Write a paper (2,000-2,500 words) in which you apply the concepts of epidemiology and nursing research to a communicable disease
Communicable diseases are common among all the population globally. A communicable disease is a condition that is caused by a highly infectious agent through direct or indirect contact from one organism to a host (Czaja, 2017). There is numerous communicable disease, for this paper, we shall concentrate on hepatitis B Infection. The purpose of this paper is to explain the epidemiology of hepatitis B infection, its chain of infection, and the treatment options available.
Definition and Background
Hepatitis B is a viral infection of the liver. It can be either chronic or acute. It is a life-threatening infection that leads to liver scarring and failure. It is commonly contracted when someone comes into contact with the blood and body fluids of an infected individual. Open wounds and sores are also a risk factor for hepatitis b infection. The organism that causes the infection is the hepatitis B virus (HBV).
The risk of developing chronic infection is related to the age of infection. About 90% of children and infants who get infected with hepatitis B develop a chronic disease compared to only 2-6% of the adult section. This clearly shows that the disease is more virulent in children than in adults. Currently, the best way to prevent the contraction of the hepatitis B virus is to get vaccinated. In most countries, all hospital workers, healthcare workforce, and people working in a human risky environment are eligible for a hepatitis B vaccination (Czaja, 2017).
There are other types of hepatitis viruses in existence, for instance, we have hepatitis A and hepatitis C. these other types are less common, less virulent, and less fatal compared to hepatitis B. Due to the high rate of infection among people, hepatitis is a worldwide health care problem that has affected many individuals as patients and healthcare workers as well.
Signs and Symptoms
The presence of signs and symptoms of the hepatitis B virus varies with age. Many people with an acute infection of the disease are asymptomatic. Those who normally show no symptoms are children below 5 years and adults who are newly infected and are immunosuppressed. Generally, 30-50% of people who are above the age of 5 years show typical signs and symptoms of hepatitis C virus once infected. However, the majority of the population with chronic HBV infection do not show symptoms of liver disease. Others may exhibit elevated liver enzymes, liver cirrhosis, or primary liver disease (Czaja, 2017).
Jaundice is common in the eyes and the urine. The white part of the eye may turn yellow, urine may also have a yellow color. The stool may change to light-colored from the time of infection. Fever and fatigue may continue for several weeks followed by joint pains, stomachache, belly pain with nausea, and vomiting. These symptoms may not show up until 1-6 months after infection.
Multiple sexual encounters or partners are a risk for contraction of the virus. The exchange of blood or body fluids through mucus membranes is the hallmark of infection. All injecting drug users do so by sharing needles and syringes put themselves at risk. Being born to a mother who is infected with the hepatitis B virus is a high-level risk factor. A person who has open wounds or sores should avoid physical contact with others to minimize transmission.
Generally, sharing of personal equipment, ear piercing needles, blades, toothbrushes, and even glucose monitoring machines may result in the exposure of blood and body fluids to others. The virus can stay infectious outside the human body or host for 7 days. This means that any form of spills, vomit, or blood outside should be treated with carefulness. Wash with household chlorine in the ratio of 1:10. Always use protective clothing like gloves and footwear while cleaning the spillage on the environment (Nahvi, & Farooq, 2020).
Perinatal transmission is the case where the virus is transmitted from mother to child during birth. This occurs mostly in endemic areas with the disease. An infected mother should be well vaccinated and treated to avoid contraction and later transmission of the virus to the baby. Through the birth canal, the baby may be exposed to blood and other body fluids that contain hepatitis B virus.
Horizontal transmission is whereby a person is exposed to blood and other body fluids that cause hepatitis B from an infected child to an uninfected child. This mostly occurs in children under the age of 5 years. Needle stick injuries, piercings, and tattoos may also risk transmission. Sexual transmission among infected individuals, men who have sex with men, heterosexual contacts, and multiple sexual partners (Blum, 2019).
In the health care setting, the reuse of needles, syringes while injecting drugs may transmit the infection from one person to another. Health workers should get vaccinated and use protective gear at all times. Moreover, medical and dental procedures may also lead to infection, for instance, dental wash and removal, tattooing with an infected individual.
Treatment of Hepatitis B
The best way to manage the infection is through vaccination. The protein immunoglobulin helps boost the body’s immune system to fight viral infection. Additionally, the infected person has to give up drinking substances that hurt the liver. Alcohol and other drugs like acetaminophen should be avoided. The patient should consult the doctor or physician before any medication, supplement, or herbal treatment.
Entecavir and Tenofovir are the newest treatment options for the hepatitis B virus. They are in liquid, powder, or tablet form. Also, lamivudine/ 3TC, Epivir, Heptovir, Epivir HBV, and Adefovir may be used interchangeably depending on the efficacy of each other although they have mild side effects on kidney function. Interferon Alfa is a shot give for 6 months and boosts the body’s immune system. It also treats the inflammation of the liver. It can also function in a combination of long-acting interferon and peginterferon alfa2a (Blum, 2019).
