Paper Sample on TBE: Tick-Borne Encephalitis: Causes, Symptoms, and Treatment

Introduction

Tick-borne encephalitis (TBE) disease results from the tick-borne encephalitis virus (TBEV) transmitted by ticks. TBEV enters the body through the skin following tick bites or epithelial cells in the human digestive tract. It then infects the blood cells, immune system organs, and the central nervous system. The disease usually presents as meningitis or meningoencephalitis (Bogovic & Strle, 2015). It starts with an acute form of recovery and later transforms into a chronic infection. The infection's acute severe complications end with paralysis and fatal outcome. Chronic diseases with cerebral complications usually last for life-long or years-long. Antiviral therapy for TBE has not been developed, so the primary preventive measure is the induction of active immunity.

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There is a wide distribution of TBE in Asia and Europe and is endemic to twenty-seven and four countries in Europe and Asia, respectively. European countries have the highest disease incidence between 10000 and 15000 annually. In China, between 2007 and 2018, an average of 3364 cases was registered with nineteen deaths. Research shows that men are likely to be highly infected than women because they take the use of protective measures against ticks more seriously (Slunge & Boman, 2018). Young people below the age of thirty years do not use protective clothing. Older people above sixty-five years do not perform tick checks, thus increasing their TBE infection capability. The mortality rates are up to 2%, while 10% of the patients suffer from neurological complications. Besides, the disease is more severe in the elderly than in the youths.

The Determinants of Health

Health determinants make some people healthy and others unhealthy ("Social Determinants | Healthy People 2020", 2020). They can be referred to as the personal, environmental, economic, and social factors influencing health status. These determinants are categorized into several factors: individual behavior, biology and genetics, social factors, policy-making, and health services. Social factors and personal behavior are our primary concern in developing TBE because they can reduce the infection risk. Social determinants represent the physical conditions and social factors in the environment surrounding people. According to Slunge & Boman (2018), there is a positive association between exposure variables, e.g., visits areas with ticks, staying in a tick-infested with ticks and TBE disease, and performing checks for tick bites. Research shows that forest workers and farmers are highly infected with TBE accounting for 18.16% of the top three causes of the disease (Chen, Li, Yin, Liu, Fu, He, & Yang, 2019). Because forests with broad-leaved trees provide suitable habitats for ticks, there is a more substantial risk effect of TBE on humans. Additionally, forests have an indirect impact on tick densities because they provide appropriate moisture for tick survival and host species.

On the other hand, individual behavior also has an essential role in the outcomes of health. The majority of health care and public health interventions focus on changing an individual's behavior; for instance, using protective clothing in areas with ticks' infestation can help reduce infection (Slunge & Boman, 2018). Tick bites pose a considerable risk to people, and avoiding tall bushes and grass and using protective clothing can prevent ticks infestation and TBE risk. However, some people have been adapted to tick bites and have thus adjusted their risk preferences. They believe that there is a low probability of contracting TBE disease from a single tick bite, but repeated tick bites cause a severe risk. They also think that a bite from a tick in a region with TBE risk is the only one that can cause an infection. Research shows that these perceptions negatively associate with TBE health risk (Slunge & Boman, 2018).

Epidemiological Triad

TBE is endemic in Siberia, Europe, Northern Japan, and China, and far-eastern Russia (Bogovic & Strle, 2015). The European TBEV subtype is predominant in Europe, in Siberia there is the Siberian TBEV subtype, while the TBEV subtype in far-eastern is dominant in far-eastern Japan and Asia. Small rodents are the primary hosts and reservoirs of TBEV. Naturally, human beings are not involved in maintaining TBEV and only host the virus accidentally. However, the virus is spread to humans through tick bites; and the primary vector in Europe is Ixodes ricinus, Eastern Europe, Asia, and Russia the vector is Ixodes persulcatus, whereas Ixodes ovatus ticks are found in far-east Japan. Around one percent of all TBEV, human infections are attained through drinking milk that is unpasteurized or milk products from livestock infected by the virus, particularly goats. Outbreaks of transmission from the oral virus have been reported in Eastern Europe, but only limited cases of TBEV diseases have been acquired in the laboratory.

