Hepatitis is an infection caused by a variety of viruses. Few of them are of global importance. The hepatitis B virus is a causal agent of the hepatitis B disease affecting millions of people throughout the world. The consequence of persistent HBV infections includes the development of chronic hepatic insufficiency, cirrhosis, and hepatocellular carcinoma. Virus infection often occurs in childhood and stays in the body asymptomatically, which leads to chronic states later in life. While addressing its epidemiology, this paper will explore hepatitis B using data from reputable sources.
Geographical Distribution
According to the Centers for Disease Control and Prevention (CDC) (2015), sub-Saharan Africa and the vast of East Asia have the highest prevalence. Approximately, between five and twelve percent of the adult population is documented to be affected by the virus annually. The CDC (2015) points out that the Amazon region and some parts of Europe have high rates of chronic infections. Lok and McMahon (2009) argue that approximately 2-5 % of the Middle East and the Indian continent population are chronically infected. Parts of Eastern Europe and North America are low endemic areas with less than one percent of chronicity.
Epidemiology
Place New Order
The recent studies conducted by the CDC (2015) indicate that there is an overall incidence of 0.9 cases per 100, 000 people who suffer from acute hepatitis B annually in the United States. Approximately 3,050 acute cases were reported to the Centre for Disease Control and Prevention in 2013. The actual figure was estimated to be tenfold higher due to the lack of symptoms. Statistics indicated that in that year about 19,764 persons acquired a new infection with the majority of individuals being adults at the age of 2544 (CDC, 2015). Over the years, the rate of a new hepatitis B viral infection has been on the decrease by 81 percent since 1991. Approximately 700,0001.4 million persons in the United States develop chronic hepatitis annually, which is a global problem. Moreover, 350-400 million people have a lifelong chronic infection (Pyrsopoulos, 2016). Being the cause of high mortality rates, at least 786,000 persons die worldwide from liver complications every year.
Cause of Hepatitis B
According to Pyrsopoulos (2016), hepatitis B is caused by the hepatitis B virus. The latter is an enveloped virus containing a double-stranded circular DNA genome belonging to the Hepadnaviridae family. This virus replicates in liver cells interfering with the liver functions. As in case of any virus infection, antibodies in the immune system are activated in a specific way to fight the infectious agent. In this process, the inflammation of the liver occurs, which may persist and cause a pathological damage.
Mode of Transmission
According to the CDC (2015), the hepatitis B virus is transmitted through the contact with infectious blood or body fluids, such as semen and saliva. It may be through mucosal membranes or the percutaneous puncture of the skin. The World Health Organization (WHO) (2002) identifies such modes of transmission as sexual intercourse with an infected person, contact through sores, infected blood transfusion, and the use of infected objects, such as needles and razorblades. Mother-to-child and horizontal transmission between infected and uninfected children is common in high endemic regions.
Usually, the hepatitis B virus is capable of surviving outside the body for at least seven days. It can cause an infection when it gets into the body of individuals not immunized with the hepatitis B vaccine (WHO, 2015). The incubation period varies between 30 and 180 days, however, signs of infection begin to appear in 75 days. This asymptomatic nature in the body may cause persistence ending up with the development of chronic hepatitis B.
Signs, Symptoms, and Complications
The CDC (2015) documents that signs and symptoms of the hepatitis B virus infection vary with age. The majority of children under the age of five years and newly infected, as well as immunosuppressed adults have an asymptomatic infection. However, 30-50 percent of adults have initial signs and symptoms, which include fever, fatigue, loss of appetite, vomiting and flu-like symptoms. More complex signs are left-sided abdominal pain around the liver region, dark urine, joint pain, and jaundice. The CDC argues that people with a chronic course of HBV may have no evidence of the liver disease. The WHO (2013) states that the symptoms may be manifested over several weeks, but may end up causing complications. The latter include chronic hepatitis, cirrhosis, liver failure or liver cancer in individuals with a chronic infection. People with an acute infection often have severe attacks that lead to death.
Treatment for Hepatitis B
An acute infection has no cure, though supportive treatment is administered. A chronic form of the disease is managed using medications (WHO, 2013). Prevention from further progression through pharmacotherapy is the primary treatment goal (Pyrsopoulos, 2016). Drugs used at first contact are first-line agents, which include Nucleoside reverse-transcriptase inhibitors, such as tenofovir and lamivudine, and hepatitis B agents, such as adefovir, dipivoxil, entecavir, and interferon alfa-2b. Pyrsopoulos (2016) describes these agents as efficient in action. Other treatment options include surgery for liver transplantation. It is a method of choice for patients with a fulminant hepatic failure not able to recover and in case of the end stage of the liver disease caused by hepatitis B.
