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Epidemiology facilitates the practice of preventive health care by helping nurses and their colleagues from other medical professions to analyze the incidence and distribution of diseases. Hepatitis B is one of the dreaded infections responsible for hospitalizations and incapacitation. The global prevalence of hepatitis B is as high as 248 million people (Schweitzer et al. 2015). The high prevalence makes hepatitis B a significant public health challenge that requires appropriate primary prevention measures. As one of the communicable diseases, hepatitis B control is effective upon interruption of its transmission routes. Moreover, a communication disease is an infection that can spread from one individual to another through various routes of transmission. Therefore, a clear apprehension of the epidemiology and transmissibility of hepatitis B is an important aspect to control and management of the disease. The purpose of this paper is to discuss the epidemiological factors of hepatitis B alongside the role of the community health nurses and its global implication.
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Hepatitis B and Its Demographics of Interest
Hepatitis B is a communicable disease with specific etiologies and manifestations. Hepatitis B virus is a member of the hepdnaviridae family of viruses and it causes hepatitis B disease that localizes in the liver. The course of the infection varies from acute to chronic because the virus can cause persistent infection for more than six months. Even though hepatitis B virus causes pathologies mainly in the liver, it can lead to systemic signs and symptoms that range from mild to severe. The patient can experience malaise, fever, fatigue, nausea, and vomiting especially during the period of transient viremia when the virus is present in blood in large quantities. The additional severe symptoms of hepatitis B infection are right upper quadrant abdominal pain, dark urine, and jaundice. Jaundice is the yellowing of the scleral surfaces in the infected host. The virus is predominantly present in blood and this makes parenteral route the most significant mode of its transmission. Therefore, sexual contact, sharing of injection needles, and mother-to-child modes are the principle routes of its transmission. Additionally, chronic hepatitis B infection can lead to complications such as liver failure, liver cirrhosis, and even hepatocellular carcinoma due to frequent healing by regeneration in the liver. Therefore, treatment with antiviral agents, interferons, and liver transplantation is appropriate to prevent these complications. The particular antiviral agents include lamivudine and adefovir while interferon alpha beta is a useful injection. Even though no specific treatment exists for acute hepatitis B infection, supportive care with fluids and antipyretics is necessary.
Hepatitis B infection has caught the attention of scientists due to its demographic characteristics that demarcate it as an important public health concern. The overall mortality rate due to hepatitis B is as high as 0.5 deaths per 100,000 individuals and its prevalence ranges from 700,000 to 2 million persons in the United States (Nelson, Easterbrook, & McMahon, 2016). Moreover, the overall incidence rate of acute hepatitis B infection in the U.S. is 0.9 per 100,000 people even though the trend posits a reduction in the incidence. Overall, these statistical data suggest that hepatitis B is still a dominant population health challenge that requires redress both at the local and international levels. Besides, over 248 million people suffers from chronic hepatitis B infection at the global level (Nelson, Easterbrook, & McMahon, 2016). Most importantly, the transmissibility of hepatitis B qualifies it as a reportable disease. Therefore, the nurse, doctors or laboratory technician should report a hepatitis B infection to the local state Department of Health immediately after its diagnosis.
Determinants of Health and the Development of Hepatitis B Infection
Determinants of health influence the occurrence of a disease in certain individuals as the rest remain in the usual state of wellbeing. According to the World Health Organization (2018), the specific determinants of health are the socioeconomic environment, physical environment, and the personal behaviors and characters. The socioeconomic circumstances that can influence health include educational level, income, political stability, and access to health services. On the other hand, availability of fresh air, clean water, healthy workplaces, and good roads are examples of physician environmental factors that promotes health. Personal behaviors such as sexual activities, substance abuse, diet, and physical exercise influence of the occurrence of both communicable and lifestyle diseases.
