Hepatitis A is a disease caused by a virus called hepatitis virus A (HAV). This virus is carried in the human feces. The virus enters into a person’s body when he or she eats food that is contaminated with the feces of an infected individual (Hepatitis A overview” Para 2)
Signs and symptoms
When a person is infected with this disease, there are chances that the person may show no symptoms or the person can just show some mild symptoms. Even if a person shows no symptoms, the feces of this infected person will still be carrying the virus and can facilitate passing over the disease to other people. As it is presented by “Hepatitis overview” (Par 3) “the common symptoms for this disease include; loss of appetite, losing weight, diarrhea, vomiting, abdominal pains, yellow and white eyes (jaundice), and itchy skin among others”.
After a period of 2 months, the hepatitis A infection in a person may disappear but it can come about once again in some individuals. The moment an individual is infected with this disease and the immune system has fought the hepatitis A virus successfully; this individual will never be infected again since his or her body is now permanently immune to the disease. Complications arising from this infection may arise but this only occurs in rare cases. There are very minimal chances for one to have his or her liver permanently damaged as a result of this infection. However, in very few cases, the infection can be quite fatal, and mostly among those people who are old and they can have permanent liver damage.
Treatment
We have no specific treatment for hepatitis A. In most cases, the immune system of an infected person engages in fighting the disease and normal health may be regained after a period of two months of infection. As a way of dealing with this disease, doctors advice the infected people to avoid taking alcoholic drinks and also to keep away from eating foods full of fats. Taking these substances may result in complications for the liver and the liver may not be able to process them and this may worsen inflammation.
Prevention
Some measures can be taken to prevent people from being infected with this disease. One of the measures that can be taken is that people should wash their hands thoroughly after getting in contact with the feces or body fluids of a person who may be infected. More so people are supposed to avoid eating unclean food and drinking water that is not clean.
If an individual was exposed to hepatitis A recently and has neither had this disease before nor has been vaccinated, he or she should inquire from the doctor about being vaccinated or being immunized using “immune globulin”. The most important reasons for an individual to be vaccinated or to receive immune globulin are that;
one may be living with a person who is infected with Hepatitis A,
a person may have had sex with a person who is infected with the disease,
one may have shared prohibited drugs through injection with a person who is infected,
one may have had very close personal contact with a person who is infected over a period of time,
a person may have taken food in a hotel where those people handling the food might have been infected or the food itself might be contaminated with the germs causing this disease.
Those people who travel from one place to the other are supposed to avoid eating meat or fish which might have not been cooked properly. They are not suparentare nt supposed to purchase on the stretes. More so, they should get vaccinated against the disease.
Considering immunization for this disease, it t is offered in a sequence of injections. The initial lone injection that is made on the arm offers protection to the person for a period of one year. The second injection that is given is a booster that makes protection to go on for a longer period, and this period is normally about ten years. It is always recommend that young children receive a vaccine in those regions that are established to be having higher chances for people to get infected with the disease. A vaccine for this disease is also recommended for that individual who is moving to a place where there are high chances of catching this disease. More so, it is recommended that those individuals who engage in sexual activities that expose them to risks of catching the disease be immunized (“Hepatitis A”).
Prognosis
The Hepatitis A virus can no longer stay in the body the moment the infection has disappeared. More than 85 percent of those individuals having hepatitis A recover from the infection after a period of three months. Nearly all those individuals who have been infected with Hepatitis A get well within a period of six months. The risk of death is low (U.S National Library).
References
“Hepatitis A”, avert.org. Avert. 2000. Web.
“Hepatitis A overview”, emedicinehealth. eMedicineHealth, 2010. Web.
