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Hepatitis B as the Major Medical Concern

Abstract

Hepatitis B is caused by the hepatitis B virus (HBV) and it causes inflammation or scarring of the liver, flu-like illnesses, abdominal pains, anorexia, and nausea among the affected individuals. The disease is majorly spread through the exchange of body fluids. The study reveals that the best way of dealing with this problem is through vaccination and public sensitization.

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Introduction

Hepatitis is a disease can result in the inflammation of the liver. The condition can be self-limiting or can develop to fibrosis (scarring), cirrhosis, or liver cancer. Hepatitis viruses are one of the most common causes of hepatitis in the world but other infections such as toxic substances (alcohol, certain drugs), and autoimmune diseases could be caused by hepatitis. There are several types of hepatitis and the most essentials are Hepatitis A, B, C, D, and E. These types of hepatitis are the greatest anxiety because of their burden of disease and death.

Hepatitis B is known as an infection of the liver caused by the hepatitis B virus (HBV). It could be caused by chronic and acute infection. There are several new infections with hepatitis B such as sub-clinical or flu-like illnesses. Jaundice can just occur in 30 to 50% of the adults and 10% in the younger children. Acute infection probably causes fulminant hepatic necrosis, which is often lethal. Disease development can cause fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma. Finally, about 25% of the infected individuals will die of the liver-related complications if not treatment

Hepatitis B virus is a member head virus group and it is a double-stranded DNA virus that is replicated by reverse transcription that is similar to the retrovirus. The virus particle is known as the virion, which consists of an outer lipid envelope and icosahedral nucleocapsid core that is composed of protein. The outer envelope includes an embedded protein that is implicated in the viral binding of and entry inside which makes the cells susceptible.

The virus is a very tiny envelope animal with a virion diameter of 42, but it is pleomorphic that means have different in the shape and size of the cells, which contains filamentous and spherical bodies lacking a core. Make sure that these particles are not infectious and they are including protein and lipids that have various forms part of the surface of the virion which is known as the surface of the antigen (HBsAg), and is created in excess through the life cycle of the virus.

The disease ordinarily starts with an ache in the right upper abdomen, nausea, and anorexia. If the fever is present in the patient, it will be usually mild. Malaise is probably deep with reluctance to drink alcohol or smoke a cigarette. When jaundice develops, there is a gradual lightness of the faeces and darkening of the urine. In patient who does not have or develop symptoms suggestive of hepatitis B, the disease is just be detected by abnormal liver function tests or/and the existence of serological markers of hepatitis B infection such as hepatitis B surface antigen (HBsAg) and (anti HBc IgM).

There are several ways to transmitted hepatitis B virus such as parenteral exposure to body fluids or infected blood. The transmission of the virus often occurs through vaginal or anal intercourse, sharing of needles and other equipment by using injecting drug users (IDUs), needle stick injuries, or through perinatal transmission from mother to child. It is transmission by biting from infected person but that happens rarely. Transfusion-associated infection is now rare in some countries as blood donation is screened.

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The period of incubation is between 40 to 160 days, with average of 60 to 90 days. A current infection of hepatitis B could be detected by the existence of HBsAg in the serum. Body fluids and blood from these patients should be infectious. In the most patients, the infection will be solved and HBsAg will be disappeared from the serum of the patient. However, the virus will persevere in some individuals who will become chronically infected with hepatitis B.

Chronic hepatitis B infection is known as perseverance of HBsAg in the serum of the patient for probably six month or longer than six months. Patients with chronic infection are occasionally indicated to as chronic carriers. Through those who are positive with HBsAg, also those in whom hepatitis B e-antigen (HBeAg) will be detected in the serum are extremely infectious. In patient who are HBeAgnegative (usually anti-HBe positive) and HBsAg positive are infectious but they are generally in the lower of infectious. New evidence proposes that a ratio of chronically infected individuals who are HBeAg negative will have high HBV DNA levels, and probably be more infectious.