Moreover, these determinants of health influence the prevalence of hepatitis B infection within the population. First, the socioeconomic environment determines health literacy and access to health care services. Individuals with high educational level are likely to acknowledge the transmissibility of hepatitis B virus. However, less educated individuals with low income and poor access to health care services will miss hepatitis B vaccination and become highly susceptible to hepatitis B infection. Secondly, unhealthy working conditions can contribute the development of hepatitis B through sharp objects because individuals can contract the infection from contaminated needles (Schweitzer et al. 2015). Therefore, individuals such as medical laboratory technicians working in unhealthy environments can contract hepatitis B infection due to exposure to sharps in their physical environment. Finally, personal characteristics and behaviors are significant contributors to the transmission of hepatitis B virus from one individual to another. Hepatitis B is mainly transmitted via the parenteral route through activities such as sexual contact and injections with contaminated needles. Therefore, individuals with multiple sex partners and people who use injectable drugs of abuse are at risk of developing hepatitis B.
Epidemiologic Triangle of Hepatitis B and the Special Considerations
Epidemiologic triangle summarizes the virulent information about a communicable disease and its transmissibility. Hepatitis B has a direct mode of transmission in the communicable disease chain. According to the epidemiologic triangle, the health care professional should consider the host, agent, and environmental factors when analyzing a disease. The host is the ultimate organism that harbors the infectious agent while the agent is the causative microorganism of the disease. There are also several environmental factors that influence disease transmission.
Agent Factors
In the case of hepatitis B infection, the infectious agent is hepatitis B virus that belongs to the hepadnaviridae family of double-stranded DNA viruses. This virus has a high affinity for a predilection to affect hepatocytes within the human liver. Moreover, the human is the reservoir of the virus as the infection is transmitted from carriers or active cases to the normal population. Individuals with the presence of surface antigen of hepatitis B virus are carriers of the disease. The microorganism is quite stable but destroyed by heat and chemicals.
Host Factors
Infants and young children are more susceptible to chronic hepatitis B infection than adults. Healthy people with strong immunity also have a capability to eliminate the virus and avoid chronic infections. However, health care workers, intravenous drug users, immunocompromised persons, and transfusion blood or organ recipients have high chances to contract hepatitis B infection. The risk increases when the individuals have contact with blood or blood products from other people (Kasradze et al. 2017). Additionally, risky sexual activities such as commercial sex workers and people with multiple sex partners can predispose one to hepatitis B. On the other hand, vaccination against hepatitis B is a protective host factor to the disease.
Environmental Factors
There are a number of physical environment factors that influence hepatitis B transmission within communities. First, communities where discrimination of individuals with sexually transmitted diseases might register higher rates of undetected hepatitis B virus. Patients from such communities will be unwilling to expose themselves for tests and screening. Moreover, poverty and inaccessibility of health care services limits vaccination against hepatitis B.
Indeed, special considerations and notifications to the community about hepatitis B exist in the United States. The U.S. National Notifiable Disease Surveillance (NNDSS) is the body that gives notifications to the public about the development of new strains of hepatitis B virus and expansion of acute infections (Ramachandran et al. 2014). The NNDSS also special considerations to schools and the general population because it notifies the community about vaccination programs against hepatitis B.
Role of the Community Health Nurse
Community health nurses are important multidisciplinary team members in the prevention, management, and control of hepatitis B within the population. The nurses have direct interactions with the susceptible individuals within the community and they can contribute to case finding by identifying the individuals at risk of hepatitis B. Moreover, the community health nurse can perform physical examinations such as yellowing of the sclera and other manifestations of hepatitis B infection on the patients at the community. In case the community health nurses identify that the patient has the physical manifestations of hepatitis B infection, they can report this incidence to the health facility and refer the patient. The nurses can also collect data and perform data analysis to determine the trends in the prevalence and incidence of hepatitis B in the population. Since hepatitis B requires a long-term monitoring of the patients, the community health nurses can also help in the follow-up care of the patients. The nurses can act as educators in this case to enlighten the community about the risk factors for hepatitis B such as intravenous drug use and multiple sex partners. Therefore, the community will be able to break the transmission cycle of hepatitis B. Finally, the community health nurses can participate in vaccination programs to inject the community members with hepatitis B vaccine.
