Hepatitis B: A Global Health Crisis
Gina Duron
Grand Canyon University: NRS 427V
November 15, 2015

Hepatitis B: A Global Health Crisis
Approximately one-third of the world’s population have been infected with the hepatitis b virus (HBV) and 240 million people are infected with chronic hepatitis b infection worldwide. This communicable disease is a potentially life threatening liver infection. It has become a global health problem that affects all areas of the world. Many organizations, health care providers, and governments around the world are working together to address the health concerns that affect different parts of the world. By understanding the health determinants that affect hepatitis b and researching the epidemiologic triangle of hepatitis b, policies and plans can be developed to guide the community health nurse in her role in reducing the morbidity and mortality of this communicable disease.
What is Hepatitis B?
Hepatitis b is a viral infection that can manifest as acute or chronic. Approximately ninety percent of adults with a normal immune status can recover completely from a newly acquired hepatitis b infection. Infants, young children, immunocompromised persons infected with hepatitis b are more at risk for developing the chronic form of disease which can lead to life threatening liver disease and liver cancer. Symptoms of HBV include jaundice of skin and sclera, abdominal pain, fever, joint pain, weakness and nausea and vomiting. This communicable disease is diagnosed by laboratory testing of blood. It affects different populations more so than others and is more prevalent in sub-Saharan Africa and South East Asia. 20,000 persons were newly diagnosed in the United States in 2013. The majority of those were males between the ages of twenty five and forty four years of age (WHO, 2015). This disease is transmitted through activities that involve exposure to infected blood and body fluids. Examples of these activities involve unprotected sexual contact with infected persons, sharing of needles by intravenous drug users, birth to an infected mother, needle stick exposure, and sharing items such as razors and toothbrushes with an infected person.
Determinants of Health
Determinants of health can affect how this disease progresses and spreads. According to Dean and Fenton (2013), “social determinants of health are the economic and social conditions that influence health of individuals and communities. They determine the extent to which a person possesses physical, social, and personal resources to identify and achieve personal goals, satisfy needs, cope with environment and achieve optimal health” (p 5). Individual behavior is a determinant of health that can affect risk for hepatitis b. A homosexual male who has unprotected sex is at risk for contracting HBV. Intravenous drug abusers who share needles are at risk for developing HBV. Social environments such as ethnicity, income and education level can affect a person’s risk for HBV. A person’s income can affect a person’s ability to access quality health care. Education level can affect a person’s ability to understand teaching given to prevent spread of disease. The physical environment of a person can determine risk of HBV. Different parts of the world are at higher risk for disease due to lack of funding for vaccines and treatment of HBV. Persons living in Western Europe and North America are affected less than persons from sub-Saharan Africa and South East Asia. Access to quality health care is not readily available due to low socioeconomic status of some countries. Clinics and physicians are not always available in certain parts of a country due to shortage of physicians and tendency to practice in more urban area.
Epidemiological Triangle
The epidemiological triangle explains the disease process and how a change in one of the factors of the triangle can affect the balance of health. The triangle consists of three factors: the causative agent, the host, and the environment. Certain behaviors in the host put them at risk for infection. A person’s occupation can put them at higher risk than others for contracting HBV. The causative agent in hepatitis b is the hepatitis b virus. The virus can cause a chronic condition in children, HIV positive patients and intravenous drug abusers. When the virus infects a healthy adult, the chances of a full recovery from HBV are very good. Where a person lives places the person at a higher or lower risk for HBV. Persons living in third world countries have a higher risk than persons living in North America. Countries with a lower socioeconomic status do not have policies in place for prevention of HBV, and if policies are in place, there is a lack of funding to follow through on preventative measures. In the United States, the Centers for Disease Control (CDC) has established guidelines for immunizations for children and persons working in the health care field. Hepatitis b is preventable with the inoculation of vaccines. Vaccines are readily available in the United States.
The Role of the Community Health Nurse
The community health nurse plays an important role in educating people on communicable diseases. They are responsible for teaching at risk groups how to prevent the spread of HBV. By teaching intravenous drug abusers not to share needles and encourage condom use in persons with multiple sex partners, the nurse is promoting disease prevention and also controlling the spread of the disease. The community health nurse is involved with surveillance of the disease by keeping records of persons infected with HBV and referring them to counseling and medical management as needed. The community health nurse monitors disease incidence and prevalence. This alerts health organizations to possible outbreaks and can prevent epidemics from occurring if caught early. The nurse monitors the epidemiologic characteristics of the disease in infected persons. This helps identify source of infection and missed opportunities for vaccination. The community health nurse works with guidelines set by World Health Organization (WHO) and the CDC among other organizations. The WHO sets the standard for evidence based treatment and policies for HBV. They offer help and support for countries experiencing endemic outbreaks of HBV to increase access to prevention by strongly promoting immunization and working with other organizations to help fund countries in need of vaccine access.
Discussion
Hepatitis b can be prevented by a simple immunization process. Unfortunately, not all countries have access to the vaccine due to lack of funds. The U.S. continues to see HBV infections due to lack of education in certain populations. Intravenous drug abusers, HIV positive persons, and men who have sex with other men are all at risk of contracting HBV and spreading the disease to others. Education by community health nurses needs to be completed to address this population of people and importance of getting vaccinated and using preventative measures such as condoms to prevent the spread of life threatening infection. With the help of community health nurses and health organizations studying the health determinants and researching the epidemiology of HBV, policies and programs can be developed to decrease the incidence and prevalence of HBV worldwide.

References
Beltran, V. M., Harrison, K. M., Hall, H. I., Dean, H. D. (2011). Collection of social determinant of health measures in U.S. national surveillance S stems for HIV, viral hepatitis, STD’s, and TB. Public Health Reports, 126 (3), 41-53.
Dean, H. D. & Fenton, K. A. (2013). Integrating a social determinants of health approach into public health practice: A five year perspective of actions implemented by CDC’s National Center for HIV/ AIDS, viral hepatitis, STD and TB prevention. Public Health Reports, 128 (3), 5-11.
Maurer, F. A. & Smith, C. M. (2013). Community/ public health nursing practice- Health for families and populations (5th ed). St. Louis, MO: Elsevier, Saunders.
World Health Organization (2015). Hepatitis b fact sheet. Retrieved November 14, 2015 from www.who.int/mediacentre/factsheets/fs204/en/