Grand Canyon University
Concepts in Community and Public Health
NRS 427V Colleen Darrow RN
June 28, 2014
Epidemiology Paper
“World wide, two billion people have been infected with hepatitis B Virus” (Shepard & Simard, 2006, p. 112) Hepatitis B virus cause liver tissue infections which is life threatening potentially. And both acute and chronic hepatitis B has a profound impact on global health. “More than 240 million people have chronic liver infections, and more than 780,000 people die every year due to the acute or chronic consequences of hepatitis B.”("WHO Media Center," 2014) The HBV is transmitted from an infected carrier to the others via contact with blood and other body fluid. Hepatitis B is also a major occupational hazard for health workers. Fortunately the infection can be effectively prevented by safe vaccine. Since 1982, safe Hepatitis B vaccine has been available; the effectiveness of preventing the infection and its long-term consequences has been established. Hepatitis B vaccine is the first vaccine which against a major human cancer.
“HBV infection may result in subclinical or asymptomatic infection, acute self-limited hepatitis, or fulminant hepatitis requiring liver transplant.” (Shepard & Simard, 2006, p. 113) The average incubation period is 90 days for a newly infected person who may develop acute hepatitis. The common signs and symptoms for acute hepatitis are nausea, abdominal pain, vomiting, fever, jaundice, dark urine, changes in stool color, and etc. If the presence of HBsAg in the serum is more than 6 months, the infected person most likely will be diagnosed with Chronic HBV. Most of the people who are infected by HBV chronically may not present any symptoms, the cost of treatment associated with complication of chronic HBV are very high. “More than 90% of healthy adult who are infected with the hepatitis B virus will recover and be completely rid of the virus within 6 months.”("WHO Media Center," 2014) However, infants are badly affected by early exposure of HBV, and “90-95% of infants exposed to the HBV will develop chronic hepatitis B, and only 30% of children aged five years or older will develop chronic Hepatitis B.” (AHA Consensus-based Nursing Guidelines, p. 25)
“Hepatitis B prevalence is highest in sub-Saharan African and East Asia.”("WHO Media Center," 2014) majority of the people in these areas are infected with HBV early in their lives, and close to 10% adult has chronic hepatitis B infection. The most common mode of HBV transmission happens from mother to infant through labor process and after. Specific treatment has not developed to treat acute hepatitis B, and the goal of care is still focus on comforting and nutritional balance. Medications that are used to treat chronic Hepatitis B are interferon and antiviral agents. Liver cancer is a fatal diagnosis and people with cirrhosis may benefit from liver transplant.
Biology, generics, social environment, individual behavior, physical environment and health services are the five recognized determinants. (Beltran & Harrison, 2011) Since the cause of HBV infection is direct contact to body fluids into their bloodstream, or mucosa membrane, therefore; the populations that are exposed to HBV depends on exposures at their working, living environments. Low-risk population groups are healthcare providers-no or infrequent blood contact, and healthy adults. Intermediate-risk population including male prisoners, healthcare providers that have frequent blood contact, staff or mental health institutions, and heterosexual with multiple partners. Immigrants and refugees from high HBV endemic areas are the high-risk groups. Homosexually men, drug user, patients on hemodialysis are also high-risk groups. ("WHO Media Center," 2014).
The epidemiological triangle has the three main factors---agent, environment, and host in the pathogenesis of disease. “HBV is a DNA virus classified in the virus family Hepadnaviridae.”(Shepard & Simard, 2006, p. 112) HBV is present in body fluids including blood, saliva, semen and vaginal fluids and can be to a susceptible individual through entering the bloodstream. Persons with chronic HBV infection are the major reservoir for transmission. Since HBV remains stable infectious on environmental surfaces for up to 7 days, contaminated surfaces and other objects can facilitate the virus transmission indirectly during the period. Many effective HBV prevention methods had been implemented before the introduction of hepatitis B vaccines. However, none of the methods had been proven to be effectively eliminated HBV. Vaccination is still the most effective HBV prevention methods. Adult immunization occurs over six months after the administration of three injections. Newborn and infants younger than 6 weeks of age can receive single antigen hepatitis B vaccine. “The safety of hepatitis B vaccine has been demonstrated in a large, prospective clinical trial and post licensure safety analyses.”(Shepard & Simard, 2006, p. 117) More than 95% of infants, children and young adult are able to maintain protective antibody levels after complete the vaccine series. And at least 20 years to life long protection should be expected in the most cases. In addition, blood safety can be maintained by screening of all donated blood components to prevent transmission of HBV.
“Community health nurse have a critical role in caring for patients with chronic hepatitis B, as they support the patient during the implementation of the management plan, including both monitoring with and with out treatment.”(AHA Consensus-Based Nursing Guidelines, p. 25) The first step of identifying infected persons is screening. Public access to HBV screening is the key to ensure early diagnosis, entry to care and initiation of treatment. Community health programs to report and follow up known cases are important. Surveillance data can assist with identification of hepatitis B-infected persons and persons who may be at risk. In order to decrease the risk of transmission, early entry to hepatitis B care and initiation of post-exposure prophylaxis are the crucial steps. Positive outcomes and a decrease in the morbidity and mortality related to chronic liver disease can be expected. Due to the complexity of health care system, it is very challenging for persons living with HBV. A multidisciplinary team of providers is needed to provide care, treatment and support. Of. At the same time, people who live with HBV infected family members are usually uninsured or underinsured. These family members need to be able to access programs that assist with HBV prevention, care and treatment-related services. Educating the general public regarding hepatitis B is another important measures for community health that helps more people reducing or eliminating their risk, getting screened, diagnosed and vaccinated. Maintaining a health lifestyle is also important for newly diagnosed persons. “Patients diagnosed with chronic hepatitis B virus infection require life long monitoring and are usually cared for by specialist teams in secondary care.”("Nursing time.net" 2014)
Hepatitis B Foundation, which was established in 1991, currently is the only national non-profit organization dedicated to the global threats of hepatitis B. The foundation “dedicated to finding a cure and improving the quality of life for those affected by hepatitis B world wide.”("Hepatitis B Foundation," 2014) The foundation focuses on research, promoting disease awareness, supporting immunization and treatment initiatives.
References AHA Consensus-based Nursing Guidelines for the Care of Patients With Hepatitis B. In AHA consensus-based Nursing Guidelines (pp. 25-37-). Retrieved from
A Nurse-Led community Hepatitis B clinic. (2014). Retrieved from www.nursingtimes.net/nursing-practice/clinical-zones/infection-control
Beltran, V. M., & Harrison, K. M. (2011). Collection of Social Determinant of Health Measures in U.S. National Surveillance Systems for HIV, Viral Hepatitis, STDs, and TB Public Health Reports, 126, 41-51. Retrieved from http://dx.doi.org
Hepatitis B. (2014). Retrieved from www.who.int/mediacentre/factsheets
Hepatitis B Foundation: Our Mission and story. (2014,). Retrieved from:
Shepard, C. W., & Simard, E. P. (2006). Epidemiologic reviews [Entire issue]. Epidemiologic reviews, 28
Understanding the Epidemiologic Triangle through Infectious Disease. Retrieved from www.cdc.gov
