Introduction
Hepatitis C is a global issue and places a significant burden on public health since it is internationally responsible for high death and morbidity rates. It is a chronic and acute infection caused by the Hepatitis C virus. Moreover, it is primarily spread through sharing unsterilized syringes used to develop and inject medicines or contact with blood from an infected individual. Its symptoms may occur in the first six months after infection and thus a lifelong infection when left untreated.
Hepatitis C is a serious condition leading to long-lasting health problems such as liver failure, damage to the liver, cirrhosis, or even death. About 30 percent of individuals infected with Hepatitis C spontaneously clear the virus without treatment within six months after infection. Georgia is one of the states adversely impacted by Hepatitis C, with a prevalence of 5.4 percent and an estimated one hundred and fifty thousand individuals living with this disease.
This research paper aims to identify the epidemiology and impacts of Hepatitis C in Georgia, discuss the disease’s significance and background, and outline the current surveillance and reporting methods. In addition, the paper will comprehensively review and analyze the descriptive epidemiology of the condition, state the guidelines for screening and diagnosis, and give a plan for how Hepatitis C is addressed.
Background and Significance of the Health Problem
Hepatitis C is a disease caused by a virus that mainly infects the liver and results in swelling. After an infection, roughly 80 percent of individuals do not exhibit any signs. The acutely symptomatic people have early warning signs, including abdominal pain, jaundice and joint pain, fatigue, and fever (Day et al., 2019). Some risk factors include people living with HIV/AIDS, having contact with a health care provider exposed to infected blood, old age, blood transfusion, and individuals who have received hemodialysis therapies for a long period.
One of the impacts of hepatitis C is perceived stigmatization, leading to higher anxiety levels and exaggerated fears of spread along with social isolation and decreased intimacy in marital relations. A serosurvey conducted in 2015 shows that about 150,000 people were living with hepatitis C infection with a prevalence of 5.4%, as shown in Table 1. By 2019, there had been a continuous testing scale-up, and about 54 313 people had been treated in Georgia (Hagan et al., 2019).
Worldwide, about 71 million individuals live with this condition, and over 411 000 deaths are attributable to hepatitis C infection. The virus accounts for 27 percent of cirrhosis cases and 25 percent of hepatocellular liver cancer cases globally (Hagan et al., 2019). Nationally, more than 4.7 million U.S. residents live with hepatitis C (Hagan et al., 2019). Table 1 summarizes the incidence and prevalence of hepatitis C in Georgia in 2015.
Table 1: Summary of the Incidence and Prevalence of Hepatitis C in Georgia in 2015.
Males are believed to report high acute hepatitis C infection rates compared to males. Healthcare givers reported 3,261 patients with acute conditions (World Health Organization, 2022). Most citizens in the United States do not seek treatment, and thus their cases go unrecorded. In 2018, physicians recorded about 137 713 cases of hepatitis C, with a 63.1 percent majority being men. Regarding age, most cases were distributed between 50 – 69 years and 20-39 years, with baby boomers reporting 36.3 percent of the cases (World Health Organization, 2022). The infection rates of this disease vary with age group, geographical distribution, ethnicity, and gender. Table 2 below shows the number of acute hepatitis C cases reported in the United States in 2019.
Table 2: Acute Hepatitis C Cases Reported in the United States in 2019.
Additionally, regarding race, the infection rates ranged from 0.2 cases in every 100 000 individuals of Pacific Islanders and Asians to 3.6 cases in every one hundred thousand individuals of Alaska Natives and Native Americas. According to a surveillance report on viral hepatitis in 2019, the incidence rate was highest in Indiana, with 4.8 in every 100 000 individuals (World Health Organization, 2022). West Virginia and Utah follow this, and South Dakota with 4.4, 4.0, and 3.2, respectively (Cupp, 2020). This condition is serious and common and can infect people of all genders and ages.
Current Surveillance and Reporting Methods
Passive surveillance is one of the methods of reporting hepatitis C. in this system, the sources of reported cases of this condition include clinics, hospitals, and laboratories which report routinely to health departments. Under the present nationwide surveillance framework, the past/present and acute hepatitis C are voluntarily and acutely reported weekly by healthcare departments to a surveillance network at the national CDC. The network depends on healthcare facilities and labs to record case reports as required by states to the departments of health (World Health Organization, 2022). Afterward, the healthcare sectors process the data and store the information on the new cases using personally identifiable information. The reporting is accomplished through automated recording systems, telephone, or toll-free numbers available at all hours.
Active surveillance is another method in which health sectors must contact the sources of reports for hepatitis C routinely and demand detailed information for reports. The reporting frequency is tracked, and information on epidemiological characteristics, including infection complications, is obtained. Under this method, reporting is done on time despite being resource-intensive and costly (Akiyama et al., 2021). The other technique is enhanced surveillance programs, which are heavily financed and supported by CDC. The primary objective of these programs is to make follow-up investigations on cases to obtain data such as risk behaviors. The additional data enables the surveillance system to answer discrete research and monitoring questions.