Hepatitis C affects the liver in humans and it is caused by Hepatitis C Virus (HCV) which has an RNA structure (World Gastroenterology Organisation, 2013). According to the National Institute of Health (2010) in the United Kingdom, individuals acquire the infection through percutaneous exposure to infected blood. Additionally, 30 percent of the infected people develop acute Hepatitis C (Goldberg & Anderson, 2004). In the event that the virus is not cleared after treatment, about 80 percent of individuals develop the chronic form of the infection (National Institute for Health and Clinical Excellence, 2010). The department of Public Health England (2013) estimates that 215,000 patients are infected with the chronic form of the disease in the United Kingdom; the prevalence of the infection in England is about 40 cases per 10,000 populations. There are variations in the ethnicity of the individuals that are infected as most infections have been reported among people of South Asian origin (Public Health England, 2013). The prevention and control strategies in England focus on the populations at-risk of the infection and majorly target injecting drug users (Public Health England, 2013). Although these strategies have been effective in the past, the cases of HVC in England are still high (Health Protection Agency, 2012). According to the Health Protection Agency (2012), the disease is projected to cause 15,840 cases of liver cancer and cirrhosis by 2020 if majority of the cases continue to be untreated. The trends between 1997 and 2008 showed that the number of patients with cancer and other HCV related complications had been increasing over the years as shown in the figure (2) below;
Figure (2) showing the number of patients hospitalized with liver cancer and other liver diseases associated with HCV infection between 1997 and 2007 (adapted from Health Protection Agency, 2009)
The increase in number of cases of liver cancer and cirrhosis may elicit a huge burden on the health care system in the United Kingdom and may result in many deaths (Health Protection Agency, 2012). The England Action Plan for Hepatitis C (2004) indicates that the testing should focus on the people who are most susceptible to the infection especially intravenous drug users. Based on a report by the Public Health England (2013), the prevalence of the disease among injecting drug users ranges from 17 to 82 percent and it varies across different regions in the United Kingdom.
Current prevention and control strategy in England and its effectiveness
The Public Heath England (2013), reports that England has continued to upgrade the prevention and control mechanisms that regard to hepatitis C infections. Since the control and prevention of HCV in the United Kingdom target on the susceptible populations, England has invested in effective community drug treatments that are accessible to the most-at-risk populations (Public Health England, 2013). There was an escalation of 114,855 individuals that received medication among those that abused injectable drugs between 2010 and 2011. The Drug Action Teams in the country have also developed other mechanisms for hepatitis C prevention that focus on drug misuse and sexual health (Health Protection Agency, 2012). One of the widely used control and prevention strategies is the provision of clean needles to the populations suspected of injecting drugs. This has been done through the Needle and Syringe Programmes (NSP) and it has proven to be successful over the years. In the duration between 2011 and 2012, a total of 25, 530 needles were supplied to the drug users (Health Protection Agency, 2012).
The drug users are also trained on proper use and disposal of the needles and syringes. In an effort to ensure that the Needle and Syringe Programmes are effective, peer education and outreach services are provided across the population. According to the Health Protection Agency (2012), these services are aimed at increasing the awareness of the public on hepatitis C infections. Moreover, the programmes target the populations at risk of infections with special focus on individuals of South Asian ethnicity. Another control and prevention mechanism that is in place in England is the monitoring of the testing and diagnosis patterns of the population (Public Health England, 2013). This enables the Department of Health to determine the effectiveness of the awareness campaigns and other prevention strategies that focus on the populations at risk of the infection as well as the low-risk population. In reference to the department of Public Health England (2013), there have been sentinel surveillance programs conducted to determine the number of patients tested and diagnosed with Hepatitis C throughout the country. The level of awareness on the disease has been on an increasing trend based on surveillance reports conducted between 2008 and 2012. The increasing trend was similar in the period between 2005 and 2008 as shown in figure (2).
Figure (2) indicates the number of patients tested for HCV and the percentage of positive tests between 2005 and 2007. (adapted from Health Protection Agency, 2009).
