Running head: EPIDEMIOLOGY PAPER - HEPATITIS B

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Epidemiology Paper - Hepatitis B Concepts in Community and Public Health NRS-427V-0102

EPIDEMIOLOGY PAPER - HEPATITIS B Epidemiology Paper - Hepatitis B

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―Communicable disease‖ means an illness caused by an infectious agent or its toxins that occurs through the direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector or the inanimate environment to a susceptible animal or human host‖ ("CDC," 2010, p. 1). Hepatitis B is one of the communicable diseases which are a contagious liver disease that results from infection with the Hepatitis B virus (HBV). CAUSES ―Exposure may occur:  After a needle stick or sharps injury - Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood    If any blood or other body fluid touches your skin, eyes or mouth People who may be at risk of hepatitis B are those who: Unprotected sex with an infected partner – one may become infected having unprotected sexual contact with an infected partner whose blood, saliva, semen or vaginal secretions enter your body.      Receive blood transfusions (not common in the United States) Have contact with blood at work (such as health care workers) Have been on long-term kidney dialysis Get a tattoo or acupuncture with unclean needles Share needles during drug use - HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts one at high risk of hepatitis B.

EPIDEMIOLOGY PAPER - HEPATITIS B 

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Share personal items (such as toothbrush, razor, and nail clippers) with a person who has the virus

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Hepatitis-B infected mother - Pregnant women infected with HBV can pass the virus to their babies during childbirth‖ ("The New York Times," 2014, p. 1).

Acute vs. chronic hepatitis B Hepatitis B infection may be either short-lived (acute hepatitis B) or long lasting (chronic hepatitis B). ―Acute hepatitis B infection lasts less than six months. If the disease is acute, your immune system is usually able to clear the virus from your body, and you should recover completely within a few months. Most people who acquire hepatitis B as adults have an acute infection‖ (" Mayo Clinic," 2014, p. 1). ―Chronic hepatitis B infection lasts six months or longer. When your immune system can't fight off the virus, hepatitis B infection may become throughout the life, possibly leading to serious illnesses such as cirrhosis and liver cancer. Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease‖ (" Mayo Clinic," 2014, p. 1). SYMPTOMS ―Signs and symptoms of hepatitis B usually appear about three months after you've been infected and can range from mild to severe. Sometimes after getting infected with the hepatitis B virus, some people may have no symptoms, few may feel sick for a period of days or weeks, and few may become very ill very quickly (called fulminant hepatitis)‖ ("The New York Times," 2014, p. 1) ―Symptoms of hepatitis B may not appear for up to 6 months after the time of

EPIDEMIOLOGY PAPER - HEPATITIS B infection. Early symptoms include abdominal pain, dark urine, fatigue, fever, muscle and joint

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pain, loss of appetite, nausea and vomiting, weakness and fatigue, yellowing of your skin and the whites of your eyes (jaundice). Most infants and children with hepatitis B never develop signs and symptoms. The same is true for some adults‖ (" Mayo Clinic," 2014, p. 1). MODE OF TRANSMISSION The recognized modes of transmission of hepatitis B are parental or percutaneous, sexual and perinatal. ―HBV is spread through contact with infected body fluids and the only natural host is human. Blood is the most important vehicle for transmission, but other body fluids have also been implicated, including semen and saliva. Transmission of HBV from carrier mothers to their babies can occur during the perinatal period, and appears to be the most important factor in determining the prevalence of the infection in high endemicity areas. There are three possible routes of transmission of HBV from infected mothers to infants: transplacental transmission of HBV in utero; natal transmission during delivery; or postnatal transmission during care or through breast milk‖ (Hou, Liu, & Gu, 2005, p. 51). WHO sites says that as ―the HBV virus is large and does not cross the placenta. HBV can't contaminate the fetus unless there have been breaks in the maternal-fetal barrier, e.g. by means of amniocentesis. Still, pregnant ladies who are infected with HBV can transmit their sickness to their infants during childbirth. If not immunized during childbirth, many of these infants develop HBV diseases, and some children develop liver failure or liver cancer in later life‖ ("WHO," 2014, p. 1). ―The studies on transplacental transmission of HBV suggested two possible mechanisms (1) hemagenous route: a certain of factors, such as threaten abortion, can make the placental microvascular broken, thus the high-titer HBV maternal blood leak into fetus' circulation (2) cellular transfer: the placental tissue is infected by high-titer of HBV in maternal blood from