The risk factor of progression chronic hepatitis B infection relies on the age at which infection is acquired. Chronic infection can occur in 90% of those who infected prenatally but it is less recurrent in those who infected as children (for example between 20 to 50% in children between one and five years of age). The risk is elevated in the patient whose immunity is impaired. About 20 to 25% of patients with chronic HBV infection worldwide have developed liver disease, causing to cirrhosis in some patients. The risk factor of developing depends on the level of active viral that replicates in the liver. Patients who have chronic hepatitis B infection- especially those with cirrhosis or/and inflammation, where there is fast cell rotation are at elevated danger of progression hepatocellular carcinoma.

The World Health Organization (WHO) has evaluated that probably more than 350 million people worldwide will chronically infectious with HBv. The WHO has already classified the countries depend on upon prevalence of HBsAg into high (over 85), intermediate (between 2 to 8%), low (less than 2%) endemicity countries.

In several high-prevalence countries, about 10% or more of people, they have chronic hepatitis infection. High-prevalence regions contain sub-Saharan Africa, most of Asia and the Pacific islands. Intermediate-prevalence regions contain the Amazon, southern parts of Eastern and Central Europe, the Middle East and the Indian sub-continent. Low-prevalence regions contain most of Western Europe and North America.

The significance of the different ways of transmission differs based on the prevalence in a particular country. In areas that have high prevalence, infections are caused by acquired predominantly in childhood – by perinatal transmission or by horizontal transmission through young children. In areas that have low-endemicity countries, most infections are caused by acquired in adulthood, where sexual transmission or sharing of blood-contaminated needles and equipment by using injecting drug users accounts for a significant ratio of new infections. In areas that have intermediate endemicity, the pattern of perinatal, childhood and adult infection is mixed, and nosocomial infection probably essential.

There are several ways to overcome hepatitis B disease and one of the most significant is to be vaccinated. The HBV vaccine is mostly efficient for over 90 percent of children and adult who take all three doses. Some patients who are immune compromised probably less likely to progress immunity to hepatitis B virus during vaccination. In this study, the researcher will look at how vaccination can be used as a means of fighting this disease.

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Materials and Methods

When conducting a research, it is important to come up with a clearly defined methodology that outlines how the data for the research was collected, the materials used in the study, and the analysis of the paper. The methodology section helps the reader to determine the viability and reliability of the paper and the extent to which it can be applied in policy making and in academic contexts. According to Alp, Tan, and Orbak (2009), defining the methodology helps the researcher to know the steps to be taken when it comes to the actual data collection and analysis when the study commences. It directs the researcher on the specific data that should be collected from the field and how the analyzed data should be presented for the readers to understand easily.

In this study, the primary aim of the researcher was to investigate how vaccination can be used to help in the fight against the spread of hepatitis B. The researcher had to collect materials that would help in this investigation. The researcher was interested in collecting both the primary and secondary data to inform this study, but the time constraint made it almost impossible to collect the primary data. As such, this study wholly relied on secondary data.

The researcher conducted a desk research by reviewing the relevant literatures that have been written about the disease and how vaccination has been used over the years as a means of reducing its spread in the United States and other countries around the world. According to Mansfield, Phadke, and Kale (2006), hepatitis B is a disease that has attracted the attention of many scholars and getting literatures that specifically focus on it is relatively easy. That is the reason why the researcher considered using these sources to inform the study.

As Gerlich (2013) says, when using literatures, one can decide to choose from various sources based on the level of reliability needed. Books, journal articles, magazines, and unpublished materials are some of the popular secondary sources of data that can be used to collect the data that is needed in a given study (Ayerbe & Pérez, 2001). According to Gerlich (2013), books and journal articles are often the most popular sources of data when high level of validity and reliability is needed.

However, in this study, the level of validity needed was very high given that the researcher only relied on secondary sources of data. The researcher opted to use peer reviewed journal articles because of their high level of validity (Xiridou, Wallinga, Dukers, & Coutinho, 2009). The study, therefore, did not use any other material as a source of data other than the peer reviewed journals.

According to Van and Banatvala (2003), when conducting literature search, it important to know how to get the materials needed from various sources. The researcher used public library and online platforms to collect the needed materials for the study. A study conducted by Gerlich (2013) advises that when looking for relevant materials from a public library, it is necessary to know how to use the modern technologies to locate them.

