Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease. Refer to “Communicable Disease Chain,” “Chain of Infection,” and the CDC website for assistance when completing this assignment.

Communicable Disease Selection

Choose one communicable disease from the options below.

Hepatitis B
Epidemiology Paper Requirements

Address the following:

Describe the chosen communicable disease, including causes, symptoms, mode of transmission, complications, treatment, and the demographic of interest (mortality, morbidity, incidence, and prevalence). Is this a reportable disease? If so, provide details about reporting time, whom to report to, etc.

Describe the social determinants of health and explain how those factors contribute to the development of this disease.
Discuss the epidemiologic triangle as it relates to the communicable disease you have selected. Include the host factors, agent factors (presence or absence), and environmental factors. Are there any special considerations or notifications for the community, schools, or general population?

Explain the role of the community health nurse (case finding, reporting, data collection, data analysis, and follow-up) and why demographic data are necessary to the health of the community.
Identify at least one national agency or organization that addresses the communicable disease chosen and describe how the organizations contribute to resolving or reducing the impact of disease.
Discuss a global implication of the disease. How is this addressed in other countries or cultures? Is this disease endemic to a particular area? Provide an example.
A minimum of three peer-reviewed or professional references is required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.




Tuberculosis has continued to be a significant health challenge globally and causing similarities and morbidities of significant promotion of the population. This paper looks at the causative organisms, transmission, symptoms, and demographics of interests, social determinants, and the epidemiologic triangle of TB. Finally, this paper reviews the role of the CHN in relation to TB prevention and mitigation of TB, the actions of the CDC, and the global implications of Tuberculosis.

Causative Organism

Tuberculosis is an infection that will be caused by Mycobacterium tuberculosis which is non-spore forming rod-shaped, aerobic bacterium.  According to Knechel (2018), Mycobacteria can be classified as acid-fast bacillus a result of their unique cell wall structures which enhance their survival. The Cell wall of the Mycobacteria will possess barriers which will contribute to the numerous medically challenging characteristics of Tuberculosis.

These include resisting to host defense mechanisms and being resistant to antibiotics. The composition and quantity of the barrier/ cell wall in the mycobacterium will affect the bacterium growth rate and its virulence. A mycobacterium’s cell wall will also be made up of an antigen known as lipoarabinomannan. This antigen is immunogenic and supports the survival of mycobacteria in the macrophages (Knechel, 2018).


M –TB is spread by droplets nuclei which are tiny airborne droplets that will be generated when a patient with laryngeal or pulmonary tuberculosis sneezes, coughs, talks or sings (Sulis, Roggi, Matteelli, & Raviglione, 2014). The tiny airborne droplets have the ability to remain suspended in the air for several minutes or hours after they have been ejected from a host’s body.

The virulence of bacilli, the degree of ventilation, the number of bacilli in droplets and the level of exposure of bacilli to UV light and incidence of aerosolization can all affect the transmission rates (Sulis et al., 2014).

Once a healthy person inhales the air with the droplets nuclei, the M tuberculosis bacteria attaches itself to the lungs of the patients and eventually causes the development of a respiratory infection. However, in some instances, the mycobacterium tuberculosis can also spread to other organs such as the lymphatics, meninges, pleura, bone/ joints and may eventually cause extrapulmonary TB (Sulis et al., 2014).


The symptoms of tuberculosis will develop through different stages.After being infected with Mycobacterium tuberculosis, a person will show no signs initially. The person will not feel sick and will not be infectious (Raviglione & Sulis, 2016). This latent phase can last from a year and even a lifetime.  This state will progress when a person’s immune system is compromised, especially when a patient is critically ill.

This will lead to the reactivation of the disease. In most cases, the coinfection with the human immunodeficiency virus will be the most notable cause of progression, which will activate the disease. Other factors that contribute to the progression of tuberculosis from the latent to the active form include renal failure, sepsis, diabetes mellitus, smoking, malnutrition, organ transplantation, chemotherapy, and long term corticosteroid usage (Raviglione & Sulis, 2016).

All these factors can, therefore, lead to the triggering and the reactivation of more infections. Such factors are, therefore, most common in critical care settings. Local healthcare providers and departments are required to maintain and registers of all people who might have tuberculosis in a given area including recurrent and new cases within a given jurisdiction such as information about clinical conditions, identification of patients, epidemiology of the diseases and the frequency of examination (Raviglione & Sulis, 2016).

After the latent stage, tuberculosis will then develop to the primary stage. In many cases, primary pulmonary tuberculosis will also be asymptomatic. Such a disease may only be observed after the running of several diagnostic tests. In this stage, the bacilli will spread from the lungs through the lymphatic system. In some instances, this may lead to the enlarging of the primary lesion.