EPIDEMIOLOGY PAPER - HEPATITIS B mother's side to fetus' step by step, and finally, HBV reach fetus' circulation through the villous capillary endothelial cells. For neonates and children younger than 1 year who acquire HBV infection perinatally, the risk of the infection becoming chronic is 90%, presumably because neonates have an immature immune system. One of the possible reasons for the high rate of

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chronicity is that transplacental passage of HBeAg may induce immunological tolerance to HBV in fetus‖. (Hou et al., 2005, p. 51) Notes: ―HBeAg stands for hepatitis B "e" antigen. This antigen is a protein from the hepatitis B virus that circulates in infected blood when the virus is actively replicating. The presence of HBeAg suggests that the person is infectious and is able to spread the virus to other people‖( Daniel, May 16, 2014, p. 1). ―The parenteral transmission includes injection drug use, transfusions and dialysis, acupuncture, working in a health-care setting, tattooing and household contact. People at high-risk of infection include those requiring frequent transfusions or hemodialysis, physicians, dentists, nurses and other healthcare workers, laboratory technicians, intravenous drug users, police, firemen, laundry workers and others who are likely to come into contact with potentially infected blood and blood products‖(Hou et al., 2005, p. 52). COMPLICATIONS HBV infection leads to many severe complications like: Cirrhosis of liver – ―Cirrhosis is a slowly progressing disease, in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly. The scar tissue blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. It also slows the production of proteins and other substances made by the liver‖ ("WebMD," 2014, p. 1). Liver tumor - People with chronic hepatitis B disease have a greater chance of liver malignancy. Liver failure or fulminant

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hepatitis – ‗Acute liver failure is a condition in which the fundamental function of the liver close down, and in such a situation, a liver transplant is important to maintain life. Infants born to hepatitis e-antibody positive or hepatitis e-antigen negative and hepatitis e-antibody negative mothers may develop fulminant hepatitis within the first 12 weeks.‘(Kelly, n.d, p. 1). ―Hepatitis D disease - Anyone chronically infected with HBV is likely to get infected with viral hepatitis — hepatitis D. One can't get infected with hepatitis D unless not infected with HBV. Having both hepatitis B and hepatitis D makes it more probable for an individual to have more complications of hepatitis. Kidney problems - Hepatitis B infection can cause kidney problems that may lead eventually to kidney failure. Children are more likely to recover from these kidney problems, than the adults who may experience kidney failure.‖ (Mayo Clinic Staff, 2014, p. 1). DEMOGRAPHICS “Hepatitis B in the World      2 billion people have been infected (1 out of 3 people). 400 million people are chronically infected. 10-30 million will become infected each year. An estimated 1 million people die each year from hepatitis B and its complications. Approximately 2 people die each minute from hepatitis B‖ ("Hepatitis B Foundation," 2014, p. 1). “Hepatitis B in the United States    12 million Americans have been infected (1 out of 20 people). More than one million people are chronically infected. Up to 40,000 new people will become infected each year.

EPIDEMIOLOGY PAPER - HEPATITIS B   5,000 people will die each year from hepatitis B and its complications. Approximately 1 health care worker dies each day from hepatitis B‖ ("Hepatitis B Foundation," 2014, p. 1). ‗Hepatitis B prevalence is most astounding in sub-Saharan Africa and East Asia. Most individuals in these areas get infected with the hepatitis B infection throughout childhood and between 5–10% of the adult group are chronically infected. High rates of these infections are found in the Amazon and the southern parts of eastern and Central Europe. In the Middle East and the Indian subcontinent, it is evaluated that 2–5% of the all inclusive community is chronically infected. In Western Europe and North America less than 1% of the population is chronically infected‘ ("WHO," 2014, p. 1). DETERMINANTS OF HEALTH ‗Social determinants of health are the economic and social conditions that influence the health of people and communities as a whole. Five determinants of population health are generally recognized as biology and genetics, individual behavior, social environment, physical environment, available health services‘ ("White Paper," 2010, p. 7). Among these determinants

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of health, those pertaining to Hepatitis B are mainly the individual behavior, social environment, physical environment and the health services available. Each individual are different, and some may get involved with drug abuse and may use any infected needle, unprotected sex with an infected person, multiple sexual partners, and some men getting involved in homosexuality, etc may get infected with the viral hepatitis. The social environment determines how an individual get exposed to the infection, like the education of the person, ones awareness about the hepatitis viral infection, how it is transmitted, job and income, etc. The social environment in which an