Online public access catalog (OPAC) is often very instrumental when using a public library (Ayerbe & Pérez, 2001). The researcher used OPAC to locate the journal articles needed by using the title of the articles, the authors, or the name of the journals as was appropriate (Van & Banatvala, 2003). The researcher was able to access a number of articles from the public library that were helpful in this research.

According to Madhavi (2003), the emerging technologies have simplified the process of collecting data from literatures because of the ease with which data can be accessed. A study by Ayerbe and Pérez (2001) showed that most of books and journal articles which were previously only available in brick-and-mortar libraries can now be accessed in online libraries. One only needs to know the key words when looking for materials from online sources (Van & Banatvala, 2003).

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In this research, key words such as hepatitis B, hepatitis B vaccination, management of hepatitis B, and treatment of hepatitis B were used. When the key words are used correctly, Madhavi (2003) says that it becomes easy to access the materials needed. The researcher was able to get a number of articles from online sources through the use of key words. Websites such as Science direct, Elsavier, Jstor, and EBSCOhost were very instrumental in helping the researcher to get the journal articles needed for the study. The literatures were reviewed to determine what they say about vaccination against hepatitis B. The information obtained from these sources about vaccination against hepatitis B is presented in the section below.

Results

Vaccination has been proven by medical researchers as the best way of dealing with hepatitis B virus among the health population (Geier, Kern, Hooker, Sykes, & Geier, 2016). As such, the United States government, through the Department of Health, has been keen on ensuring that every American is vaccinated against the virus, especially those who are at risk of acquiring the disease either because of their occupation or way of life. In this study, the researcher collected data to find out the pattern that has been taken in this country in terms of promoting vaccination against the hepatitis virus. The graph below shows this pattern from 1994 to 2013.

Hepatitis B vaccine coverage.
Figure 1: Hepatitis B vaccine coverage.

As shown in the graph above, the government has made a concerted effort to ensure that as many people as possible get vaccinated against hepatitis B virus. As shown in the above figure, in 1994, only about 77.4 of the American population had been vaccinated of the virus. By 1999, over 95.4% of the population was vaccinated. In 2013, it is reported that over 99.4% of the population are vaccinated. It means that only a small percentage of less than 0.6% of the Americans, have not been vaccinated.

It is a clear demonstration that the government has made a concerted effort against this disease by ensuring that as many people as possible are vaccinated against the disease. As Geier et al. (2016) say vaccination not only helps the vaccinated individuals but also their loved ones, especially if they may share fluids at one point in life in any way. It increases the number of people who are free from the virus, which in turn reduces the rate of spread of the virus within the society.

As the graph above shows, from 1994 to 2013, the government has made great efforts to ensure that people are vaccinated against hepatitis B virus. It is important to determine if the effort made in vaccination has translated in having significant reduction in the rate of infection within the American society. It is necessary to review statistics about the rate of infection by the virus over this period, and the possible changes in those suffering from the disease over the past few years since the government started this campaign. The figure below shows incidences of acute hepatitis B in the United Sates from 1980 to 2014.

Incidences of hepatitis B in the United States.
Figure 2: Incidences of hepatitis B in the United States.

As shown in the figure above, from 1980 to 1994, there was a sharp increase in those suffering from hepatitis B. The rate of infection was high and this caused concern for the government to look for ways of dealing with this problem. As such, the government came up with the comprehensive vaccination plan that not only focused on traditional diseases such as polio but also hepatitis B (Geier et al., 2016). As shown in figure 1, the campaign started in 1994.

Figure 2 above clearly indicates that it was in 1994 that the increase in the incidences of hepatitis B stopped rising. For the years that followed, the United States started experiencing a sharp decline in the incidence of this disease. In 1994, it was estimated that there were close to 30,000 people suffering from this disease in the United States. By 2013, this number had dropped to less than 3,000. This was a significant achievement to the United States’ government in its fight against hepatitis B virus. There is congruency between increased vaccination and reduced incidences of those suffering from the disease. It shows that the more people are vaccinated, the less the number of people who suffer from this disease.

