A Hepatitis Incident in North Dakota

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Table of Contents

Introduction
Background
Public Health Implications
Planned Response. Health Promotion & Illness Prevention
Conclusion
References

Introduction

The healthcare system faces the essential task of supporting public health. Epidemiology contributes to this goal by defining the patterns of diseases and striving to develop the most effective measures for their prevention and control. Nurses play an influential role in developing and applying epidemiology knowledge, primarily through community outreach (Macha & McDonough, 2012). The current paper considers a hepatitis incident of unknown etiology in a child in North Dakota. Such a problem can become a severe threat to public health, and it is of particular concern that the younger generation is affected since the disease can impact their entire life.

Background

Over the March-September period, the half year of 2022, several diseases have been of concern in the United States. Despite a slight decline in incidence, COVID-19 continues to spread, and an additional threat has emerged due to the monkeypox outbreak. However, a review of the news presented on the North Dakota Department of Health (NDDoH, 2022) website showed that a hepatitis incident caused the most significant concern in the state over the studied period. The disease affected the child, and its cause is unknown. The young patient from Grand Forks County was hospitalized for a short period, after which the child recovered at home (NDDoH, 2022). North Dakota is not the only state where children have suffered from this condition.

The cases of hepatitis caused severe concern and therefore required investigation. Locally, NDDoH (2022) urged medical officers to check records for various suspicious cases of hepatitis, also requiring studies. Moreover, the Department joined the Centers for Disease Control and Prevention (CDC), which uses epidemiological investigation tactics to discover the causes of hepatitis in children (NDDoH, 2022). While there was only one patient in North Dakota, 109 cases were recorded, of which 90% needed hospitalization, 14% had a liver transplant, and five children died nationwide in May 2022 (Kimball, 2022). According to the World Health Organization (WHO, 2022), hepatitis affects patients of both genders, but most cases are children under six years old. Epidemiological research is the basis for searching for the causes of the disease and ways to combat it.

Public Health Implications

The investigation, which NDDoH joined, did not reveal the exact cause of hepatitis. The latest updates were in August 2022, reporting an increase in cases in various states (Centers for Disease Control and Prevention [CDC], 2022b). Some children exposed to the disease also had signs of adenovirus infection, resulting in assumptions about the association between diseases (NDDoH, 2022). However, this linkage has not been officially confirmed as a prerequisite for the emergence of hepatitis (Kimball, 2022). At the same time, the study also discarded such possible causes as bacteria, the virus causing COVID-19, Wilson disease, and autoimmune hepatitis (CDC, 2022a). As a consequence, the key findings of the investigation are the exclusion of possible causes, but work continues, concentrating on control and prevention.

The spread of hepatitis to children carries a significant threat, having a negative impact on their health. In particular, the disease has symptoms such as vomiting, diarrhea, jaundice, fever, hepatomegaly, and other manifestations that occur in a majority of patients (Zhaori, 2022). Since the causes of the condition have not yet been established, treatment is primarily supportive. At the same time, hepatitis can lead to severe liver damage and failure, and as a result, the child may need transplantation (Zhaori, 2022). As statistics confirm, in severe cases, the disease leads to the death of patients.

The negative impact on health and demand in treatment and control also leads to financial implications. The treatment for considered hepatitis is supportive and directed towards the symptoms, which may vary in cases (Zhaori, 2022). As a result, the cost of treatment is also different for patients. Liver transplantation surgery, necessary for those whose liver is badly damaged, has a high price. According to Ewumi (2022), payment must cover procurement, preparation for surgery, physician services, post-operative care, and other aspects, which in total is more than $875,000. Additional expenses are spent on conducting an epidemiological study, which includes providing employees, paying for materials, and other necessary elements. Thus, hepatitis of an unknown cause should already have significant financial consequences, and the potential cost may increase with its spread.

Planned Response. Health Promotion & Illness Prevention

Given the complexity of the disease and its health and financial implications, it is essential to take measures to prevent it. In particular, recommendations from NDDoH (2022) suggest that parents closely monitor potential symptoms of hepatitis and, in case of suspicion, consult a doctor for the necessary help. While the association with adenovirus infections is not officially confirmed, the Department still recommends monitoring its symptoms as well (NDDoH, 2022). They include manifestations of sore throat, fever, pink eye, diarrhea, and pneumonia (NDDoH, 2022). Crucial aspects of health promotion are measures to prevent the appearance of diseases, including considered hepatitis. NDDoH (2022) suggests being careful when symptoms of any illness appear and staying at home, as well as washing hands, and following vaccination guidelines. The WHO (2022) expands recommendations by suggesting avoiding crowded places, using safe water and food, and keeping homes clean. These measures will reduce the number of children that can get hepatitis.

Another aspect of health promotion and prevention of hepatitis is the work of medical personnel with the public. The Intervention Wheel offers a framework for working with the population, considering various aspects (Minnesota Department of Health [MDH], 2019). Several interventions identified in this approach can be used in the studied case of hepatitis. Since there is no established cause of the disease, nurses must apply practical actions from red wedge interventions. They include surveillance, investigations, screening, case-finding, and outreach (MDH, 2019). Efforts to educate the population are also needed, which imply consultations, counseling, and teaching. Such measures will contribute to communities’ awareness and ability to prevent the disease and take action in the case of symptoms manifestation.

Part of the activity of public health nurses is the impact on politics. In the case of hepatitis of unknown cause, medical staff needs to protect the interests of patients and facilitate the investigation of its causes through stakeholder involvement. Moreover, their influence on the policy may include providing recommendations for disease control, drawing stakeholders’ attention to the problem, and urging society to follow guidelines (MDH, 2019). Although hepatitis is a serious concern, these measures are still sufficient to prevent it, and it is essential to direct efforts to investigate the cause.

Conclusion

Thus, a study of public health incidents in North Dakota found that in addition to COVID-19 problems, the case of hepatitis with an unknown cause in the child also caused serious concern in half a year. The disease has affected many more children in other states, and the NDDoH has joined the CDC epidemiological investigation to find the causes. Hepatitis negatively affects health, manifesting in unpleasant symptoms and leading to liver failure and, as a result, the need for transplantation. Such operations and investigations have significant financial implications but are necessary for treatment. Critical interventions include continuing research, educating the public, and protecting their interests.

References

Centers for Disease Control and Prevention. (2022a). Children with hepatitis of unknown cause. Web.

Centers for Disease Control and Prevention. (2022b).Investigation updates. Web.

Ewumi, O. (2022). How much does a liver transplant cost?Medical News Today. Web.

Kimball, S. (2022). CDC investigating 109 cases of severe hepatitis in kids across two dozen states, including 5 deaths.CNBC. Web.

Macha, K., & McDonough, J. (2012). Epidemiology for advanced nursing practice. Jones & Bartlett Publishers.

Minnesota Department of Health. (2019). Public health interventions: Applications for public health nursing practice [PDF document]. Web.

North Dakota Department of Health. (2022). North Dakota Department of Health investigating hepatitis in child with unknown cause. Web.

World Health Organization. (2022). Severe acute hepatitis of unknown aetiology in children – Multi-country. Web.

Zhaori, G. (2022). Severe acute hepatitis of unknown causes in children–Current findings, questions, opinions, and recommendations, a mini‐review.Pediatric Investigation, 1-8. Web.

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