Epidemiology, What? Is that even an English word? Epidemiology is the study of health and health concerns in a population with an emphasis on establishing cause and effect. Epidemiology looks at how the disease manifests and spreads through out a population that are a risk and come up with effective prevention and treatment. Epidemiology Triangle
Epidemiology is different from medical fields because it does not focus on one individual it focuses on a group. Epidemiology directly impacts public health. Epidemiology is centered on three factors in a population setting, the Host, the Agent, and the Environment. These three factors are part of the Epidemiology Triangle. The Host is the population the disease or health problem concern. The host is the Human who can come in contact with the disease. There are a lot of things that intrinsic the host and are often called risk factors. Opportunities for exposure often are influenced by the person’s behaviors for example Sexual practices, hygiene, a person’s choices and age and sex. Sometimes people are more susceptible due to genetic composition, nutrition, immune system, anatomic structure, present illness, medications and psychological makeup.
The Agent is the health concern or the health problem. An Agent must be present for a disease to occur, but presence of an agent is not always sufficient to cause a disease. There are many factors that influnance weather an exposure will to an organism will result in disease, including pathogenicity and dose. The environment is the geographical area where the disease takes place and refers to the extrinsic factors that affect the agent and opportunity for exposure. The factors that are environmentally include social economic factors such as overcrowding populations, sanitation issues and availability of health care. Throughout the remains of this paper there will be examples of the epidemiology triangle as it focuses on Human Papillomavirus or HPV. Population and Disease of interest
The Human Papillomavirus refers to a virus that comes from the family of Papillomavirus. This family establishes infections in the keratinocytes of the skin or mucus membranes. There are more than 100 different strains of the virus. History shows that HPV infections are linked all the way back to ancient Greece and Rome. It was described as lesions in the genital area which matches up to HPV induced warts. The doctors of the ancient times wrote it as lesions with sexual activity, it was not until the 1970 when researchers identified it as warts caused from HPV. Assessment of the Population
The center for disease control and prevention say that approxmently 20 million Americans currently have HPV and another 6.2 million become infected every year. The CDC also says that 50 percent of Americans become infected at some point of their lives. HPV virus has more than 100 different strains, many of which are harmless and cause no signs or symptoms or illness and will clear up on their own however there are types of the virus that cause a huge amount of trouble and including genital warts , cervical cancer, vaginal cancer, and even anal cancer. HPV types 16 and 11 cause 90 percent of genital wart, about 20 percent of the vulva and rectal cancers and between 60 percent of the vaginal cancers.
HPV type 16 and 18 are the result of 70 percent of the cervical cancers in the United States. Unlike Aids and HIV some types of HPV can be passed through skin to skin centrally or by touching someone who is infected with HPV virus. HPV that caused genital HPV signs and symptoms can only be passed through vaginal or anal intercourse. There is a chance that a mother could pass it to her child during childbirth. HPV is not sexist and both men and women can contract the disease and because sometimes there are no signs or symptoms it can be passed to other people unknowingly. HPV has shown high in what is sad to say but middle and high school students. Many of these students are sexually active and use no means of protection there is a vaccine that teens and young adults can get to help prevent HPV. Relationship of Disease to the various levels of prevention
Prophylactic vaccination against high risk human papilloma virus 16 and 18 represents an exciting means of protection against HPV related malignancy. However, this strategy alone, even if there is a level of cross protection against other oncogenic viruses, cannot completely prevent cervical cancer. In some countries cervical screening programs have reduced the incidence of invasive cervical cancer by up to 80 percent although this decline has now reached a plateau with current cancers occurring in patients who have failed to attend for screening or where the sensitivity of the tests have proved inadequate. Cervical screening is inevitably associated with significant anxiety for the many women who require investigation and treatment following abnormal cervical cytology. However, it is vitally important to stress the need for continued cervical screening to complement vaccination in order to optimize prevention in vaccines and prevent cervical cancer in older women where the value of vaccination is currently unclear.
