Hepatitis B: An Epidemic
The World Health Organization defines epidemiology as “the study of the distribution and determinants of health- related states or events, and the application of the study to the control of diseases and other health problems” (CDC, 2014). Determinates of health are “the circumstances in which people are born, live, work and age as well as the systems put in place to deal with illness”. The communicable disease chain is a model beneficial to integrating the many concepts of communicable diseases (Maurer & Smith, 2009). A nurse has a significant role in preventing and controlling infectious disease. A vital factor in preparing for clinical nursing practice is having an understanding of the infection process and techniques on how to prevent it. This paper focuses on a prevalent communicable disease, Hepatitis B. This writer will give a description of the disease, the demographic affected by the disease, what determinates contribute to the development of Hepatitis B, she will discuss the epidemiology triangle of the disease, explain the role of the community health nurse in this community, and explain various agencies and resources patients diagnosed with this disease can access.
Hepatitis B is a serious liver infection caused by the hepatitis B virus. Two types exist: the acute illness and the chronic illness. In the acute illness, the immune system is able to rid the body of the virus and a complete recovery may occur in a few months. Chronic hepatitis infections last six months or longer. These occur when the patient’s immune system can no longer ward off the virus. The infection then become life-long and can lead to more serious illnesses. The chronic infections can go undetected for many years and usually aren’t diagnosed until a patient becomes seriously ill from liver disease (Mayo Clinic, 2014). Symptoms can take up to three months to appear and include “abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea and vomiting, weakness and fatigue, and jaundice or yellowing of the skin and whites of the eyes”. “The hepatitis B virus is easily spread through contact with the blood or other body fluids of an infected person. People can also be infected from contact with a contaminated object, where the virus can be live up to seven days” (CDC, 2012). Infants can become infected at birth if their mother is infected. Children and adults can become infected by “close contact with blood and body fluids through breaks in the skin, contact with objects that have blood or body fluids on them, having unprotected sex with an infected person, sharing needles, or being stuck with a used needle”. Complications from chronic hepatitis B include cirrhosis, an increased risk for liver cancer, liver failure that could lead to the need for a transplant, kidney problems, and Hepatitis D which is a viral form of hepatitis that can only be acquired if the patient has hepatitis B. Currently, no cure exists for hepatitis B. If a patient has an acute infection they may not need treatment. Their doctor will help patients to reduce symptoms. If a patient is suffering from the chronic form of hepatitis, antiviral medications can help fight the virus and decelerate the degeneration of the liver. An injection of hepatitis B immune globulin must be given within twenty four hours of coming in contact with the virus may help guard you or a patient against the disease (CDC, 2012). In order to prevent hepatitis it is important for patients to know the current hepatitis status of their sexual partners, use a new condom every time they have sex, stop using illicit drugs, be very cautious about tattooing and body piercing parlors, and always ask about the hepatitis B vaccine before you travel. The hepatitis B vaccine is given as a series of three to four injections over a period of six months. It is recommended for all infants, children not vaccinated at birth, health care workers, anyone infected with HIV, individuals with multiple sexual partners, illicit drug users, anyone who would be exposed to hepatitis B, and world travelers (WHO, 2014).
Hepatitis B causes considerable morbidity and mortality worldwide. More than 400 million people have chronic hepatitis B. In the United States alone, 38,000 people become infected every year and about two to four thousand of those individuals die from cirrhosis or liver cancer caused by hepatitis B (Lin & Kirchner, 2004). One of the world’s most common and serious infectious diseases, hepatitis b virus causes more than one million deaths in a single year! “The incidence of the hepatitis B carrier state in populations is related most importantly to the incidence and age of the primary infection” (Lin & Kirchner, 2004). In low risk areas of the world, the highest incidence of the disease is seen in teens and young adults. In endemic areas of Asia and Africa, epidemiological patterns show that most infections occur in infants and children due to maternal-neonatal transmission (Lin & Kirchner, 2004).