Healthcare givers are required by law to report Hepatitis C to the department of health in Minnesota. That can be done through 877-676-5414/ 651-201-5414, and also, to prevent the spread of the disease through perinatal transmission to infants, all cases of pregnant mothers must report to the Minnesota department of health. However, nationally, surveillance for this condition has proved difficult (Akiyama et al., 2021). No serological markers are available for the disease, cases are ported based on positive lab reports, and most health departments lack sufficient resources. Finally, implementing strategies, including serial serological surveys and sentinel surveillance, may enhance the management and assessment of case reports of suspected cases.
Descriptive Epidemiological Analysis of the Health Problem
Most individuals get hepatitis C by sharing surgical equipment, including needles used to prepare and inject drugs from an infected person. Internationally, this disease has infected more than one hundred and thirty million individuals, most of whom are acutely infected. Regarding geographical distribution, regions including Turkey, the United States, Japan, and Spain have an average prevalence rate of hepatitis C infection between 1.0 and 1.9 percent (Cupp, 2020). In America, youths aged 30 -49 years have the highest prevalence accounting for two-thirds of all infections in the country. That trend means that the transmission of this disease occurred in young adults in the last 20 – 40 years (Roudot-Thoraval, 2021). Individuals who inject drugs are most vulnerable to hepatitis C infection.
The main transmission mode of this disease includes the transfusion of unscreened blood products and sharing unsterilized medical tools, but not transmitted through breast milk or causal contact. The incubation period for this infection is between two to six weeks, with symptoms such as dark urine, loss of appetite, and vomiting. Though expensive, administering Pan-genotypic direct-acting antivirals for adolescents, adults, and children below three years proves effective in treating hepatitis C. The financial burden of this condition exceeds USD 10 billion yearly in the United States. The social impact includes increased stigmatization due to fear of transmission, fueled by misinformation.
Diagnosis and Screening Guidelines
Since most hepatitis C infections are normally asymptomatic, few individuals are diagnosed when the infection is current. One of the ways of diagnosing hepatitis C is through testing for the presence of anti-HCV antibodies using a serological test to identify persons already infected with the condition. In the second case, when the test results are positive for the antibodies mentioned above, polynucleotide tests for HCV ribonucleic acid are done to validate the infection and therapy (Liu et al., 2019). After an individual has been diagnosed with this disease, an evaluation must be performed to determine cirrhosis and fibrosis (Centers for Disease Control and Prevention, 2020). That may be done by conducting several non-invasive tests, including liver biopsy.
Screening of hepatitis C involves a series of interventions in a group with no symptoms or signs of infection. A selective screening may be utilized by testing all people at higher risk of contracting hepatitis C. The other method is universal screening, whereby all people in a specific category, such as all persons between 20-35 years, are tested (Schillie et al., 2020). One of the guidelines for universal screening is that it must be done once in a lifetime for all persons who have attained 18 years (Schillie et al., 2020). Moreover, it should be screened for all expectant mothers during antenatal except when the infection is below 0.1 percent. Another national screening standard is that the test should be done on any individual who requests screening.
Furthermore, routine testing should be done regularly for individuals with ongoing risk factors, including those who have received maintenance hemodialysis. The screening should also be done once for all individuals with recognized exposures regardless of setting prevalence or age. That includes persons living with HIV, those who have received a surgical operation or blood transfusion before July 1992, and those who have ever shared syringes, among other drug preparation equipment (Cupp, 2020). Measuring the antibody to the hepatitis C virus in an individual’s serum is one of the screening tests for this disease. The present screening test, which is available, has a specificity of 100 percent and a sensitivity of more than 97 percent. It has a 98 percent predictive value and costs more than USD 100 (Tan et al., 2018). This sensitivity rate shows that the screening will detect more than ninety-seven percent of people exposed to the infection. The test might be adjusted to increase the sensitivity and minimize the specificity.
Plan of Action
After graduation, nurse practitioners can develop a care plan aimed at managing hepatitis C in the community setting. They should also be sensitive to the community members regarding the disease progress, prognosis, and treatment of hepatitis C. Some primary interventions for addressing hepatitis C infection include nurse practitioners providing a comprehensive hard-reduction service to individuals who inject drugs. They should also offer safe handling and disposal of waste and sharp objects and secure and appropriate health care injections.
The secondary interventions aim to reduce the risk of further hepatic injury and avoid fibrosis progression. They include vaccinations against hepatitis A and B (Yazdani et al., 2022). Other measures include educating patients to avoid sharing personal items and to engage in protected sex whenever possible. One of the tertiary interventions that the nurses should embrace is conducting scheduled surveillance of hepatitis C infection, mainly in high-risk populations, to enhance early detection and increase the feasibility of curative treatment. The efficiency of the above interventions would be based on research in which they are randomized to one group and a placebo. The outcomes will be measured by gathering data through semi-and structured interviews, surveys, and customized client assessment tools.
Conclusion
Hepatitis C is a liver infection chiefly caused by the hepatitis C virus. It is normally transmitted when the virus from an infected person enters the bloodstream of an uninfected individual. In 2015, Georgia reported the highest number of persons living with hepatitis C.
As of 2020, the state had adopted a plan to eliminate hepatitis C infection to lower the prevalence by about ninety percent. In addition, regular screening for hepatitis C is highly recommended, especially for high-risk populations and individuals born between 1945 and 1965. Even though there is no specific vaccine for the hepatitis C virus, there are various methods of preventing this disease, including avoiding behaviors that may facilitate the spread of the disease, mainly injecting drugs.
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