Grand Canyon University
Concepts in Community and Public Health
NRS-427V-0501
Benchmark Assignment: Epidemiology Paper
Hepatitis B
The definition for Hepatitis changes with whom you ask. To some it means a horrible painful way to die while others are able to look at it as a disease. The word Hepatitis means liver inflamation. The liver is a large, glandular, reddish-brown organ located in the upper right side of the abdomen. It consists of 5 lobes and secretes bile into the gallbladder and into the small intestine and aids in the digestion of lipids. Hepatitis is often caused by a virus. Hepatitis A, B, and C are the most common types in the United States but there is also a type D, E, and there was thought to be an F but after a thorough investigation they failed to prove its existence. Hepatitis B (HBV) is a liver disease that is contagious. It is believed that approximately 1.2 to 1.4 million people in the United States have chronic Hepatitis many of which are not officially diagnosed. There are two stages or categories of Hepatitis B, chronic and acute. Chronic Hepatitis B is anyone who has had the virus for longer than 6 months ("Hepatitis B," 2010) and at this point it is considered a lifelong illness. The beginning or acute phase of Hepatitis B is the first 6 months of being exposed to the virus. During this first 6 months some people are able to fight the infection off and get rid of it. Symptoms may vary and young children may not have any symptoms. Adults generally have results within 3 months and they can last a few weeks to six months. Possible symptoms may include: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, grey colored stools, dark urine, and joint pain.
The Hepatitis B virus is caught from an exposure to semen, blood, or other body fluid of an infected carrier. This is done by the body fluid of an infected person entering the body of a non-infected person. Using the Epidemiologic Triangle we can see how this works. The host carries the virus, then through the exposure of a host’s body fluid to an unaffected person the agent is passed on. The environment that this takes place is the body fluid to body fluid exchange. The routes of transmission may be both vertical and horizontal. Mother to child is an example of vertical and intravenous drugs would be an example of horizontal.
The Host is the carrier of the hepatitis B virus.
The Agent is the Hepatitis B virus itself.
The environment is the body fluid to body fluid exposure.
The Host is the carrier of the hepatitis B virus.
The Agent is the Hepatitis B virus itself.
The environment is the body fluid to body fluid exposure.
Figure 1(CDC, n.d.)
Hepatitis B is not transmitted via food or water, breastfeeding, hugging, kissing, coughing, sneezing, sharing utensils, or holding hands ("Hepatitis B FAQs for Health Professionals,"). No link to animal transmission has been found. Hepatitis B virus can live outside the body for more than 7 days and still be capable of causing an infection. Body fluids, especially blood, whether wet or dry should be cleaned using 1:10 bleach to water when disinfecting the area. Universal precautions should be used to clean up any spills. Common Ways to transmit Hepatitis B | * Sex with an infected carrier. * Sharing needles, syringes, and drug-prep equipment that has been contaminated with the virus. * Passed on from mother to fetus. * Needle sticks. * Contact with the blood or sores from an infected person. * Contact with mucosal or infected body fluids. * Sharing any items that may be exposed to blood such as toothbrushes or razors with an infected person ("Hepatitis B FAQs for Health Professionals," 2015). | 25% of children and 15% of adults die prematurely from cirrhosis or liver cancer. Most people infected with hepatitis B will remain asymptomatic until cirrhosis or end-stage liver disease. There are 2 billion people worldwide who are infected and an estimated 12 million in the United States. It is believed that 5,000 Americans and 1 million people worldwide die each year from complications or hepatitis itself. Pacific Islanders and Asians have the highest risk of contracting HBV. In the United States most newborns are vaccinated. Determinants to screening and treatment for the Asian & Pacific Islanders as well as others may include: * Knowledge and awareness of the virus causing low testing rates. * Cultural stigma as many immigrants have cultural beliefs and fears pertaining to a positive diagnosis of HBV. * Language barriers as many are not native English speakers and have a limited understanding. * Lack of health insurance or a discomfort with western medicine. * Inability to access vaccine as vaccination programs have not been implemented in some countries. * Inaccuracy of tests especially for African infants.
Treatment is varied. There are several drugs used to treat hepatitis in the United States. Intron A, Epivir-HBV, Pegasys, Baraclude, Hepsera, Viread, and Tyzeka are the only FDA approved drugs that have been shown to slow the virus and decrease liver damage and in some cases the virus is killed completely ("Hepatitis Treatments," n.d.). Ultimately vaccination is the best way to prevent HBV. The vaccine has been found to be effective and safe. Administration is given over a 6 month time and consists of 3-4 shots ("Hepatitis B," n.d.) and is estimated to be 95% effective. Everyone should be vaccinated but the following groups are strongly advised to receive the vaccine. Infants and children, healthcare workers, anyone sexually active especially men in same sex relationships, those who have infected family members or friends, diabetics, and those on dialysis may have an increased risk of acquiring hepatitis B. Those with a documented yeast allergy or an adverse reaction to the vaccine should not be vaccinated. The cost of the 3 shot vaccination is about $75-$165 in the United States, but infants and children can often receive them for free from public health clinics ("Hepatitis B vaccine," n.d.). The community health nurse has a wide and varied job with and disease process: Prevention- Could be addressed by expanding screening and referrals, improving access to vaccines and insuring best practice in healthcare settings.
Education- Education on high risk factors in the community and healthcare workers, increased promotion of prevention efforts in high risk lifestyles, healthy lifestyle encouragement, and teaching universal precautions in relation to body fluids.
Research- Acquire resources to adequately provide local and state surveillance. Education and investigation of reporting requirements and standardization of reporting. Use acquired information to focus teaching on high risk areas. Continue research into privation, care, and treatment.
Treatment- Ensure provider access to current guidelines for care and treatment. Establish referral and follow up network to ensure treatment for both insured and uninsured. Provide timely care. Ensure and encourage infant vaccination. Policy- Establishment and regulatory services. Inclusive policy development to insure no racial, social, financial, or sexual detriments. Implantation of program, with a plan to quickly and accurately provide change in policy as needed to stay current with best practice.
By maintaining this framework the community health nurse may insure a decrease in hepatitis b and improved outcomes. One national agency for hepatitis B research and education is the Hepatitis B Foundation. They are proclaimed to be the only non-profit organization who are entirely dedicated to the finding a curehepatitis B problem. Their mission is to find a cure and improve the quality of life for all those whose lives are affected by hepatitis B ("Our mission and story," n.d.). This mission is implemented by providing educational materials regarding drugs, clinical trials, a liver specialist’s directory, and fund raisers to provide money for research, outreach, and advocacy programs. The can be found at. http://www.hepb.org/index.html
References Understanding the Epidemiologic Triangle through Infectious Disease. (n.d.). Retrieved from http://www.cdc.gov/bam/teachers/documents/epi_1_triangle.pdf
Hepatitis B. (2010). Retrieved from http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf
Hepatitis B and C Treatments. (n.d.). Retrieved February 19, 2016, from http://www.fda.gov/ForPatients/Illness/HepatitisBC/ucm408658.htm
Hepatitis B vaccine. (n.d.). Retrieved February 19, 2016, from http://www.hepb.org/hepb/vaccine_information.htm
Hepatitis B vaccines to prevent hepatitis B . (n.d.). Retrieved February 19, 2016, from http://www.vaccines.gov/diseases/hepatitis_b/
Our mission and story. (n.d.). Retrieved from http://www.hepb.org/about/our_mission_and_story.htm
Viral Hepatitis - Hepatitis B Information. (2015). Retrieved February 19, 2016, from http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm
