Viral Hepatitis B: Understanding the Disease and the Role of Agencies in Controlling It

This paper focuses on the various aspects of viral hepatitis B and the role of various agencies in controlling or eradicating this disease. It also includes the plan for harm reduction, elimination or eradication of the disease.

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Table of Contents
Overview.........................................................................................................................................2
The Event.........................................................................................................................................2
The Cycle of Infection.....................................................................................................................3
Positive and negative action and interaction...................................................................................5
The plan for harm, eradication, elimination or reduction................................................................7
Conclusion.......................................................................................................................................9
Appendix........................................................................................................................................10
References......................................................................................................................................11
1

Overview
Hepatitis B is a liver infection that may be life threatening and is caused by a virus called
hepatitis B virus. It is one of the major health issue globally. It may lead to chronic infection that
puts humans at increasing risk of death due to liver cancer and cirrhosis. Hepatitis B is most
widespread in East Asia and sub- Saharan Africa where about 5-10% of adults are chronically
infected. It is also found in the southern parts of central and eastern Europe and in the Amazon at
high rates. In the Indian subcontinent and Middle East 2-5% of population are chronically
infected (World Health Organization., 2015). Whereas in western Europe and North America
less than 1 % population are infected.
This paper will focus on the various aspects of viral hepatitis B and the role of various agencies
in controlling or eradicating this disease. According to the research conducted by CDC (Centers
of Disease Control and Prevention) there were more than 15000 new cases of Hepatitis B in the
U.S. in the year 2013. The rate of new infection was more common in age group between 25
years to 44 years and less likely in younger population of age below 15 years CDC. This clearly
varies the major modes of transmission of virus in adults through sexual intercourse with an
infected person, exposure to infected blood, illicit drug use and consequences of universal
immunization of infants through vaccination (Centers of Disease Control and Prevention., 2013).
There has been a decrease in number of cases to be precise by 82% since 1990 in the US due to
increased vaccination and awareness of HIV and hepatitis B which resulted in practice of safer
sex. The person affected with hepatitis B is said to have an acute infection. The people who are
able to eradicate this virus is said to be cure of infection.
The Event
The world first came to know about hepatitis in 1965 when Dr. Baruch Blumberg examined the
blood samples to discover an antigen which marked the presence of Hepatitis B virus. He was
previously examining the influence of the inherited traits in people in relation to their
susceptibility to the same disease. The main objective of this was to find out whether the genetic
differences were associated with particular disease or not. The doctor with his team travelled to
different parts of the world to collect blood samples of hemophiliac patients who received
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multiple blood transfusions. Later, Dr. Blumberg along with his team members determined an
unknown antigen from the blood sample of Aboriginal people of Australia and named it as
Australian antigen (M.Block, et al., 2016). The detailed research of that antigen, identified the
cause of Hepatitis B.
It is a viral infection that can get transmitted via exposure to semen, blood and other bodily
fluids. It can also be transmitted to the new born babies at the time of birth from an infected
mother or other family members (Borgia, et al., 2012 ). The transmission of this virus occurs
through transfusion of contaminated blood, blood products, contaminated injections for drug use
or medical procedures.
The deadly virus mainly attacks the liver causing various chronic and acute diseases. The virus
can survive for at least 7 days outside the body of the host. The virus at this stage can affect an
unvaccinated person. The average incubation period of this virus is 75 days but it can vary from
30 to 180 days. The Hepatitis virus can be detected after 30 to 60 days of infections (Nettleman
& Mortada, n.d.).
It has been found that East Asia and Sub- Saharan Africa is highly prevalent of Hepatitis B virus.
The healthcare professionals are at higher risk of getting infected because of their day to day
interaction with the patient. Although the vaccination against hepatitis B is available in most of
the countries but it is not often practiced (Mueller & Stoetter, 2015). It has been found that more
than 2 billion people in the world have the history or current evidence of hepatis B infection.
Among these, there are more than 250 million people who are chronic carrier of this disease and
this disease is responsible for more than 600,000 deaths each year.
The Cycle of Infection
The process in which the pathogen passes from one host to another is known as chin of infection.