It is likely that vaccination will ultimately change the natural history of HPV disease by reducing the influence of the highly oncogenic types HPV 16 and 18. In the long term this is likely to lead to an increase in recommended screening intervals. HPV vaccination may also reduce the positive predictive value of cervical cytology by reducing the number of truly positive abnormal smears. Careful consideration is required to ensure vaccination occurs at an age when the vaccine is most effective immunologically and when uptake is likely to be high. Antibody titers following vaccination in girls 12-16 years have been shown to be significantly higher than in older women, favoring vaccination in early adolescence prior contact with the virus. Highest prevalence rates for HPV infection are seen following the onset of sexual activity and therefore vaccination would need to be given prior to sexual debut. Values Potential Personal and Cultural biases and Conflict
Since 20 percent of adolescents are sexually active at the age of 14 years, vaccination has been suggested at 10-12 years. However, parental concerns over the sexual implications of HPV vaccination may reduce uptake of vaccination thereby reducing the efficacy of an HPV vaccination programs. Concerns have already been raised over the acceptability of a vaccine preventing a sexually transmitted infection in young adolescents, particularly amongst parents or communities who consider their children to be at low risk of infection. This may be a particularly sensitive issue for ethnic minority groups. As a parent of an adolescent this is of great concern to me that parents are in complete denial about what their child is doing at this age, form observing the teens in generally they do not tell their parents the complete truth and beat around the bush when they are questioned about what they are doing. When this writer was in middle and high school this was not a subject that was spoken of and school did not take the time to educated on this subject but yet there were several girls that has baby’s or toddlers by the time that they finished high school or if they were even able to finish high school.
In the middle schools and high schools now there are school based clinics that have the time and educate the teens on the different issues that could arise if they are sexually active and do not use protection. These school based clinic hand out free condoms and provide birth control for teens that cannot have it provided at home or do not want to notify the parents of their actions they are involve in. the school based clinics are also sites where these teens can obtain the HPV vaccine on their own without a parents consent. This writer thinks that it is a wonderful idea but on the other hand teens often think that if they get the vaccine and start on the birth control that they are protected and can have sexual intercourse when and with whom they want, when infect the vaccine only helps protect them from getting HPV that can cause cancer and the birth control will only protect them from being a teen mother.
There is only one vaccine that will prevent HPV. Gardasil is the only human papillomavirus vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, Gardasil helps protect against 2 types of HPV that cause about 70 percent of cervical cancer cases, and 2 more types that cause about 90 percent of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against approximately 90 percent of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against approximately 70 percent of vaginal cancer cases and up to 50 percent of vulvar cancer cases. Gardasil may not fully protect everyone, nor will it protect against diseases caused by other HPV types or against diseases not caused by HPV. Gardasil does not prevent all types of cervical cancer, so it’s important for women to continue routine cervical cancer screenings. Gardasil does not treat cancer or genital warts. GARDASIL is given as 3 injections over 6 month period.
Throughout this paper the Epidemiology triangle was mentioned the host was brought up through the point that teen are sexually active sometimes starting at the age of 12 years old and that HPV can affect both sexes men and women. This paper brought up the Agent in the triangle which would be the transmission, treatment and the prevention. We learned that HPV can be transferred skin to skin but the HPV that effects the genital is transmitted through sexual intercourse and often has no sign and symptoms until it is too late. We also learned that HPV can be transmitted without anyone knowing. The prevention was also spoke of it is the vaccine that you can get to help protect from certain types of cancers and that teens are able to obtain the vaccine through the school based clinics without parent consent. There is also birth control and condoms available through the school based clinic.
The third step in the triangle is the environment and that was combined with prevention in a way that HPV is effecting or teens all over and that it has become a huge problem for them to be sexually active at such a young age and not really have the knowledge behind what they are doing. It was also talked about that HPV is linked all the way back to ancient Rome and Greece. HPV is going to continue to be a problem throughout the nation and is going to always need continuing education to help prevent and cut down on out breaks. The US as a whole need to take steps and speak to their children, nieces and Nephews about the causes of them being sexual active while in their teenage years and as adult and parents they need to be open to the fact that their perfect doesn’t do anything wrong teen might be just doing things without you knowing.
Dang, M. T. (June 2012). Let Teens provide their own concent for the vaccine. View Point, 112(6), 6. Holland, C. (June,2011). Infectious disease in children. Retrieved from http://www.pediatricsupersite.com Infectious disease. (2013). HPV. Retrieved from http://www.Infectious Disease and prevention.com Dombrower, A. (2009). Where did Human Papillomavirus
originate. Retrieved from http://www.ehowhealth.com Goldman, M. (2010). HPV. Retrieved from http://www.women and health.com Streicher MD, L. (2010). The Truth about HPV. Figure Magazine, 1(1), 1. Denver Health School Based Clinic. Lake Middle School.