A study by Geier et al. (2016) looked at the population at greatest risk of infection by hepatitis B virus to determine how relevant it was to introduce them to vaccination. The figure below shows how people of different age groups have varying degree of being infected by the virus from 1990 to 2006.

Hepatitis B infection incident by age.
Figure 3: Hepatitis B infection incident by age.

As shown in the figure above, people of different age groups have varying degree of being infected with this virus. From 1990 to 2006, there is a clear pattern in the infection rate that is shared by people irrespective of their ages. It is clear that there has been a consistent drop in the rate of infection and this can be attributed to increased vaccination and public sensitization that has been going on since 1994 as discussed above.

However, the data above shows that people of different ages have varying risk levels of acquiring the disease. As of 2016, children below 15 years had almost negligible risk rate of acquiring this virus. This may be attributed to the improved maternal care in the United States that has significantly reduced the rate at which mother to child infection can occur. The group with the second lowest infection rate after the minors is the adults aged over 45 years.

The low risk level among these seniors may be attributed to the fact that at this age, these people are more responsible about their life and are not as likely to engage in substance abuse and irresponsible sexual behavior as the younger adults. As discussed above, unprotected sex and sharing of needles, especially among the drug addicts, are some of the leading causes of the infection of the virus. People aged 15-24 years are having the second highest rate of getting the infection.

Those within the age of 25-44 have the highest risk of acquiring hepatitis B virus. This is so because it is the age where people are adventurous when it comes to the use of drugs and activities that may involve sharing body fluids. It is a big relief that vaccination is helping in the fight against the virus and people of all ages now have reduced chances of getting the infection. The graph below, which shows the factors that lead to the spread of the virus from one person to the other, conforms that indeed those aged 25-44 years are at the greatest risk of acquiring the virus because they are sexually active and are more likely to use drugs compared to the rest of the population.

Risk Factors.
Figure 4: Risk Factors.

As shown in the above data, 50% of the spread of the virus is caused by sex (both heterosexual and homosexual activities). As such, those who are sexually active have the greatest risk of acquiring the virus. Another 15% is caused by sharing needles by the drug users. Household contact and healthcare employment causes negligible risks.

Discussion

Hepatitis B is one of the diseases whose impacts cannot be ignored because they make the infected individual susceptible to other serious health complications such as liver cirrhosis, and cancer. As shown in the data above, the United States’ government has made a concerted effort to ensure that incidences of hepatitis B infection are significantly reduced. However, it is important to appreciate the fact that the problem has not been completely eliminated. A section of the society still suffers from this problem.

As shown in the analysis conducted above, most of the ways through which hepatitis B virus is spread from one person to another has a lot to do with the behavioral patterns of people. Drug abuse and irresponsible sexual behavior increases the risk of acquiring this disease by over 65%. Other causes such as household contact and healthcare employments can also be significantly reduced through responsible behavior and caution when handling patients suffering from this disease.

As such, Madhavi (2003) says that the weapon that should be used against the fight against this disease is public empowerment. When people are empowered through proper education, they get to know how to protect themselves from any form of infection. The statistics above shows that a section of the society is still not yet vaccinated against hepatitis virus despite the empirical proof that have confirmed its effectiveness in dealing with this problem.

It is possible that these people are not yet aware of this disease, benefits of vaccination, and the kind of danger they expose themselves to by not being vaccinated. Through proper vaccination, the country is able to eliminate this virus or reduce its incidences to negligible levels, just like what the country was able to achieve in the fight against polio.

In the analysis above, some of the most common ways of spreading this virus has been clearly outlined. Drug use and irresponsible sexual behavior are some of these top causes of the spread of this virus. In the modern globalized society, American citizens cannot be restricted within the borders of their country. The movement of Americans to various parts of the world as tourists or for business or medical purposes has been on the rise over the recent years due to the increasing size of the middle class. It, therefore, means that those who travel to countries with high prevalence of hepatitis B can still acquire the disease if they are not vaccinated and end up being socially irresponsible.