There are five determinants of population health that are generally recognized in the factors that contribute to the development of hepatitis B. The first determinate is biology and genetics. Men are the most susceptible to chronic infection, but both can become infected at the same rate depending on that individual’s exposure to the infection (Blumberg, 2006). One out of every three people have been infected by hepatitis B. Commonly this virus affects Asia, southeast Asia, India, parts of Africa and South America, Eastern Europe, the Middle East and the United States. The next determinant is individual behavior. Individuals who inject drugs, have unprotected sex, and partake in other dangerous behaviors are more at risk for developing Hepatitis B. Often times, those who partake in these risky behaviors are low income, not well educated, single individuals. These individuals may frequently not have access to quality care, may not be insured, or have a previous diagnosis of some kind of disease. The last determinate is physical environment. Hepatitis, any form, is very common in individuals who are or have been incarcerated.
The epidemiology triangle analyzes the relationship between three major risk factor categories that influence the occurrence and prevention of disease and injury: Host factor, agent factor, and environmental factor (Maurer & Smith, 2009). The host for hepatitis B is any human being. The agent factor is a causative agent called Hepatitis B virus. Environmental factors that contribute to one acquiring hepatitis B include alcohol, smoking, and environmental contaminants like afalatoxin.
For a community health nurse there are five areas of focus when educating a population on hepatitis B. The first area of focus is prevention. Nurses should ensure access to hepatitis B vaccination for the population; improve access to hepatitis B screening, increase timely referrals focused on sexual health services, integrated counseling, screening, vaccination and referral services into current delivery systems. Next the community nurse should educate by increasing the knowledge of hepatitis B among the public, ensure access to culturally sensitive and language appropriate material, and increase the knowledge and promote a healthy lifestyle to those who have been diagnosed. In the surveillance and research focus one needs to secure adequate resources for state and local surveillance, improve disease reporting among labs and providers, learn to inform patients of recommendations for prevention programs by using surveillance data, and develop and appraise evidence-based practice for interventions for hepatitis B. A community health nurse should always assure timely access to hepatitis B diagnosis, care, post-exposure prophylaxis and treatment. They should institute programs to support care and treatment for all patients no matter their insurance status. The most important thing a community nurse can do is to address the needs associated with hepatitis B through the coordination of care.
One national organization that helps combat hepatitis B is the Hepatitis B Foundation. It is the lone national non-profit organization that is committed to hepatitis B. Their mission is to find a cure and improve the quality of life. The organization funds focused research of hepatitis B, promotes disease awareness, supports the need for immunizations and treatments, and is an excellent resource for patients and families (Hepatitis B foundation, 2014.). The website is incredibly easy to use and directs you to useful information and many useful resources.
Hepatitis B is the most common liver infection in the world! For any nurse who educates populations on communicable diseases should really educate themselves on the description of the disease, the demographic affected by the disease, what determinates contribute to the development of Hepatitis B, the epidemiology triangle of the disease, understand his/her role in the community , and know various agencies and resources patients diagnosed with this disease can access.

References
Blumberg, B. (2006). Does hepatitis B affect human gender ratios? . Astrobiology Magazine. Retrieved from www.astrobio.net
Diseases and conditions: Hepatitis B. (2014). Retrieved from www.mayoclinic.org
Epidemiology. (2014). Retrieved from www.who.int/topics/epidemiology/en/
Global alert and response : Hepatitis B. (2014). Retrieved from www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index4.html
Hepatitis B Vaccine: What you need to know. (2012). Retrieved from www.cdc.gov/vaccines/vpd-vac/hepb/defult.htm
Hepatitis B foundation. (n.d.). www.hepb.org
Lin, K. W., & Kirchner, J. T. (2004, January 1). Hepatitis B. American Family Physician, 69. Retrieved from www.aafp.org/afp/2004/0101/pg75.html
Maurer, F., & Smith, C. (2009). Community/public health nursing practice (4th ed.). St. Louis, Missouri: Sunders Elsevier.