Hepatitis B the Silent Killer

Hepatitis B is one of the most serious communicable diseases. This disease attacks the liver one of our major organs of the body.” The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.” (Hepatitis B Vaccination, 2014)Hepatitis means inflammation of the liver. The Hepatitis B infection is caused by the hepatitis B virus (HBV). There are different types of Hepatitis, A, B, C, D, and E.These viral infections causes 78% of liver cancers and HBV alone infects an one in three worldwide. (Global Health Topics Communicable Diseases , 2014) The public has become more concerned with this disease like other communicable diseases because the virus is easily transmitted from person to person. This viral infection can cause either acute or chronic insult.

The signs and symptoms of HBV vary by age. Persons that are 5 years old and greater have signs and symptoms 30-50% of the time, whereas most children less than 5 and newly infected immunosuppressed adults are asymptomatic. There is a period of 6 weeks to 6 months before a person can have symptoms. Symptoms began an average of 90 days after exposure. It is incredible that HBV can last outside the body for at least 7 days and still be able to infect a person. The signs and symptoms for HBV are: fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice. HBV is the infection in a chain of infection that can be interrupted through health education and risk reduction.

It all starts with the infection present in a person (the human reservoir), such as HBV. Next in the chain is the infection ability to exit through activities that require percutaneous or mucosal contact with the host. Then there must be transmission of the HBV to the susceptible host. The transmission of HBV is by there being a puncture through the skin or mucosal contact with the infectious blood or body fluids. Body fluids such as semen, saliva, sex with an infected person, birth to an infected mother, sharing items such as needles, razors, or toothbrushes with an infected person are all different ways that HBV can be transmitted.” It isn’t spread through food or water, sharing eating utensils, breastfeeding, and hugging, kissing, handholding, coughing or sneezing.” (Hepatitis B Information for Health Professionals, 2014) Being intimate with an infected person allows for exposure and the infection. Once the portal of entry is made to the new host, the host then develops the signs and symptoms of GBV.

Complications of HBV can be severe for acute infections and potentially lead to death of the infected person. Other complications are chronic hepatitis, cirrhosis, liver failure, and liver cancer. Approximately 1 out of 5 people with chronic HBV infection die from infection. There is no cure for HBV, however there are medications that treat chronic HBV. The medicine to treat chronic HBV are antiviral drugs. Treatment of HBV for acute cases isn’t in the form of medication. Antiviral medications are recommended for chronic cases, if the virus is replicating. Some of these medicines are: Interferons and Nucleoside reverse transcriptase inhibitors (NRTIs). As with any medication there are side effects. Interferons side effects include from a fever to loss of hair. Preventive vaccinations are given in a series of 3 intramuscular injections at least 8 weeks apart.

Those that are recommended that should receive this vaccination are: healthcare workers, HIV testing and treatment facilities, facilities treating drug abuse and prevention, correctional institutions, and chronic hemodialysis centers and end-stage renal disease programs for example. Postvaccination can be done 1-2 months after the completion of the vaccine. This vaccine has been available since 1982. This vaccine has an efficacy of 95% in prevention and chronic consequences. HBV vaccine was also one of the first vaccines against a major human cancer. (Hepatitis B FAQs for Health Professionals , 2014) HBV in the U.S. On a global level there is an astounding 240 million with chronic HBV. Yearly an estimated 786,000 die from this infection worldwide. These statistics show how HBV causes a high mortality and morbidity worldwide.

According to the CDC, the state of Georgia incidence of acute HBV from 2008-2012 of reported cases has declined from 187 to 109, with Florida reporting 247 the most of states reporting. There are many determinants of health that make people healthy or not. Some of those determinants are: income and social status, education, physical environment, genetics, and the person’s behaviors to name a few. As these determinants or others relate to a person with HBV their unsafe practices of sex puts them at an increased risk. Engaging in sex with an infected person can be the silent killer. Another is if the person working in the lab stuck himself with a need of a person with HBV. This is why in the medical field the use of PPE always can’t be stressed enough, along with safe practices such as no recapping of needles ever. As this infection can also be transmitted during birth, mothers infected can pass this infection to their newborn.

The community health nurse’s role is one of many facets. Their first responsibility is one of education. Giving the patient the knowledge on how to best protect themselves along with preventing exposure to infections of any kind is pivotal to their success. Educating the public on abstinence, use of condoms, the importance of hand washing, no sharing of personal items such as toothbrushes with an infected person and prenatal care for the expectant mother, so that testing can be done to determine her hepatitis status are all educational information that is needed to aid in the prevention of this incurable disease. Next the community health nurse should implement the teachings to help change or improve their risk factors that apply to them. Individualize each patient’s care will encourage compliance, because they had their input in the decision making. If there is literature available for the patient regarding the information discussed it should be given.

In addition the nurse must also assess whether or not the patient can read. Then the next important step would be the follow up with the patient. The community health nurse must stress the importance of the patient’s return visit. Calling the patient to remind them of their scheduled visit sometimes help with keeping their appointment. Keeping records that are accurate, detailed and legible that are easily accessed is a must. One national organization named the American Liver Foundation (ALF) has funding that is used specifically for research and education.

This organization is nationwide with chapters along with support groups that help those with liver disease and their family. ALF also has a donor program that is aimed at educating the public about the importance of organ donation. Contacting them is as easy via email or a phone call. You can send an email by completing a form on the contact page of the ALF website. Their website address is www.liverfoundation.org, their phone number is 1-800-GO LIVER. Someone is available 24hours a day to provide information. Their pamphlet and other information is in English and Spanish.

References

Body The Complete Human . (2007). In P. Daniels, T. Gura, S. Hitchcock, L. Stein, J. Thompson, & S. Betchel, Body The Complete Human How It Grows, How It Works, and How to Keep It Healthy and Strong. D.C.: National Geographic. Global Health Topics Communicable Diseases . (2014). Retrieved from United States Department of Health and Human Services: http://www.globalhealth.gov/global-health-topics/communicable-diseases Hepatitis B FAQs for Health Professionals . (2014, March 21). Retrieved from Centers for Disease control and Prevention: http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm Hepatitis B Information for Health Professionals. (2014). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/hepatitis/HBV/index.htm Hepatitis B Vaccination. (2014, /hep). Retrieved from Vaccines:VPD-VAC/Hep B: http://www.cdc.gov/vaccines/vpd-vac/hebp/default.htm