TBE cases are more prevalent during warm seasons (Bogovic & Strle, 2015). This mainly occurs between April and November during the increased activity of the ticks. In Central Europe, the two-peak cases are observed in June and July and the other case in September and October. In the Far-East and Siberia, the cases are seen in May and June. Men are the most infected than women among all age groups, and 10-20% of all the cases reported are in children. Moreover, the TBE prevalence has become a global problem following the increased tourism activity. So, TBE diagnosis should not be considered for those in the endemic region only, but should also be added to the central nervous system differential diagnosis. The risk of TBE associated with traveling is dependent on the travel season, degree of unprotected exposure in the out-doors, and consumption of unpasteurized daily products.

Management of an Infectious Disease

The management of an infectious disease is an intense process. As stated by the American Association of Nurse Practitioners (AANP), nurse practitioners offer acute, primary, and specialty services of healthcare to diverse patients (Writers, 2018). Their advanced clinical training authorizes them to treat conditions, diagnose illnesses, and offer evidence-based health training to patients. They assess the patients by performing physical evaluations, examining medical histories, and conducting or ordering diagnostic tests.

The management of infectious diseases has several activities. The first activity involves active surveillance to detect the case by contacting the population to seek information about their health conditions (Ryerson & Massetti, 2017). After inspection, the case is recorded through case registration, then epidemiological and laboratory confirmation is done. The next activity involves reporting suspected and confirmed cases, analyzing, and interpreting the data. The public health surveillance system provides information for appropriate health response and control of the outbreak. Lastly, supervisory visits are conducted to provide feedback on the progress of the epidemic.

The PDCA (plan, do check, and act) model is integrated to support the implementation of evidence-based practice (Chen, Zheng, Wu, Zhang, & Lin, 2020). The "plan" activity involves defining the contaminated areas and stating the nursing staff's responsibilities and roles during the prevention of the outbreak. "Do" involves proposing and taking the appropriate measures to increase management awareness of their responsibilities. "Check" consists of ensuring that each patient's nursing care and quality inspection is fully implemented. "Act" involves offering improvements and countermeasures for the ongoing problems. The quality control staff and nurses follow up on the identified problem and ensure patient care effectiveness. In the case of a new challenge, it is brought in the PDCA cycle for management.

References

Bogovic, P., & Strle, F. (2015). Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and management. World Journal of Clinical Cases: WJCC, 3(5), 430.

Chen, X., Li, F., Yin, Q., Liu, W., Fu, S., He, Y. & Yang, G. (2019). Epidemiology of tick-borne encephalitis in China, 2007-2018. Plos one, 14(12), e0226712.

Chen, Y., Zheng, J., Wu, D., Zhang, Y., & Lin, Y. (2020). Application of the PDCA cycle for standardized nursing management in a COVID-19 intensive care unit. Annals of Palliative Medicine, 9(3), 1198-1205.

Ryerson, A. B., & Massetti, G. M. (2017). Peer reviewed: CDC's public health surveillance of cancer. Preventing chronic disease, 14.

Slunge, D., & Boman, A. (2018). Learning to live with ticks? The role of exposure and risk perceptions in protective behaviour against tick-borne diseases. PloS one, 13(6), e0198286.

Social Determinants | Healthy People 2020. Healthypeople.gov. (2020). Retrieved 1 August 2020, from https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/social-determinants.

Writers, S. (2018). What is a Nurse Practitioner and What Do They Do? - NP FAQ.

NursePractitionerSchools.com. Retrieved 1 August 2020, from https://www.nursepractitionerschools.com/faq/what-is-np/#:~:text=According%20to%20the%20American%20Association%20of%20Nurse%20Practitioners%20(AANP)%2C,health%20education%20to%20their%20patients.