Pertussis: At-Risk Indicators and Health Determinants

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Table of Contents

Introduction
Determinants of Health
Epidemiological Triad: Pertussis
Role of the Nurse Practitioner
Conclusion
References

Introduction

The disease chosen for this assignment is pertussis, also known as whooping cough. It is a human respiratory disease caused by the Bordetella pertussis virus. After the bacteria cling to the cilia in the respiratory system, they release inflammatory toxins. It is an aspect that causes symptoms like coughing severely, among others. Coughing comes to a release of bacteria into the air for others to breathe, thus causing further spread. For some, the symptoms are mild, and they spread the disease without knowing they have it, especially to infants. This paper aims to analyze pertussis by comprehensively evaluating its at-risk indicators, defining its health determinants, scrutinizing it with the epidemiology triad, and tying it in with the role of nurse practitioners in applying medical interventions grounded in evidence-based practice.

In developed countries, mortality is significantly higher, ranging between 19.7% and 31% (Shi et al., 2021). When children are born, they get a vaccine, which wears off later, leaving teenagers and adults susceptible to the disease should an outbreak occur. While recovering for adults and teenagers is relatively easy, complications such as bruised ribs or broken blood vessels could emerge. The most high-risk demographic is infants without vaccination under a year of age. The statistics show that they register the highest prevalence and incidence rates at 72.3 infected for every 100,000 of those aged below six months and 32.7 per 100,000 between six and twelve months (Havers et al., 2021). Their treatment would have to be in the hospital, while older demographics, especially expectant women, should get booster shots. With medication, it is possible to alleviate the symptoms and wean off the disease.

Determinants of Health

Health People 2020 provides the leading health indicators that point to healthy living, healthy development in all aspects, and healthy behaviors. The two identified factors that connect with pertussis are environmental quality and access to health services (CDC, 2019). based on Healthy People 2020, the initiative behind more access to health services is to allow the proper identification and containment of contagious ailments such as pertussis. The provision of enough equipment and staff makes the detecting, managing, and surveillance processes easier. However, in environments where health institutions cannot handle patients’ capacity or manage their condition properly, healthcare workers acquire it. A strong case has been made for educating personnel on the essence of immunizing healthcare workers who continuously underestimate pertussis’ contagiousness among adults (Riccò et al., 2017). In a well-structured setup, patients suspecting they have the disease report to medical facilities where healthcare providers do tests, confirm, investigate further, and provide the data to health authorities for epidemiology recording.

The other factor is environmental conditions, given the ease at which people transmit pertussis. As aforementioned, some carriers have the disease but manifest mild symptoms while they can still transmit it to others. Therefore, the link between pertussis and the environmental aspect is using this element to curb the spread of the disease. Delivering the best care to patients and the populace, in general, demands a clean environment. Additionally, government efforts at immunizing and giving boosters to infants and adults reduce the incidence rate among at-risk demographics (Noel et al., 2021). Healthcare workers must ensure patients are not at risk of acquiring pertussis due to the environmental aspect fostering the disease’s spread.

Epidemiological Triad: Pertussis

The epidemiological triangle represents the interrelations between the host, agent, and environmental factors. The agent factor refers to the disease carrier, which can be a bacteria, virus, or what most refer to as germs. The instance herein covers pertussis transmitted by the bacteria known as Bordetella pertussis, which causes internal havoc to the respiratory system. The host factor is the organism that is home to the agent and offers it a place to survive, which, in this case, is human beings. Most infants under a year old and yet to complete their vaccinations are the most at-risk demographics. Data shows that the lower the coverage of vaccination, the higher the prevalence in children with pertussis. In the 1940s, when vaccines were not so readily available, the US had to deal with as many as 200,000 sick children, while in 2012, the last time pertussis peaked, the cases did not exceed fifty thousand (NFID, 2022). With age, the initial vaccine offers little help against pertussis, highlighting the need for boosters to go to the older and now-susceptible teenagers and adults. Violent and incessant coughs and difficulty breathing are some of the most commonplace symptoms.