This may eventually lead to pleural effusion. Pleural effusion can develop will, therefore, developed as a result of the bacilli infiltrating the pleural space in the adjacent area. Such effusion may remain small in some instances and seem to resolve consequently (Knechel, 2018). However, in some instances, such effusions can become huge and induce symptoms such as pleuritic chest pain, fever, and dyspnea. In most tuberculosis patients,’ dyspnea will develop from the poor gas exchange in the regions of the affected lung tissue.

Most patients with pleural effusion may also struggle with a lack of breath sounds and dullness and percussion because of the excess fluid, which might have entered the pleural space (Raviglione & Sulis, 2016).

About 5 to 10 percent of all the people who are exposed to M tuberculosis primary progressive tuberculosis also referred to as active tuberculosis will develop.  Active tuberculosis symptoms will include progressive fatigue, weight loss, malaise, night sweats, and chills and low-grade fever. Patients with active tuberculosis will also display signs of wasting as a result of altered metabolism and lack of appetite, which is a response of immune and inflammatory responses.

In some instances, finger clubbing may also occur as a result of poor oxygenation in the body. In many cases, a cough may also develop with the cough, which may have sputum streaked with blood (Knechel, 2018). Tuberculosis will be treated through the use of antibiotics for a period of six months.

Demographics of Interest

Although different actions have been taken over time to control it, tuberculosis had continued to be a substantial public health issue of concern globally despite the slow and regular decline in the incidence of the disease which has been witnessed over the past decade. According to the WHO, nearly 8.6 million new cases of tuberculosis were reported globally, which caused nearly 1.3 million deaths (Wu & Dalal, 2016).

Of these cases, nearly 2.9 of those who suffered from TB were women. Most cases of tuberculosis were witnessed in Asia and Africa, with 58% and 27% incidence rates, respectively. Tuberculosis has been documented as the main killer of the people who are infected with HIV. In the US in 2017, nearly 9,105 new cases were reported. This is equivalent to 2.8 cases for every 100 000 persons.

This was a considerable decrease from the number of tuberculosis cases that were reported in 2016 and also the lowest case counts across the US. The incidence rates represented a 2.3 % decreases from 2016.  In 2016 there were 528 reported TB deaths in the US. In the US, TB cases are 33 times higher for Asians than whites and nine times higher amongst African Americans than Whites while being eight times higher for Hispanics / Latinos than Whites (Knechel, 2018).

The control of TB requires strengthening and maintaining current TB control priorities.  Ending TB will also require increased efforts of identification and treatment of latent TB infections, especially among high-risk populations.

Tuberculosis is a reportable disease with Healthcare providers who diagnose and take care of patients with any form of TB such as nun pulmonary and pulmonary being required to report the cases to their local health officers (LHO) or the local health department (LHD). The healthcare providers are also required to report the status of all patients to the health officer in their locality after three months.

The local health facilities of the local health department is charged with the responsibility of controlling tuberculosis in their given jurisdiction at all times (Raviglione & Sulis, 2016). The local health department and local health officers are also required to maintain a TB control program .The local health officer and departments are also changed by overseeing isolation and maintaining all outpatient treatment and diagnostic measures related to TB (Raviglione & Sulis, 2016).

Social Determinants of Health

Social determinants of health are different environmental conditions in which people live learn and are born, which will affect their health outcomes and risks to different diseases. Social conditions such as social, economic, and physical such as a church, workplaces school, and neighborhood will affect the health outcomes of an individual. Such as one’s neighborhood may affect their access to affordable housing, public safety, emergency health services,education level, and availability of healthy foods and environments which are free of any toxins (Hargreaves, Boccia, Evans, Adato, Petticrew & Porter, 2015).

According to WHO, poverty is a strong social determinant of TB. Working environments associated with poverty such as overcrowded and poorly ventilated environments are huge factors that contribute to the transmission of TB. Malnutrition will also contribute to the progression of the active form of TB. Poverty also contributes to low health knowledge which will contribute to low knowledge of the risk factors of TB such as smoking, alcohol abuse, and HIV (Wu & Dalal, 2016).

Epidemiologic Triangle of TB

The epidemiologic triangle is a scientific model utilized to study health problems. The epidemiologic triangle is comprised of three corners which include the agent, host, and the environment (Hargreaves et al., 2015). The agent will entail the causes of a given disease. In tuberculosis which is an infectious disease, the agent will be the microbe known as the Mycobacterium. Mycobacterium tuberculosis is a non-spore forming rod-shaped, aerobic bacterium (Sulis et al., 2014).