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individual is involved in shows his /her whereabouts and this helps one to keep them disciplined in their life. The health facility available in the community is an essential factor that determines the health of the public, and the health care sectors can take initiatives to conduct health education to the public and create awareness among the people regarding the modes of transmission of HBV and how one can protect oneself from getting infected with viral hepatitis. EPIDEMIOLOGIC TRIANGLE ‗The epidemiological triangle comprises of the host, agent, and environmental factors that affects health. The host is the human or animal who provides room for the agent. The agent is the disease causing microorganism and the environment point towards the external and internal environment that either allows or reject the agent to invade the host. So when an environment is favorable for the micro organism, it enters the host and the disease process is started.‘ (Maurer & Smith, 2013, pp. 204-206). The epidemiological triad pertaining to Hepatitis B is:

("Epidemiological trial Image," n.d, p. 1)

EPIDEMIOLOGY PAPER - HEPATITIS B Host – When an individual get exposed to certain environmental factors such as sources of infected blood like any blood transfusion, contaminated needles, any contact with an infected person and the various other ways as mentioned in the causes for hepatitis be like get done a tattoo or an acupuncture, hepatitis B infected mother, etc the disease causing organism gets the portal for entry to the host body. If the host is not protected or immunized, the micro organism starts the infection process and the host may present with symptoms and in some occasions without any symptoms and can be a carrier of the disease. Agent- ‗Factors associated with the agents causing infectious diseases include pathogenicity, infective dose, physical characteristics, organism specificity, and antigenic variations. Pathogenicity, or seriousness, encompasses invasiveness and virulence, terms used to assess the

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strength of the agent in victims. Highly virulent (stronger) organisms cause greater morbidity and mortality.‘ (Maurer & Smith, 2013, p. 205). Environment - When people (host) are in a favorable environment for the virus to enter the body, it enters and causes infection. The hepatitis B virus can even enter the host from contaminated surfaces. ROLE OF COMMUNITY HEALTH NURSE ‗Community health nurses must be familiar with basic information about communicable diseases, including causative organisms, incubation period, mode of transmission, symptoms, protective measures, and the necessary treatments. The ultimate goal of the nurse is to protect people from getting infected with communicable diseases. This information is crucial to plan care aimed at preventing transmission of infectious diseases, or alleviate the symptoms of persons who have acquired a disease.‘ (Maurer & Smith, 2013, p. 210). Nurses‘ role in the

EPIDEMIOLOGY PAPER - HEPATITIS B prevention of Hepatitis B is very important. The nurse should have thorough knowledge

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regarding the disease causing organism, Hepatitis B Virus, ‗it‘s incubation period which is from the time of exposure to onset of symptoms is 6 weeks to 6 months‘ ("Centers for Disease Control and Prevention," 2012, p. 1), its mode of transmission, complications and community health concerns, treatment and nursing management which includes the preventive measures too. The general population should be made aware of the disease, its process and complications, and the importance of the hepatitis b vaccination, so that these communicable diseases can be kept afar to an extent. The nurse has the vital role of initiating the primary, secondary and tertiary prevention according to the target population he /she margined. The nurse should assess and screen the population to find out the disease threats. The primary prevention focuses on the health education and creation of the awareness in the people regarding the disease and should encourage vaccination, staying away from the activities that allow the entry of the disease organism. The secondary prevention should focus on those people who are newly detected with the disease, and should start with the treatment for the virus as early as possible to minimize the effects of the disease progress and treating at the earlier stage will enable the person to be away from the complications. The tertiary prevention is for those target population who is already infected with hepatitis B virus and are chronic, and for these people screening should be done to find out the disease progress, and from the complications of hepatitis B. NATIONAL ORGANIZATION ‗The Centers for Disease Control and Prevention (CDC) is a national agency in United States and this agency screens the population for the various diseases, especially the

EPIDEMIOLOGY PAPER - HEPATITIS B communicable diseases and provides the statistics and surveillance about the diseases, the