Complications of Hepatitis B
The chronic development of hepatitis B in all children and adults may lead to serious complications. Liver cirrhosis, scarring may impair liver function and may eventually lead to liver failure. Chronic infection may also lead to liver cancer or primary liver disease. End-stage liver disease is when your liver is not able to function completely. Evidence has shown that people with chronic hepatitis B infection are more likely to have some types of kidney disease. Another complication I the inflammation of blood vessels or phlebitis. In pregnancy, the infected mother may pass the infection to the newborn during birth.
Hepatitis B is a notifiable disease nationally and is reportable by the state health departments to the NNDS. Health care providers and facilities are obliged by law to notify and report acute hepatitis B infections to local health jurisdictions within 24 hours whereas a chronic infection within 1 month. The local health jurisdictions are therefore responsible to notify the Washington state department of health and communicable disease epidemiology within 7 days for case investigation and completion.
In the years 2015, the world health organization estimated that approximately 350-400 million people in the world are living with chronic hepatitis B infection, with disease prevalence varying among geographical regions, from 1-20%. Consequently, a total of 887000 deaths resulted from the effects of hepatocellular carcinoma and liver cirrhosis. In the years 2016, 10% of the people living with hepatitis B (27 million) were aware of their infection while 16.7% were on treatment (4.5 million people. In 2019, the world health organization estimated that children under 5 years with hepatitis B infection dropped drastically under 1% from 5% in the previous era (Blum, 2019). The highest prevalence of hepatitis B is in the western pacific region and the African region ranging from 6.2% and 6.1% of the adult population respectively. In the region of Americans, 0.7% of the population is infected.
Social Determinants of Health for Hepatitis B
Social determinants of health are complex integrated factors in different social structures and cultures that affect the access, utilization, and exploitation of health services. Such factors may be affected by the socio-cultural and political environment of the country. Barriers to access to testing services and lack of access to medical care play a major role in the burden of care to combat hepatitis B infection. In some other parts of the world, the country of origin, cultural factors influence how people access and utilization of care services (Nahvi, & Farooq, 2020).
Early testing of individuals to find out their state of health could lead to vaccination of those who are negative or treatment of those with positive results to prevent secondary infection. This is possible because many people are living without an awareness of their hepatitis B infection status. On the other hand, social-cultural and ecological factors also influence how people receive health services.
Epidemiological Triangle of Hepatitis B
The epidemiological triangle consists of three factors, the host, the agent, and the environment.
The host factors that affect infection include age, race, sex, genetic profile, previous diseases, immune status, religion, customs, occupation, marital status, and family background. The infection is highly virulent in children compared to adults. Those who are immunocompromised show no apparent symptoms but may develop a chronic disease in the long run. The host factors will determine the level of virulence and extent of infection realized in the host’s body. Special consideration has to be taken in cases of transmission from the host. The general public, schools, and the community should be informed of the occurrence of the infection. High level of hygiene factors, washing hands, and foodstuffs before consumption (Cao et al, 2021).
The agent factors are divided into chemical, biological, and physical factors. Biological factors are bacteria and viruses that cause an infection. Chemicals like alcohol, smoke, and poison may affect the distribution of infection. Most liver failures are worsened by the consumption of alcohol or related substances. Finally, environmental factors include temperature, humidity, and altitude. A good environment, with conducive factors moderate temperatures leads to the thriving of the virus. Harsh temperatures destroy the nature of the virus on open or outside the host.
Role of the Community Health Nurse
The role of a community health nurse is integral in the management of hepatitis B infection. The nurse is responsible for raising the alarm of infection, identification, and reporting of probable signs and symptoms for investigations. All suspected cases are identified by the community health nurse. They help in the identification of high-risk patients. They include injecting drug users, patients who received a blood transfusion, and blood products. They also help in the prevention of infection and treatment of hepatitis B infection. The most important factor is through education and health promotion. Community health nurses teach members of the community to be vigilant and keep high standards of hygiene
In the year 2010. The world health organization rolled out the global hepatitis B program. The task force was set up to coordinate efforts to deal with the viral infection and support member states to develop adequate policy and capacity to reduce the global burden of viral hepatitis B. The first feature was to publish the program on prevention and control of viral hepatitis a framework of global action in the year 2012 (Cao et al, 2021).
It was responsible for raising awareness, mobilizing resources, and promoting partnerships for disease eradication. The taskforce was also responsible for creating an evidence-based policy and research data for appropriate action. Screening of individuals, care, and treatment was necessary to prevent further transmission of the infection. Additionally, they also developed standards for global hepatitis B surveillance and monitoring and provision of further management.
Geographical regions like sub-Saharan Africa, Southeast Asia have an endemic prevalence of hepatitis B of over 8%. Globally, hepatitis B is the cause of almost 80% of all liver cancer/primary liver disease. It has a dire effect on the global economy for testing, treatment, and surveillance. The world’s workforce has been greatly affected by the infection of viral hepatitis B especially healthcare workers (Cao et al, 2021).
In conclusion, hepatitis B viral infection is life-threatening condition that affects a majority of the world’s population. It is endemic in some parts like the sub-Saharan Africa and Southeast Asia. The treatment and management of the infection if comprehensive and require a collaboration of a multidisciplinary team for effective management.
Blum, H. E. (2019). Global epidemiology of acute viral hepatitis A–E. Viral Hepatitis: Acute Hepatitis, 1-16. https://doi.org/10.1007/978-3-030-03535-8_1
Cao, G., Jing, W., Liu, J., & Liu, M. (2021). The global trends and regional differences in incidence of hepatitis a from 1990 to 2019 and implications for its prevention. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3790419
Czaja, A. J. (2017). Global disparities and their implications in the occurrence and outcome of autoimmune hepatitis. Digestive Diseases and Sciences, 62(9), 2277-2292. https://doi.org/10.1007/s10620-017-4675-y
Nahvi, N., & Farooq, S. (2020). Seroprevalence of hepatitis B, hepatitis C and HIV 1 / 2 in patients undergoing surgery in a tertiary care hospital in North India (a hospital based study). Clinical Epidemiology and Global Health, 8(1), 45-48. https://doi.org/10.1016/j.cegh.2019.04.004
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Topic 2 DQ 1
What are social determinants of health? Explain how social determinants of health contribute to the development of disease. Describe the fundamental idea that the communicable disease chain model is designed to represent. Give an example of the steps a nurse can take to break the link within the communicable disease chain.
Resources within your text covering international/global health, and the websites in the topic materials, will assist you in answering this discussion question.
The social determinants of health are the conditions of birth, development, employment, living, and aging. They include income, education, housing, and work (Social Determinants of Health, 2018). The social determinants of health are linked to health outcomes and health disparities. A growing body of research has shown that addressing the social determinants of health can improve health outcomes and reduce health disparities. There are many ways to address the social determinants of health. Some approaches include policy changes, community-based initiatives, and individual-level interventions. It is important to note that no one method is suitable for everyone and that different approaches may work better in various settings.
There is growing evidence that social determinants of health play a significant role in disease development. For example, studies have shown that factors such as poverty, poor housing, and lack of access to healthcare can lead to a higher incidence of disease (World Health Organization, n.d). In addition, social determinants of health can also affect the course of an illness and make it more challenging to manage. Therefore, it is a crucial issue to consider, as social determinants of health can significantly impact human health and well-being. Thus, ensuring everyone has access to the resources they need to maintain a healthy lifestyle is vital.
The communicable disease chain model illustrates the transmission and control of infectious diseases. The pathogen, reservoir, portal of exit, method of transmission, the portal of entry, and new host are the six different linkages that make up the model. According to Study.com (2019), each link in the chain plays a specific role, and each one can be broken or interrupted in various ways. For example, a nurse might perform multiple actions to break the chain of infectious diseases. Some of the most popular steps a nurse may use include, but are not limited to, adequate hand washing, wearing PPEs, using all necessary safety precautions, and using the proper sterilization and cleaning methods.
In conclusion, social determinants of health significantly impact individuals’ well-being. Therefore, nurses should understand them and incorporate better practices to prevent the spread of diseases.
Social Determinants of Health. (November 30, 2018). Social Determinants of Health. Healthy People. Retrieved from https://www.healthypeople.gov/2020/topicsobjectives/topic/social-determinants-of-health
Study.com. (2019). Chain of Infection: Definition & Example. Retrieved from https://study.com/academy/lesson/chain-of-infection-definition-example.html
World Health Organization (n.d). Social determinants of health. Retrieved from https://www.who.int/social_determinants/sdh_definition/en/
Social Determinants of health can be political. Our political temperament and governmental structure play heavily into the healthcare resources that are available to the citizen. It was interesting to learn that healthcare for all, in the United States, was proposed as early as 1904, and was for a time pursued by Franklin D. Roosevelt’s administration. When the doctor’s association of the time protested he pulled back to pursue the Social Security Act. Post-WWII Europe embraced healthcare for all as a deterrent to communism, while the United States felt that “socialized” medicine promoted communism. The American Medical Association, comprised of MDs, has continued to lobby and exert political power against healthcare reform, including the ACA. For years it was the pressure that they exerted on Medicare that prevented those in rural communities from being able to seek care from advanced practice nurses and NPs. While at the same time not being able to attract MDs to their rural communities to serve their people. To be more precise Advanced Practice RNs and NPs could provide care Medicare would just not pay them for it. The AMA’s pressure was to protect power and revenue for their constituency, disappointing. In most areas of inequity if you follow the money or the power the true nature of things will be revealed. Thankfully the Affordable Care Act addresses some of these past hurdles.
Gilligan, H. (2018, May 23). Socialized medicine was coined in the US, not Europe. Timeline. Retrieved September 10, 2022, from https://timeline.com/socialized-medicine-was-coined-in-the-us-not-europe-30438fad9d69
Rangel, C. (2010, March 23). H.R.3590 – 111th Congress (2009–2010): Patient Protection and Affordable Care Act. Congress.Gov | Library of Congress. Retrieved May 26, 2022, from https://www.congress.gov/bill/111th-congress/house-bill/3590