The environment refers to the favorable conditions the agent factor might prefer to stay in, thrive, and gradually infect the host. Upon catching pertussis, the host transmits the bacteria to others through sneezing and coughing. Sometimes, what happens is that someone comes too close or they find themselves in an enclosed space. Once one case occurs, halting the transmission becomes difficult in the absence of complete immunization (Esposito et al., 2019). After exposure, the symptoms are likely to manifest between five to ten days and, in some cases, after the first twenty-one days (CDC, 2021). After experiencing a runny nose, fever, coughing, and apnea in the first few days, symptoms may escalate to vomiting, fatigue, and difficulty breathing. If vaccinated, it is possible to avoid contracting the disease in the first place.

Role of the Nurse Practitioner

According to the AANP, nurse practitioners (NPs) have a broad scope of practice, including conducting assessments, diagnosing, care coordination, patient education, and counseling. They are accountable to the patient and, as such, remain “responsible to the public and adaptable to the dynamic changes in health care” by combining their roles as administrators, advocates, researchers, educators, mentors, and providers (AANP, 2019). With no direct cure for pertussis, supportive therapy is the best intervention that NPs give patients. The primary intervention lies in using prescribed antibiotics such as azithromycin, macrolides erythromycin, and clarithromycin to alleviate the symptoms. With the drugs approved by the CDC for persons aged one month and older, this intervention doubles up as the best practice model for the general population (CDC, 2022). Secondary interventions include monitoring the coughing and its severity and facilitating rest and good nutrition. If inpatient care is for an infant, data collection for apnea using an apnea monitor, analyzing the beats per minute, and following up is necessary since 67% of babies with pertussis have apnea (Aetna, 2022; Ochi et al., 2017). Tertiary interventions include educating the patient and their families about the condition and the dos and the don’ts, such as proper positioning, the importance of more fluid intake, and taking medication.

Conclusion

The assignment allowed for the analysis of pertussis as an infectious disease, its symptoms, at-risk demographics, and how NPs can intervene with treatment. The biggest lesson was how essential vaccination is to prevent contagious disease that lacks a cure. When underestimated, symptoms such as coughing and runny nose could escalate and lead to complications. In its epidemiological chart, it was possible to see the host, agent, and environmental factors and how they sustain this disease’s spread. The interventions at the hands of NPs range from primary interventions like drug administration to tertiary alternatives such as educating patients. Prevention and correct diagnosis are vital components in managing the infection.

References

AANP. (2019). Scope of practice for nurse practitioner. American Association of Nurse Practitioners. Web.

Aetna. (2022). Apnea monitors for infants. Health Insurance Plans. Web.

CDC. (2019). Leading health indicators. Centers for Disease Control and Prevention. Web.

CDC. (2021). Signs and symptoms. Centers for Disease Control and Prevention. Web.

CDC. (2022). Pertussis (Whooping Cough) Treatment. Centers for Disease Control and Prevention. Web.

Esposito, S., Stefanelli, P., Fry, N., Fedele, G., He, Q., & Paterson, P. et al. (2019). Pertussis Prevention: Reasons for Resurgence, and Differences in the Current Acellular Pertussis Vaccines. Frontiers In Immunology, 10.

Havers, F., Moro, P., Hariri, S., & Skoff, T. (2021). Epidemiology and Prevention of Vaccine-Preventable Diseases: Pertussis. Centers for Disease Control and Prevention. Web.

NFID. (2022). Whooping cough (Pertussis). National Foundation for Infectious Diseases. Web.

Noel, G., Lotfi, M., Mirshahvalad, S., Mahdi, S., Tavel, D., & Zahraei, S. et al. (2021). Hospital-based prospective study of pertussis in infants and close contacts in Tehran, Iran. BMC Infectious Diseases, 21(1).

Ochi, M., Nosaka, N., Knaup, E., Tsukahara, K., Kikkawa, T., & Fujii, Y. et al. (2017). Recurrent apnea in an infant with pertussis due to household transmission. Clinical Case Reports, 5(3), 241-245.

Riccò, M., Gualerzi, G., Bragazzi, N., Vezzosi, L., & Balzarini, F. (2017). Pertussis immunization in healthcare workers working in pediatric settings: Knowledge, Attitudes, and Practices (KAP) of Occupational Physicians. Preliminary results from a web-based survey. Journal Of Preventive Medicine And Hygiene, 61(1), E66–E75.

Shi, T., Wang, L., Du, S., Fan, H., Yu, M., & Ding, T. et al. (2021). Mortality risk factors among hospitalized children with severe pertussis. BMC Infectious Diseases, 21(1).

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