Organization Addressing Hepatitis B
The Hepatitis B Foundation is a national charity organization in the United States that focuses researching cure to hepatitis B and promoting quality of life among the hepatitis B patients. This organization promotes disease awareness, supportive immunization and treatment programs, and provide primary information to the general public, patients and their families, and the health care community (Hepatitis B Foundation, 2018). The nonprofit organization provides a platform for philanthropists to donate and support these programs. For example, the members of the Hepatitis B Foundation conduct roadshow campaigns to raise awareness of the transmissibility of the infection through sexual contact and sharing sharp objects. Therefore, individuals with multiple sex partners and intravenous drug users can modify their personal behaviors upon listening to their messages.
For example, the organization has the renowned Just B Storytelling Campaign where individuals with hepatitis B share their personal experiences (Hepatitis B Foundation, 2018). Additionally, the immunization programs are fit for the alleviation of the susceptibility of the general population. Immunization sensitizes the immune system and boost the immune response once an acute hepatitis B attack occurs. Therefore, previous immunizations help the population to stop progression to the chronic phase of hepatitis B infection that can lead to liver failure and cancer. Lastly, the organization provides information about hepatitis B to the general public and health care providers. Consequently, the public remains informed about the disease and the health care system becomes updated about its new incidences. Therefore, this organization reduces the impact of hepatitis B because patients will get treatment early after the case findings.
Global Implication of Hepatitis B, Address, and Endemicty in Other Countries
Hepatitis B has a global impact on travel and immigration patterns in the era of high human mobility. People travel from high endemic to low endemic regions of the world and this increases the risk for global spread of hepatitis B. Other countries such as Canada and New Zealand have adopted the global vaccination coverage for both adults and children against hepatitis B to address the spread of hepatitis B infection through immigration (Nelson, Easterbrook, & McMahon, 2016). The health care workers vaccinate infants as well as adults at high risk such as health care workers who might come into contact with contaminated blood products.
Moreover, hepatitis is highly endemic in the Sub-Saharan Africa with a prevalence rate that exceeds 8% (Nelson, Easterbrook, & McMahon, 2016). This observation on the endemicity of hepatitis B implicates that there are several carriers of the disease in the Sub-Saharan African region. Therefore, one of the recommendations for controlling the spread of the infection is to screen and vaccinate immigrants from these high-risk countries. The countries ensure that all the immigrants have certificates for hepatitis B screening and vaccination before they can receive their valid passports. The low-endemic countries benefit from this arrangement because they will avoid receiving immigrants who can spread the disease to the rest of the population. Besides, the natural history of hepatitis B infection proceeds to the chronic phase only if the surface antigen persists in the patient’s blood. Therefore, the immigration departments will identify both patients with recent infection and ones on chronic active infection.
In conclusion, this discussion reveals hepatitis B as a potential public health challenge that affects a large population at both the national and international level. Hepatitis B predominantly affects the liver and manifests with the features of the failing liver functions such as jaundice, nausea, vomiting, fatigue, and malaise. Moreover, the symptoms can complicate into liver failure, liver cirrhosis, and cancer. Therefore, the community health nurses have responsibilities to identify patients at risk in the community, refer for medical treatment, and educate them during follow-up care. The Hepatitis B Foundation is an outstanding organization within the United States in fighting hepatitis B by raising awareness in the community and supporting immunization programs. Even though hepatitis B is a disease of global health concern, Sub-Saharan African countries are hepatitis B endemic regions. Therefore, the community health nurses should cooperate with international travel agencies to ensure that all the immigrants are screened and immunized against the disease.
- Hepatitis B Foundation. (2018). Mission and history. Retrieved from http://www.hepb.org/about-us/mission-and-history/.
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