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prevention of the disease, etc. The center takes initiatives in providing vaccination for infants and children, adults, screening the pregnant mothers for the HBsAG and the guidelines for further treatment. The contact information of CDC is Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 USA - 800-CDC-INFO | (800-232-4636) | TTY: (888) 2326348‘ ("Centers for Disease Control and Prevention ," 2012, p. 1). ―The Hepatitis B Foundation is the only national non-profit organization solely dedicated to the global problem of hepatitis B. The foundation is dedicated in finding a cure and improving the quality of life for those affected by hepatitis B worldwide and the commitment includes funding focused research, promoting disease awareness, supporting immunization and treatment initiatives, and serving as the primary source of information for patients and their families, the medical and scientific community, and the general public‖ and the contact address is:- Email: contact@hepb.org, Phone: (215) 489-4900, Fax: (215) 489-4920; Mailing Address: 3805 Old Easton Road, Doylestown, PA 18902‖ (" Hepatitis B Foundation ," 2014, p. 1) ‗Hepatitis-infected individuals can become carriers for life. The very young have the greatest risk of acquiring carrier status. About 90% of infants infected with HBV at birth will become carriers, whereas the risk for young adults is far less. Screening pregnant women for infection and treatment substantially reduces the risk of HBV transmission to infants‘ (Maurer & Smith, 2013, p. 197). ‗It is estimated that two billion people worldwide are infected with hepatitis B virus, and more than 350 million of them have chronic liver infections which put them at high risk of death. The hepatitis B vaccine is highly effective, and its use is spreading throughout the world‘ (Maurer & Smith, 2013, p. 123). As nurses we all have vital role in the primary, secondary and tertiary prevention of hepatitis B. Making the people knowledgeable

EPIDEMIOLOGY PAPER - HEPATITIS B about the facts pertaining to hepatitis B can prevent the occurrence and spread of this

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communicable disease. North America and Western Europe has less than 1% of their population affected with Hepatitis B, and this is achieved through persistent hard work in screening the population and providing the primary, secondary and tertiary prevention. So let us encourage the nurses all over the world to join their hands and minimize these diseases.

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References Cirrhosis of the Liver. (2014). Retrieved June 1, 2014, from http://www.webmd.com/digestivedisorders/cirrhosis-liver Daniel, C. (May 16, 2014). HBeAg. Retrieved June 1, 2014, from http://hepatitis.about.com/od/ghi/g/HBeAg.htm Diseases and Condition Hepatitis B. (2014). Retrieved June 1, 2014, from http://www.mayoclinic.org/diseases-conditions/hepatitis-b/basics/causes/con-20022210 Epidemiological triangle. (n.d). Retrieved June 1,2014, from https://www.google.com/search?q=epidemiological+triad&safe=active&rlz=1C2RNVG_ enQA531QA531&source=lnms&tbm=isch&sa=X&ei=z-eLUDeI4HrygOTqoA4&sqi=2&ved=0CAYQ_AUoAQ&biw=1242&bih=607#facrc=_&imgd ii=_&imgrc=GEN_SiM_CltPbM%253A%3BYz8ZNQWT_A6ClM%3Bhttp%253A%25 2F%252Fclassconnection.s3.amazonaws.com%252F537%252Fflashcards%252F113553 7%252Fpng%252Fcapture1327962327092.png%3Bhttp%253A%252F%252Fwww.study blue.com%252Fnotes%252Fnote%252Fn%252Fexam1%252Fdeck%252F4084559%3B460%3B537 Hepatitis B. (2014). Retrieved June 1, 2014, from http://www.nytimes.com/health/guides/disease/hepatitis-b/overview.html Hepatitis B Geographical distribution. (2014). Retrieved, from http://www.who.int/mediacentre/factsheets/fs204/en/ Hepatitis B Information for Health Professionals. (2012). Retrieved from http://www.cdc.gov/hepatitis/HBV/

EPIDEMIOLOGY PAPER - HEPATITIS B Hepatitis B how is HBV spread. (2014). Retrieved June 1, 2014, from http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html

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Hou, J., Liu, Z., & GU, F. (2005, January 5, 2005). Epidemiology and Prevention of Hepatitis B Virus Infection. International Journal of Medical Sciences, 2(2), 50-57. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142225/ Kelly, D. (n.d). ACUTE LIVER FAILURE. Retrieved June 1, 2014, from http://www.md.ucl.ac.be/pedihepa/ALF.htm Maurer, F., & Smith, C. (2013). Community Public Health Nursing Practice (5th ed.). Retrieved from https://pageburstls.elsevier.com/#/books/978-1-4557-0762-1/recent Mayo Clinic Staff (2014). Hepatitis B Complications. Retrieved June 1, 2014, from http://www.mayoclinic.org/diseases-conditions/hepatitis-b/basics/complications/con20022210 Menu of Suggested Provisions for State Tuberculosis Prevention and Control Laws Definitions for Consideration. (2010). Retrieved from http://www.cdc.gov/tb/programs/laws/menu/definitions.htm Our Mission and Story. (2014). Retrieved June 1,2014, from http://www.hepb.org/about/our_mission_and_story.htm Social Determinants of Health. (2010). Retrieved from http://www.cdc.gov/socialdeterminants/docs/SDH-White-Paper-2010.pdf Statistics. (2014). Retrieved June 12014, from http://www.hepb.org/hepb/statistics.htm