This chain has 6 individual links which has to remain intact for this chain to be successful. These
are the virus, pathogen that is the cause for the disease, the reservoir: the place where the
pathogen is found, portal of exit: the process by which the pathogen leaves its place, modes of
transmission: the process which explains how the pathogen passes from an infected person to a
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healthy person, portal of entry: the process by which the pathogens transfers in a new host and
the vulnerable host is the last link of chain (World Health Organization., 2017).
Relevant reservoir
The reservoir for the pathogens is the habitual where the virus lives, nurtures or grow and
multiply its numbers: the reservoir mainly includes animal, human and the environment. It is not
certain that the reservoir would be the source for the transmission of the agent to a host (Centers
for Disease Control and Prevention., 2012). The reservoir for the hepatitis B virus is the human
being as the virus gets transmitted to another person through bodily fluids. The hepatitis B virus
can service for 7 days on surfaces for example blood stains, razor blades, table tops. These places
are as effective for the transmission of virus as it is with humans with direct contact the virus
however is not capable of penetrating the skin and need a break for the transmission. The
appearance of an individual can be misleading as a healthy having no symptoms of the disease
can be a potential carrier or reservoir of hepatitis B.
Portals of exit: This is the process by which the pathogen leaves the reservoir. As mentioned
above the human is the reservoir for virus, the nose or blood or throat discharges, mucous
membrane (Butler, 2013). The virus can exit the body of the host through the mouth, skin, nose
or cut on the skin.
Modes of transmission:
The virus gets transmitted when the semen, blood or other body fluids of the contaminated
person affects the healthy person (Seeger & Mason, 2015). The various modes are: sexual
intercourse with an infected solution; from an infected mother to the child during the birth; use of
infected needle or syringes or the sharing of equipment used for drug preparation; healthy person
coming in contact with the blood or open sores of an infected person; use of razors, tooth brushes
and use of equipment like glucose monitor or thermometer of an infected person; direct contact
of blood from the sharp instruments or needle sticks of an infected person; biting of a child to
another child also transmits the virus.
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The portals of entry:
The pathogens enter into the body of the host either through inhalation, penetration or ingestion.
The portal of entry provides the pathogen access to reach to the cells or tissues where they can
grow and multiply. The infectious agents use the same point or portal to exit and enter to a new
host (Taguri, 2017). The hepatitis B can get into the body of the host through any opening in the
body through which a fluid containing virus can enter. For example: open cut or wound.
Susceptible host: the last link of the chain is the susceptible host (Grimm, et al., 2011). This
depends upon number of factors like specific immunity, genetic or constitutional factors,
nonspecific factors which determines the individual ability to limit the pathogenicity or resist
infection. The person susceptibility either increase or decrease depending upon the individual’s
genetic make-up.
The protective antibodies which act against a specific agent is known as specific immunity. In
response to the infections, vaccine or toxoid, these antibodies may develop or can be acquired by
injection of antitoxin or immunoglobulin or transfer from mother to infant. The other factors
which increases the susceptibility to infection by weakening the individual’s defenses are
alcoholism, malnutrition and therapy or disease which disrupts the non-specific response.
Positive and negative interaction and action
The factors influencing the healthcare includes 3 stakeholders, which includes the patient,
healthcare workers and the organization (Ward, 2018). All these factors play an important role in
achieving effective, efficient and secured or safe healthcare. The aim for achieving common goal
between these factors can produce both negative and positive outcomes in regard to infections
eventually resulting in imbalance and inconsistencies between cities, countries and even
facilities.
As per the research around 0.8 million to 1.4 million people in the United States are the patient
of chronic hepatitis B. there is no proper awareness about the hepatitis B among the social
service providers, healthcare providers and general public. Due to lack of proper awareness
about the person methods and about the prevalence of chronic hepatitis B and the targeted
population for medical management and screening of HBV which further contributes in
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continuing transmission, missed opportunities for the pre-assessment and medical care, missed
opportunity for prevention and even vaccination and resulting in poor health outcomes in
infected people (U.S. Department of Health & Human Services., 2017). The existence of this
disease is still high due to several reasons and the other fraction of old aged people who have
contributed in increasing the number of liver cancer by times in comparison to last 30 years data.