It may be necessary to approach the fight against this disease from a global perspective. The United States still remains the most admired country in the world that attracts immigrants from all over the world (Van & Banatvala, 2003). If these immigrants have this virus, then they can easily spread it locally to the unvaccinated population or those whose vaccinations are not as effective as would be desired.

That is why the United States should work together with other foreign nations to help in the fight against hepatitis B. Center for Disease Control and Prevention is currently working with World Health Organization and other international medical research agencies to find ways of dealing with this global problem so that it can be completely eliminated in the modern society. To achieve success, the government needs the support of the citizens who must promise to be socially responsible in all their activities, including presenting themselves for vaccination.

Conclusion

Hepatitis B is one of the major medical concerns that the governments of the United States, and many other governments all over the world, are trying to eradicate because of its serious socio-economic impacts on the society. Vaccination has been determined to be one of the best ways of dealing with this problem. This research paper has revealed that public sensitization is particularly important in the fight against hepatitis B.

When people are aware of this disease, they get to appreciate the need to get vaccinated and to lead a responsible lifestyle that can reduce the chances of acquiring the disease. Through proper vaccination and responsible behavior, the American society can be freed from the medical problems associated with hepatitis B. The study also proposes a multi-agency and multi-nation approach while dealing with this problem because it affects the global society.

Americans can still acquire this disease if they travel to other countries or if infected people from other countries visit the United States. Just like polio, the best way of achieving success is to ensure that the global society takes a united approach in not only treating the infected population but also vaccinating those who are healthy and in promoting awareness about how the virus is passed from one person to another. Through this approach, the global society will be able to manage hepatitis B.

References

Alp, H., Tan, H., & Orbak, Z. (2009). Bell’s Palsy as a Possible Complication of Hepatitis B Vaccination in A Child. Journal of Health, Population and Nutrition, 27(5), 707-708.

Ayerbe, M., & Pérez, A., (2001). Assessment of Long-Term Efficacy of Hepatitis B Vaccine. European Journal of Epidemiology, 17(2), 151-156.

Geier, D., Kern, J., Hooker, B., Sykes, L., & Geier, M. (2016). Thimerosal-Preserved Hepatitis B Vaccine and Hyperkinetic Syndrome of Childhood. Brain Science, 6(9), 45-81.

Gerlich, W. (2013). Medical Virology of Hepatitis B: how it began and where we are now. Virology Journal, 10(29), 10-239.

Madhavi, Y. (2003). Manufacture of Consent? Hepatitis B Vaccination. Economic and Political Weekly, 38(24), 2417-2424.

Mansfield, P., Phadke, A., & Kale, A. (2006). Blanket Hepatitis B Vaccination Is Questionable In India. BMJ: British Medical Journal, 332 (7547), 976-976.

Van, P., & Banatvala, J. (2003). Vaccine Induced Protection Against Hepatitis B. BMJ: British Medical Journal, 326(7380), 105-105.

Xiridou, M., Wallinga, J., Dukers, N., & Coutinho, R. (2009). Hepatitis B Vaccination and Changes in Sexual Risk Behavior among Men Who Have Sex with Men in Amsterdam. Epidemiology and Infection, 137(4), 504-512.

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StudyCorgi. (2021, February 27). Hepatitis B as the Major Medical Concern. Retrieved from https://studycorgi.com/hepatitis-b-as-the-major-medical-concern/

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"Hepatitis B as the Major Medical Concern." StudyCorgi, 27 Feb. 2021, studycorgi.com/hepatitis-b-as-the-major-medical-concern/.

1. StudyCorgi. "Hepatitis B as the Major Medical Concern." February 27, 2021. https://studycorgi.com/hepatitis-b-as-the-major-medical-concern/.


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StudyCorgi. "Hepatitis B as the Major Medical Concern." February 27, 2021. https://studycorgi.com/hepatitis-b-as-the-major-medical-concern/.

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StudyCorgi. 2021. "Hepatitis B as the Major Medical Concern." February 27, 2021. https://studycorgi.com/hepatitis-b-as-the-major-medical-concern/.

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StudyCorgi. (2021) 'Hepatitis B as the Major Medical Concern'. 27 February.

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