Assignment: Epidemiology in Public and Global Health

Assignment: Epidemiology in Public and Global Health

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Assignment: Epidemiology in Public and Global Health

Write a 3- to 4-page paper that includes the following:

  • A summary of the article, including the title and author
    • Identify the title of the article with in-text citation and corresponding reference in the reference list
  • The relationship among causal agents, susceptible persons, and environmental factors (epidemiological triangle)
  • The role of the nurse in addressing the outbreak
  • Possible health promotion/health protection strategies that could have been implemented by nurses to mitigate the outbreak
  • Epidemiologic surveillance is used in public and global health. For this Assignment, begin by locating a recent article about an outbreak of an infectious or communicable disease. The article can come from a newspaper or other source but your paper must be supported with at least three scholarly sources of evidence in the literature which may include your text or course readings.

Plague Outbreak

Plague is a disease that affects humans and other mammals that is caused by the bacterium, Yersinia pestis (CDC). People typically get plague through a flea from a rodent that is carrying the bacterium. If the plague is pneumonic, it can be spread from person to person through droplets when they cough. Plague has become well known for killing millions of people in Europe during the Middle Ages. While modern medicine has become effective in treating plague, it can cause serious illness or death without proper treatment.

Plague can manifest in three main clinical forms, bubonic, pneumonic, and septicemic. Bubonic plague is characterized by patients suddenly developing fever, headache, chills, weakness, and at least one swollen and painful lymph node. The bacteria will multiply in the lymph nodes closest to where it entered the body. Septicemic plague will cause all of the same symptoms as bubonic, while also causing abdominal pain, shock, and possibly bleeding into the skin or other organs. This may cause skin and other organs to turn black and die, with the fingers, nose, and toes being the most common places for this to occur. This form of plague typically develops as a result of untreated bubonic plague. The most serious form of plague is pneumonic plague. This is the only form of the disease that can be spread from person to person, through infectious droplets. Infected people will have all of the same symptoms of bubonic plague, along with a rapidly developing pneumonia, which can lead to respiratory failure and shock.

Article Summary

I chose to write about the 2017 plague outbreak in Madagascar after reading the article, “The 2017 Plague Outbreak in Madagascar: Data Descriptions and Epidemic Modeling” by Van Kinh Nguyen, Cesar Parra-Rojas, and Esteban A. Hernandez-Vargas. This article was published in December 2018 and addressed the concern of the plague outbreak in 2017. Plague is endemic to Madagascar and occurs annually; however, the 2017 outbreak was the most severe in history. There were a total of 2,417 cases confirmed, with 209 people dying from the disease. Through response by the World Health Organization and the government of Madagascar, this outbreak was able to be stopped. By strengthening the identification and treatment of plague cases, many deaths can be prevented (Nguyen, 2018). In the rural areas of Madagascar, it is important to teach people how to control their interactions with rodents and their fleas, as this is the most common way that plague is spread. Lastly, it was very important to teach people to practice safe and dignified burials of corpses.

Epidemiological Triangle

Plague, like any other disease, has to have an agent, a host, and an environment. This is what makes up the epidemiological triad. In a developing country like Madagascar, everything comes together for a disease like plague to strike. When there is an outbreak, it is not stopped quickly due to the poor healthcare system in Madagascar.

Casual Agents

A casual agent is referred to as an organism that is capable of causing disease (Stanhope and Lancaster, 2016). Casual agents can be fungi, viruses, bacteria, or parasites. Plague is caused by a bacteria, Yersinia pestis, and is usually first spread through fleas from infected rodents. A person is bitten by the flea from the infected rodent and is then infected with the disease themselves.

Susceptible Persons

Plague can affect anyone who comes into contact with it; however, according to the World Health Organization “Plague is a disease of poverty. It thrives in places with poor sanitary conditions and inadequate health services” (2017). In 2017, Madagascar ranked as the 10th poorest country in the world (Tasch, 2017). In a region as poor as this, it is easy for a disease such as plague to thrive. People live in unsanitary conditions and do not have the money to seek treatment if they do get sick.

Environmental Factors

Environmental factors can facilitate the transmission of an infected agent and are related to patients biological, physical, cultural, and social factors (Stanhope and Lancaster, 2016). The plague outbreak in 2017 was originally brought on by a 31-year old man who was bitten by an infected flea. He boarded a bus to travel across the country, and along the way his symptoms worsened and he eventually died in transit. This man not knowing that he was infected with plague led to everyone in contact with him on the bus contracting plague. The CDC recommends reducing the rodent habitat around your home or place of work, to wear gloves when skinning or coming into contact with animals that could be infected, and to use repellent when you could be exposed to rodent fleas such as when hiking outdoors.

Role of the Nurse

The nurse’s role is to aid in protecting the public from an infectious disease outbreak. It is our job as nurses to educate the public on how to prevent this disease and to seek proper medical care when displaying symptoms of plague. Nurses are responsible for working with health officials to monitor and respond to an outbreak. To properly respond to an outbreak, nurses must be educated on the disease, be competent in caring for those that are infected, and must follow government regulations. Lastly, it is the nurse’s role to assist in surveillance and investigation of the outbreak.

Health Promotion Strategies

Health promotion depends on the different levels of prevention. The three different levels are primary prevention, secondary prevention, and tertiary prevention. Primary prevention would involve providing proper education to the citizens of Madagascar. Secondary prevention is investigating the outbreak of plague. Finally, tertiary prevention would be treating those that are infected with this disease.


Plague has become an endemic disease in Madagascar. Every year there are at least dozens of people that die from this disease, with 2017 being the worst year to date. Through proper education and treatment, this disease can be prevented. It is our job as nurses to aid in education and treatment efforts. Implementing these strategies should prove effective in mitigating the outbreak of plague in the future.


Centers for Disease Control and Prevention. (2018). Plague. (n.d.). Retrieved March 16, 2019, from

Nguyen, V. K., Parra-Rojas, C., & Hernandez-Vargas, E. A. (2018). The 2017 plague outbreak in Madagascar: Data descriptions and epidemic modelling. Epidemics,25, 20-25. doi:10.1016/j.epidem.2018.05.001

Tasch, B. (2017, March 7). RANKED: The 30 poorest countries in the world. Retrieved March 16, 2019, from

Mead, P. S. (2018). Plague in Madagascar — A Tragic Opportunity for Improving Public Health. New England Journal of Medicine,378(2), 106-108. doi:10.1056/nejmp1713881

Tsuzuki, S., Lee, H., Miura, F., Chan, Y. H., Jung, S., Akhmetzhanov, A. R., & Nishiura, H. (2017). Dynamics of the pneumonic plague epidemic in Madagascar, August to October 2017. Eurosurveillance,22(46). doi:10.2807/