Hepatitis B Virus Infection

Hepatitis B
Hepatitis B virus (HBV) is a major public health problem across the globe as it contributes to nearly 1 million deaths annually. It is an infection that basically attacks the liver and has the potential to generate acute and chronic diseases. This communicable disease is mostly transmitted from mother to child during birth. Additionally, HBV is transmitted through contact with body fluids like blood. Since it is a life-threatening condition, the viral infection has received considerable attention in the healthcare sector. Healthcare professionals and other relevant stakeholders have developed various initiatives to help lessen the prevalence of this infection and mitigate its impacts worldwide. This paper analyzes this communicable disease, determinants of health relating to its development, epidemiological triad, and role of the nurse practitioner in the management of the infectious disease.
Analysis of the Communicable Disease
The World Health Organization (2019) defines hepatitis B virus as a viral infection that attacks the liver and has the potential of causing acute and chronic diseases. The two common modes of transmission of the virus are perinatal transmission (from mother to child during birth) and horizontal transmission (through contact with body fluids such as blood). The infection is spread by piercing, needlestick injury, exposure to infected body fluids and blood, and tattooing. Since HBV is a potentially life-threatening condition with high prevalence rates, it is a major public health problem across the globe. HBV can cause chronic infection and increases the risk of people dying from liver cancer and cirrhosis. In essence, the infection results in considerable human morbidity and mortality due to the effects of chronic infection (MacLachlan & Cowie, 2015). Most of the newly infected cases of HBV are asymptomatic while some people have acute illness with symptoms that last for weeks. Some of these symptoms include dark urine, abdominal pain, vomiting, extreme fatigue, nausea, and jaundice (yellowing of the skin and eyes). The probable complications associated with this infection include acute liver failure, liver cancer, chronic liver infection, and cirrhosis. Since there is no specific treatment for the infection, existing care approaches focus on maintaining comfort and adequate nutritional balance. They include medications using oral antiviral agents like tenofovir and entecavir as well as lifestyle changes like avoiding alcohol.
MacLachlan & Cowie (2015) state that HBV is associated with geographically diverse epidemiology given variations in age, population prevalence, mode of acquisition, and the probability of progression. Perinatal transmission accounts for the majority of cases of this viral infection. High prevalence rates of HBV are evident in Asia-Pacific and sub-Saharan African countries. The prevalence rate of this infection in the United State is estimated to be nearly 0.4% (Kim, 2012). People aged between 25-44 years have the highest incidence rates of HBV at 4.0 per 100,000 people while children have the lowest incidence rates at 0.1 per 100,000 people. On the other hand, the incidence rate of HBV is higher in men (2.7 per 100,000) compared to women (1.6 per 100,000). While the U.S. has witnessed a steady decline in incidence/prevalence rates of HBV in all racial and ethnic groups, Asian/Pacific Islander races have the highest rates among non-Hispanic blacks followed by Alaskan Natives. Asians have the highest prevalence rates of HBV infection at 2.74% followed by non-Hispanic blacks and non-Asian/non-blacks at 0.64% and 0.15% respectively (Kim & Kim, 2018).
Determinants of Health
According to Healthy People (2020), health status is influenced by various factors including personal, social, economic, and environmental factors. These factors fall under five broad categories: individual behavior, biology and genetics, social factors, policymaking, and health services. The development of HBV infection is influenced by various factors relating to the determinants of health. Social determinants of health that influence the development of HBV infection include barriers to testing, cultural factors, ecological factors, lack of access to medical care, and country of origin (Greene et al., 2017). Additionally, biology and genetics play a role in the development of this viral infection. According to Zhang et al. (2019), the genetic diversity of several genes associated with intrinsic and adaptive immunity is linked to HBV infection.