The host in the epidemiologic triangle entails organisms such as animals or humans who will be exposed to given diseases. In some instances, the host may be just a carrier while it may also be an animal that gets sick. In some instances, the host may not show signs and symptoms of infectious diseases such as the latent stages of tuberculosis. For tuberculosis, the hosts are human beings (Hargreaves et al., 2015).

The environment in the epidemiologic triangle will entail the external conditions and surroundings which affect the host and allow the disease to be transmitted or causes the disease. For tuberculosis, environmental factors will include inadequate ventilation, overcrowding, poverty, and malnutrition (Sulis et al., 2014).

To prevent the spread of tuberculosis, most effort is placed in ensuring that the host in humans does not come into contact with the disease-causing agent, which is the mycobacterium. Efforts to curb the spread of tuberculosis thus include isolation of the infected patients, public health promotion campaign to the general population to live in well-ventilated buildings and avoid overcrowding and efforts to promote better nutritional low-income areas (Hargreaves et al., 2015).

Role of the CHN in Maintaining Community Health.

The community health nurses will play different roles in infectious disease prevention and health promotion in the communities they serve. These include acting as the primary disease prevention specialist in their areas. In this regard, the community health nurses will focus on both the short and long term care for disease prevention.

For example, in relation to diabetes, the community health worker will implement different campaigns to prevent its spread such as advocating for proper ventilation in workplaces and residential areas, and better nutrition for the community (Knechel, 2018).

The community health nurse will also act as the main community educator in relation to infectious diseases such as TB. This will include presenting materials that educate the community on the risk of diseases such as smoking and alcohol for TB. This may also include sex and HIV education classes (Raviglione & Sulis, 2016).

The community health nurse will also act as the main researcher of health issues in the community they serve. This will include the collection and the use of evidence so as to execute positive changes and ensure better health in the community. For example in the case of Tuberculosis the CHN may collect data related to the prevalence of the disease in their community,  analyses such data, report such data to the necessary authorities and also take time to understand the causes of the new infections (Knechel, 2018).

Such research will help CHN implement effective public health initiatives. In all their functions the demographic data will be important in determining the health of the community as it will provide a picture of the environmental, social and economic factors which may affect the health outcomes of a population (Raviglione & Sulis, 2016).

National Agency

The Centers for Disease Control and Prevention (CDC) plays an essential role in reducing and resolving the impact of tuberculosis. The CDC sustains and funding and research in TB prevention and drug-resistant TB with such research being necessary in reducing TB infections in the US and globally. The CDC also formulates the policies which should be followed by health organizations and healthcare providers in dealing with TB patients such as procedures of isolating such patients to avoid the spread of the diseases and the procedure which should be followed in reporting of new cases (Knechel, 2018).

Global Implications of Tuberculosis

According to the WHO, nearly 8.6 million new cases of tuberculosis were reported, which caused nearly 1.3 million deaths.  Of these cases, nearly 2.9 of those who suffered from TB were women. Most cases of tuberculosis were witnessed in Asia and Africa, with 58% and 27% incidence rates, respectively (Wu, & Dalal, 2016). Both India and China accounted for nearly 38% of the total number of TB cases in 2016.

Tuberculosis is not endemic to Asia despite the high prevalence rates with the disease being found in nearly all regions of the world with varying prevalence rates. The high TB prevalence rates in Asia have been credited to the socioeconomic status and the high exposure to of the population in these countries to risk factors such as smoking. As a result of being densely populated, there is a lot of overcrowding in both India and China, which facilitates the spread of TB the high number of smokers in China also contributes to this. All efforts in these countries to curb TB, therefore, have to sensitize to the public on the risk of overcrowding and harmful habits such as smoking.



Hargreaves, J. R., Boccia, D., Evans, C. A., Adato, M., Petticrew, M., & Porter, J. D. (2015). The

social determinants of tuberculosis: from evidence to action. American journal of public health101(4), 654–662. DOI:10.2105/AJPH.2010.199505.

Knechel,  N.A. (2018).Tuberculosis: Pathophysiology, Clinical Features, and Diagnosis. Critical

Care Nurse. Vol. 29 no. 2 34-43.  DOI: 10.4037/ccn2009968.

Raviglione, M., & Sulis, G. (2016). Tuberculosis 2015: Burden, Challenges, and Strategy for

Control and Elimination. Infectious disease reports8(2), 6570. DOI:10.4081/idr.2016.6570.

Sulis, G., Roggi, A., Matteelli, A., & Raviglione, M. C. (2014). Tuberculosis: epidemiology and

control. Mediterranean journal of hematology and infectious diseases6(1), e2014070. DOI:10.4084/MJHID.2014.070.

Wu, J., & Dalal, K. (2016). Tuberculosis in Asia and the pacific: the role of socioeconomic status

and health system development. International journal of preventive medicine3(1), 8–16.

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