the increasing number of patient suffering from hepatitis B is also due to the fact as large number
of people or patient suffering from chronic HBV migrate from hepatitis endemic regions like
southeast Asia, East Asia and Sub-Saharan Africa to the US. The other reason for the prevalence
of chronic hepatitis B infection is due to lack of access to harm reduction programs, also lack of
access to anti-viral vaccines to a population where the risk of infection is very high
The vaccine of hepatitis B in the United States was made available back in 1982. The steps or
strategy to eliminate hepatitis B transmission includes: i. preventing the transmission of HBV to
infant by screening all the pregnant women for HBs Ag and by giving immunoprophylaxis to
children born from infected to children born from infected women; ii. Regular assessment and
immunization of all the infants; iii. The vaccination programmes for the unvaccinated children
aging less than 19 years with main emphasis to 11 to 12 years of children; iv. The adults or
adolescents who are at high risk of infection or the person with history having relation with
multiple partners, drug users, sexual contact with HBV infected, health public safety who are
exposed to blood in workplace should be vaccinated. The healthcare providers are the first on to
encounter the patient suffering from chronic HBV and that the reason the hygiene of the health
care worker is significant in reducing the spread of infection (Dusheiko, 2015). However,
according to the observations only 40% of the time healthcare workers practiced this habit in
contrast to their perception which was significantly higher. As alcohol-based sanitizers do not
destroy the pathogens, it is very important for the healthcare providers are equipped with both
skills and knowledge required to break the chin of infection, where the staff practice hygiene
which increases the compliance rate. As per one of the research, the increase in compliance by
20% resulted in decreasing in the infection by more than 50%.
The public also plays importance role when it comes to hygiene of the healthcare workers while
providing patient care (Hirnschall, 2015). It has been found that public gets engaged in
compliance and are aware enough to ask healthcare workers to was their hand before providing
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any care or service. With the assistance of visual indications to recognize healthcare workers
interest in the initiative, permitted the public in setting multidisciplinary commitment to break
the chain of infection.
The organization is already contributing or playing important role in health care where it updates
public on food or medication and safety procedure (Valdiserri, 2015). The release of statements
at specified time which encourages the relationship with the media persons which shows the
organization intention or transparency which allows them time to review the statements before
its release to public. This process is more useful for the clusters of infection which allows more
time to form treatment plan and collect more information by forecasting public questions which
the uncertain problems or panic reduces.
The plan (interventions) for harm reduction, elimination or eradication
The hepatitis is considered as one of the silent epidemics of the U.S. As per the statistics, more
than five million people in the United States have chronic hepatitis but they are unaware about
the factors which are at very high risk for fatal, severe, complications from the disease, that
increases the risk of transmitting the virus to others as well (Razavi, 2018).
The viral hepatitis can exist and may go unobserved for several years before displaying as
cirrhosis, liver disease or even liver cancer. The hepatitis is one of the causes of death in the U.S.
claiming more than 18,000 every year. It is one of the major sources of liver cancer and one of
the cause of increasing liver transplant (Koh & Valdiserri, 2014). According to data of 2007,
there were more number of death of people in comparison to HIV.
In order to confront the cause of mortality and morbidity, the government of the United States
led to the establishment of cross-agency action plan (Aspinall, et al., 2011). The plan was
developed under the U.S. department of Health and Human Services in 2011 for fighting against
the viral hepatitis articulated dynamic and robust steps for improving the viral hepatitis infection.
After 3 years of its release, all the agencies and offices came across human and heath survey
which was joined by housing and urban development, the U.S. development of justice’s
development of veteran affairs (Trépo, et al., 2014).