Epidemiological Triad
The epidemiological triad is a model used by scientists to study health problems and enhances understanding of infectious diseases and how they spread. It comprises three vertices: the agent, host, and environmental factors. The agent or microbe that causes HBV infection is the hepatitis B virus, which is passed through body fluids, blood, or semen. This virus is a member of the hepadnaviridae family of viruses and is a partially double-stranded DNA virus. This virus is common in Asia-Pacific and sub-Saharan African regions, which have high incidence rates of the infection. The organism harboring the disease or host is hepatocytes, which are infected liver cells. Once it gets past the immune system, the hepatitis B virus attaches to a membrane of liver cells while its core particles penetrate the liver cell. Most people who get this infection are aged between 25-44 years. While most cases of the infection are asymptomatic, the individual could show symptoms like dark urine, jaundice, nausea, extreme fatigue, vomiting, and abdominal pain. The virus is transmitted through perinatal transmission, sexual transmission, intravenous drug use, needle stick injuries, and skin penetrating procedures. Asian/Pacific Islander races and Alaskan Natives are at high risk of HBV infection, especially through perinatal and sexual transmission. Additionally, people from parts of Africa where the infection is common are also likely to transmit it even to other racial or ethnic groups.
Role of the Nurse Practitioner
As previously indicated, there is no specific treatment for HBV infection, especially acute or chronic cases. Therefore, current approaches focus on the management of the infection through maintaining comfort and nutritional balance. Nurse practitioners play a critical role in the management of patients with HBV infection and other measures relating to this infectious disease including surveillance, interventions, reporting, data collection, data analysis, and follow-up. According to the American Association of Nurse Practitioners (2019), the role of nurse practitioners is evolving and entails diagnosing illnesses, treating conditions, and conducting evidence-based patient education.
With regard to the management of HBV, nurse practitioners carry out screening and testing programs given that most cases of this infection are asymptomatic. They work with primary care physicians to develop interventions for patients depending on the specific factors relating to the development of the infection. During this process, nurse practitioners conduct follow-up as part of tertiary interventions for HBV management. They provide screening results to primary care physicians for further research and development of evidence-based practice. Nurse Practitioners also carry our follow-up based on screening results, refer HBV patients to primary care physicians, and conduct patient education based on evidence-based practice.
In conclusion, hepatitis B is a viral infection that has developed to become a major public health problem worldwide. The infection, which attacks the liver, is a communicable disease mostly transmitted from mother to child during birth and through contact with body fluids such as blood. The prevalence and incidence rates of this infection differ across populations based on age, country of origin, race, and gender. However, Asia/Pacific Islander and Alaskan Natives races have higher prevalence and incidence rates of HBV infection. In addition to affecting more men than women, the infection is common among people aged between 25-44 years. The development of this infection is influenced by social factors such as barriers to testing, cultural factors, ecological factors, lack of access to medical care, and country of origin. Given the lack of a specific treatment, the management of HBV focuses on maintaining comfort and adequate nutritional balance. Nurse practitioners play an important role in the management of this infection disease given their evolving role in diagnosis, treatment, and patient education.
References
American Association of Nurse Practitioners. (2019, January 28). Nurse Practitioner Role Grows to More Than 270,000. Retrieved July 23, 2020, from https://www.aanp.org/news-feed/nurse-practitioner-role-continues-to-grow-to-meet-primary-care-provider-shortages-and-patient-demands
Greene, K.M., Duffus, W.A., Xing, J., & King, H. (2017). Social Determinants of Health Associated with HBV Testing and Access to Care among Foreign-born Persons Residing in the United States: 2009-2012. Journal of Health Disparities Research and Practice, 10(2), 1-20.
Healthy People. (2020). Determinants of Health. Retrieved from U.S. Department of Health and Human Services website: https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health
Kim, H. & Kim, W.R. (2018, August 22). Epidemiology of Hepatitis B Virus Infection in the United States. Clinical Liver Disease, 12(1), 1-4.
Kim, W.R. (2012, March 1). Epidemiology of Hepatitis B in the United States. Hepatology, 49(5), S28-S34.
MacLachlan, J.H. & Cowie, B.C. (2015, May). Hepatitis B Virus Epidemiology. Cold Spring Harbor Perspectives in Medicine, 5(5). doi: 10.1101/cshperspect.a021410
World Health Organization. (2019, July 18). Hepatitis B. Retrieved July 23, 2020, from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
Zhang, Z., Wang, C., Liu, Z., Zou, G., Li, J. & Lu, M. (2019, August 13). Host Genetic Determinants of Hepatitis B Virus Infection. Frontiers in Genetics, 10(696),1-24.