidemiology is defined as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems” (Stanhope & Lancaster, 2008). The study of epidemiology is important because it search for causes or factors that are related with increased risk or likelihood of disease, it deals with group of people rather than with individual person, and it helps public health with decision making and aids in developing and evaluating interventions to control and prevent health problems (CDC, 2012).
Epidemiology is used to “monitor the health of various populations, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health” (Stanhope & Lancaster, 2008). Epidemiologist treat communities and populations by looking at disease transmission, exposure, possible for spread of disease and ways to avoid the return of disease, just like a physician treats an individual.
Epidemiology is considered “the core of science of public health and is described as a constellation of disciplines with a common mission: optimal health for the whole community” (Stanhope & Lancaster, 2008). Epidemiological Triangle Epidemiological triangle can be applied to better understand the transmission of RSV. Epidemiological triangle have three parts: agent or the “what” , is the cause of the disease: host or the “who” is an organism harboring the disease; and environment or the “where” are those factors that cause or allow disease transmission. In RSV transmission, the agent is RSV.
RSV is the leading cause of lower respiratory infection in infants and young children (host). Infants who have congenital abnormalities of the airway, neuromuscular disease, congenital heart disease, and infants who were born premature have a higher risk of developing RSV. RSV has been recognized for at least 100 years. The virus start out in the upper respiratory tract in respiratory epithelial cells. The spread of the virus down the respiratory tract happens by call to call transfer along intracytoplasmic bridges (snycytia) from upper respiratory tract to lower respiratory tract (Medscape, 2011).
RSV “enters its host through the mucous membranes of the mouth, eyes, or nose. Proteins found on the viral surface cause neighboring uninfected cells to fuse with infected cells, spreading viral progeny from cell to cell. The fusion of cell membranes creates syncytia, which initiate the release of inflammatory cells and mucus buildup in the lungs. The incubation period is 4 to 5 days” (Lawrence, P. 2011). Most infants will have this infection by the age of 2. RSV is very contagious, it can be spread through droplets when someone sneezes or coughs with the virus.
The virus can also live on surfaces, hands, clothing (environment), and can be spread by touching someone who are contaminated with the virus (KidsHealth, 2012). Respiratory Syncytial Virus is the most common germ that causes lung and airway infections in infants and young children. RSV spreads rapidly in day care centers and crowded households. The virus can live for half hour or more on hands and can live up to five hours on countertops, and several hours on used tissues.
Infants and young children who are attending day care, being near tobacco smoke, living in crowded conditions, and having school-aged brothers or sisters have an increased risk for RSV (PubMed Health, 2011). RSV infections generally occur during fall, winter and early spring in a temperate climates. The severity and timing of RSV circulation vary from year to year in a given community. Symptoms of RSV varies depending on the child’s age. Symptoms usually appear 4 to 6 days after coming in contact with the virus.
Mild symptoms such as cold-like symptoms, cough, stuffy nose, sore throat, headache and low-grade fever usually occur in older children. Severe symptoms such as cyanosis, labored breathing, croupy cough, reduced appetite, tachypnea, wheezing and fever usually occur in infants under the age of one. Mild infections usually go away without treatment, however infants and children with severe RSV infection needs to be admitted to the hospital for treatment. Treatment include oxygen, humidified air, IV fluids, and breathing machine.
Other health problems can develop as a complications of RSV infection, these include ear infection (middle ear), asthma, dehydration, atelectasis, sudden heart failure (usually occurs in older adults with heart and lung problems), bronchiolitis, pneumonia, and lung failure (MayoClinic, 2011). Types of epidemiology There are two types of epidemiology: descriptive epidemiology and analytic epidemiology. Descriptive epidemiology “collects information to characterize and summarize the health even or problem, it is the most basic and is fundamental to the work of an epidemiologist” (CDC, 2012).
Descriptive epidemiology examines factors like age, socioeconomic status, education, availability of health services, race and gender. Descriptive epidemiology deals with who, what, when and where. Analytic epidemiology “relies on comparisons between groups to determine the role of various risk factors in causing the problem” (CDC, 2012). Analytic epidemiology deals with the remaining questions: Why and How. The type of epidemiology used in this study is descriptive because it describes how RSV infection affects certain type of population at a given time.
Epidemiological Data According to CDC, each year in the United States, an estimated 75, 000 to 125, 000 among children less than one year old are hospitalized due to RSV and results in approximately 1. 5 million outpatient visits among children under the age of five (CDC, 2012). By the age of 2 years old, 90% to 95% of children are infected with RSV infection at least once and reinfection is common. The mortality rate is less than 1% in children who are hospitalized with RSV infection and less than 500 deaths per year are attributed to RSV in the United States.
Infants with chronic lung disease, congenital heart disease, or was born premature have 3% to 5% mortality rate and spend twice as long in the hospitals as other patients with RSV infection. All races are susceptible to RSV but the frequency of hospitalization for RSV disease is higher in males than with females with the ratio of 2:1 (Medscape, 2012). RSV trends are done by collecting data from the National Respiratory and Enteric Virus Surveillance System (NREVSS). This is used to determine the onset, offset, and peak of RSV season.
NREVSS is a laboratory-based surveillance system that monitors that circulation of RSV and other respiratory viruses. The participating laboratories report the number of RSV test and the number of positive RSV infection to CDC weekly. According to the NREVSS, the onset occurred from mid- November to early January, and the offset occurred from mid -March to late April in the year 2010 to 2011. From June 2010 to June 2011, 509 laboratories a week, reported RSV testing (CDC, 2011). “Of these 509 laboratories, 179 (35. 2%) from 42 states met inclusion criteria and reported a total of 320, 751 tests, of which 50, 860 (15.9) were positive” (CDC, 2011). Serum is tested for RSV-specific immunoglobulin M (IgM) and immunoglobulin G (IgG).
“Presence of IgM indicates RSV infection; IgM develops 5 to 8 days after onset of symptoms. False-positive IgM test results can occur in first month of life because of the presence of maternal RSV IgG. A 4-fold increase IgG levels indicate active RSV infection. The formation of IgG takes 2 to 4 weeks after onset of infection, and maternal antibodies can inhibit IgG development in infant” (Lawrence, P. , 2011). Levels of Prevention.
Preventing of disease has three levels: primary prevention which prevents the disease from occurring, secondary prevention which finds and treat the disease early, and tertiary prevention which slow down the disease or prevent disease from causing other problems or complications (CDC, 2012). In RSV infection, the primary prevention is educating parents, caregivers, and health care providers on how to avoid RSV exposure. Education information include good hand hygiene, avoiding modifiable risk factors such as smoking, cough etiquette, and proper disposal of contaminated tissue.
A drug called palivizumab, given monthly during RSV season, is a prophylaxis to prevent RSV. This drug is given to children younger than 2 years old who are at high risk for serious RSV disease, it helps prevent the development of serious RSV disease but it does not help cure or treat children who are already suffering from the disease. As of today, researchers are still working on developing a vaccine for RSV. Secondary prevention is putting patient in a single room while in the hospitals to prevent the spread of infection to other infants or children, IV fluids, breathing treatments and oxygen are given.
tertiary prevention is treating the infection early, bringing the infants or children to health care providers or hospitals early can help prevent complications of RSV infection. The study of epidemiology is important for communicable disease and illness, such as RSV infection. Epidemiology helps as answers the what, who, when, where, and why health-related events occur. It helps us better understand how infections are spread through the epidemiological triangle, and stopping one part of that triangle prevent the spread of diseases and illnesses.
Primary, secondary, and tertiary preventions can help prevent the transmission and complications of RSV infection.
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