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The Influence of Health Determinants on the Development of the Hepatitis B Disease
The Office of Disease Prevention and Health Promotion (ODPHP) (2016) describes health determinants as factors that influence peoples health status. They include policymaking, social factors, health services, individual behavior, biology and genetics. Policies made by a state affect populations health, influencing a change in peoples behavior (ODPHP, 2016). Such policies include proper blood procedures, proper disposal of sharps, and the appropriate use of gear when performing invasive procedures. The lack of policy enforcement in hospitals may predispose to contact through vertical and horizontal transmission.
Social determinants are social factors and the physical environment where people are born and grow to be adults. They impact the quality of health through the availability of daily needs, such as food, education, social interaction, socio-economic factors and persons immediate environment (ODPHP, 2016). The lack of education on the disease transmission process may make people vulnerable to hepatitis B. In addition, a poor social-economic status making people share sharp objects like razor blades may predispose to the acquisition of the disease. Access to quality health services and individual behavior may influence the possibility of a direct contact with infected persons (ODPHP, 2016). For instance, people indulging in unhealthy practices, such as unprotected sex and sharing needles during the use of drugs can foster the spread of the disease. The lack of quality health services and policies may predispose a patient to the illness in case non-sterile equipment is used.
The Epidemiologic Triad
The epidemiologic triangle consists of an external agent, host and the environment where the host and the agent interact causing the disease to the former. In case of hepatitis B, the virus is present in the environment. Such factors as environmental temperatures promoting a suitable ecological state for it support its survival. In the environment, the virus enters the host through a portal of entry. The latter may be through a skin cut or mucosa during sexual intercourse or blood transfusion. Factors promoting the penetration of the virus into the blood stream include hygiene, intact skin, condom use, and the knowledge of a caregiver. The vector is the hepatitis B virus that survives in body fluids.
The Role of the Community Health Nurse
The responsibility of the community health nurse is to ensure that any disease outbreak is reported promptly and prevent further spread and new outbreaks. For instance, the nurse ensures that the reporting protocol for the hepatitis B virus is adhered to in the community. The one sensitizes the community of its signs and symptoms. In case of any contact, the infected person or the community health nurse should report to the nearby health care facility. Similarly, taking care of a patient suspected of hepatitis B, the nurse has the responsibility of reporting the same.
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On the same note, the community health nurse ensures that the patient is isolated according to countrys protocol to prevent further spread of hepatitis B, while providing immediate care until the individual recovers completely. Follow-up plans are organized between the nurse and the patient. The former educates the latter and his or her family members on the disease process, the agent facilitating transmission, and the transmission chain to prevent more cases of exposure. Usually, data on the number of individuals exposed to the virus are reported to countrys epidemiologic authority that keeps statistics. The nurse ensures that data correlate with ground findings during an analysis and are precisely analyzed when combining outbreak reports critical for future projections and education purposes. While working, the community health nurse collaborates with other professionals.
The Role of the World Health Organization
The World Health Organization is a health agency working to ensure the safety of individuals. It produces various disease protocols. The WHO provided the first guidelines for the prevention, care, and treatment of the chronic hepatitis B infection in March 2015 (WHO, 2015). It also raises awareness through the evidence-based policy and prevents disease transmission through vaccination, safe injection practices, and blood safety. Besides this, it provides wider access to monitoring and screening, treatment options and services concerning hepatitis B (WHO, 2015).
Conclusion
The hepatitis B disease affects the liver. Its prevalence is high in the sub-Saharan region. This disease may be contracted early in life, remains asymptomatic in childhood and resurfaces later developing into chronic hepatitis B. Symptoms may vary from vomiting and fatigue to flank pain and jaundice. Its transmission is through body fluids, such as semen, saliva, and blood. Its treatment is based on antiviral agents. Health education, involving the epidemiologic triad and the determinants of health, is critical in preventing the spread of the disease. The World Health Organization is at the forefront of addressing hepatitis B using such health professionals as community health nurses. This paper has explained various aspects of hepatitis B epidemiology in its entirety using the CDCs and WHOs findings.