The various actions plan for controlling or eliminating hepatitis B are as follows:
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Priority Area 1: Educating Communities and Providers to Decrease Health Inequalities
Priority Area 2: Enhancing Care, Testing, and Treatment in order to Prevent Cancer and Liver
Disease
Priority Area 3: Strict Monitoring to Identify Viral Hepatitis Disease and Mode of Transmission
Priority Area 4: Eradicating Transmission of Viral Hepatitis that are Vaccine-Preventable
Priority Area 5: Reducing Viral Hepatitis Caused by Behaviors of Drug Use
Priority Area 6: Protecting Workers and Patients from Health Care-Associated Viral Hepatitis
Applying the above six priorities in the later stage of 2013, various agencies worked together
with the federal partners (Locarnini, et al., 2015). In order to check or identify the strategic
action which undertook in the beginning of 2014. The parties and other partners participated in
implementing and developing the plan, and agreed that these priorities areas are very important,
with an objective to the achieve desired goal.
1. Educating Communities and Providers to Decrease Health Inequalities
With an aim to reduce the incidence of viral hepatitis few goals were formed which includes:
building a care workplace who are prepared and ready to act as per the need of the infected
person; decreasing the disparities in the lower-class people and by educating the societies about
the importance of viral hepatitis.
2. Enhancing Care, Testing, and Treatment in order to Prevent Cancer and Liver Disease
The goals of this action are: identification of the infection with viral hepatitis in the early stage of
the disease; referring and suggesting the infected person with hepatitis for treatment and care;
improving the accessibility and quality of care and eventually the treatment of sick person; lastly
advance level of research for assisting the infected person or viral hepatitis prevention and
effective treatment and enhanced care for the infected persons.
3. Strict Monitoring to Identify Viral Hepatitis Transmission and Disease
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The goals of priority 3 includes: monitoring the patient with viral hepatitis associated with health
disparities, transfer and disease; proper assessment and delivery of resources for prevention,
treatment services and care of hepatitis B; introduction and implementation of new laboratory
procedures and technologies in order to enhance the hepatitis surveillance.
4. Eradicating Transmission of Viral Hepatitis that are Vaccine-Preventable
The goals of priority 4 includes: elimination of child to mother transmission of hepatitis B; to
achieve vaccination of hepatitis B for vulnerable youth and adults; designing and testing of new
or improved vaccine for hepatitis B and indication for their optimal usage.
5. Minimizing Viral Hepatitis Caused by Behaviors of Drug Use
The goals of this priority consist of: ensuring that the person injecting that drug have access to
hepatitis treatment, care and prevention; proper usage and mobilization of community resources
for the prevention of hepatitis triggered by drug use, injection; proper expansion and delivering
hepatitis care, treatment services, prevention in correctional settings; high level of research in
order to enhance the prevention of hepatitis who uses the drug.
6. Protecting Workers and Patients from Health Care-Associated Viral Hepatitis
The goals of the priority 6 include: Controlling and reduction of contamination of viral hepatitis
in patients due to drug usage and misuse of medical devices; controlling occupational
transmission of hepatitis transmission in proper healthcare settings.
Conclusion
From the above paper, it is evident that, hepatitis B is still one of the leading cause of deaths in
most of the part of the world. The disease gets transmitted through blood, semen, used vaccines,
drug use and other bodily fluids. The disease is more prevalent in East Asia and sub-Saharan
Africa. The disease mainly affects the liver causing liver cirrhosis. The paper also briefed about
the cycle of infection explaining all six individual links reservoir, portal of exit, modes of
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transmission, portals of entry. Although the number of infected person in the U.S was less in
comparison to other parts of the world, they still check details before issuing any prescription.
The paper also explained about the positive and negative impact of government action and
interaction in and its effects on the common people having chronic hepatitis. The paper also
explained about the different action plans required for reducing, eliminating or eradicating viral
hepatitis. Some of the ways for reducing viral hepatis B includes: Providing proper access to
treatment for the infected persons, providing appropriate training and educating healthcare
workers on the symptoms, causes and ways of eradicating the transmission of disease of
diseases. The government should play major role in preparing policy according to the need of
people so that people get all kinds of facilities in combating disease of this nature.
Appendix
After the completion of this unit, my competencies became very clear. This also made me aware
about others and their compliance level. The learning from this unit made the concepts easier to
understand which not only enhanced may knowledge and skills on the concepts covered but also
helped to understand the proper usage of resources, identifying the barriers to various issues and
ways to eradicate them. This unit helped me on getting more rationale to the practices, which I
also used in encouraging others for the respective role.
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