According to the Department of Health (2004), the prevention and control strategies also include the provision of drug treatment services and drug adherence advice by specialists. These strategies also focus on the prison populations through the provision of disinfecting tablets (Department of Health, 2004). In addition to the prevention and control mechanisms that focus on the groups at risk of infections, the testing of blood donors has also been incorporated to target the low-risk population. This is important as it acts as a marker of the prevalence of Hepatitis C in the wider population. In reference to the department of Public Health England (2013), the current treatment regimens incorporate Interferon and Ribavirin which are the licensed treatments regimens in the United Kingdom. The drugs are either given in combination or as a monotherapy depending on the extent of infection and their contraindication (Public Health England, 2013).
Current challenges in the control and prevention of HCV in England
A decade after the development of Hepatitis C action plan in England, there are still several challenges that are associated with the control and prevention of the disease. According to a report by the Health Protection Agency (2012), there have been financial challenges in the procurement of the drugs used in hepatitis C treatment as they are very expensive. This incurs a high cost on both the patients and the government. Depending on the duration of the treatment required by the patients, the cost of treatment ranges from 6,246 to 12,741 pounds (Health Protection Agency, 2012). The treatment is usually prescribed for duration of 24 weeks for the genotypes 2 and 3 and 48 weeks for genotype 1 (Patruni & Nolte, 2013). This is due to the high prevalence of the infection that is still present in the population. Moreover, statistical modelling in England have projected that the number of people living with illnesses associated with lack of HCV treatment will rise to 15,840 if majority of the cases continue to be untreated (Public Health England, 2013). This is a signal that more money will be required for the management of complications such as cirrhosis and liver cancer. Additionally, the public health awareness programs in England do not seem to be 100 percent effective as the incidence of the disease continue to rise.
The lack of adherence to the drugs is another major challenge that is facing England and the rest of the United Kingdom (Hawkes, 2012). In a report commissioned by the Hepatitis C Trust in England, Hawkers (2012), indicates that the current treatment regimens are expensive and complex. Moreover, they have various side-effects that are associated with their intake such as depression, flu, and fatigue. Therefore, majority of the drug users are not well suited to such side effects and end up not following the recommended instructions when taking the treatment. More recently, protease inhibitors have been incorporated to the treatment regimens and this has made the treatment more complex and hence lack of adherence. According to the department of Public Health England (2013), lack of adherence has additional cost implication to the prevention and control of HCV as more people are likely to get infected.
Based on the report by Hawker (2012), there is also lack of consistency in the adoption of the guidelines outlined in the Hepatitis C Action Plan for England and this has had negative implication on the prevention and control strategies. The same report states that only a third of the health care providers implement the Hepatitis C guidelines to the letter. Moreover, the hospitals are characterized by delays in initiating the treatment to the patients (Hawkes, 2012). These challenges could explain why the incidence and prevalence of the disease is still high despite the prevention and control measures that are in place. In a report by the Hepatitis C trust in England, the authors note that the current control and prevention strategies are characterized by inequalities in focusing on the socially deprived population (Hepatitis C Trust, 2013). These populations include; homosexuals, the homeless, and first generation immigrants. Such inequalities are projected to cost England an additional 31 to 33 pounds annually.
Rationale for or against Introducing the New Strategy versus Relying on Current Prevention Methods
According to a report by the Health Protection Agency (2013), the current prevalence of hepatitis is estimated to be 0.5 percent which is high considering the control and prevention strategies that are currently in place. The introduction of new control and prevention strategies would require additional funding from the government (Royal College of General Practitioners, 2005). As a result, there will be additional burdens on the already strained health sector. Moreover, there have been challenges due to poor coordination among the different organs involved in the prevention and control of Hepatitis C. The current prevention strategies could be effective if there was proper coordination between the various agencies involved (Hepatitis C Trust, 2013). Therefore the government should avail more funds to ensure that the current control and prevention mechanisms are carried out efficiently. There has been a remarkable decline in the number of HCV cases in England since the implementation of the Hepatitis C Action Plan (Public Health England, 2013). This is a sign that the interventions in place have been effective and hence require additional funding to be completely effective.
The Hepatitis C Action Plan has well-defined guidelines on the conduct of public health awareness campaigns. However, the campaigns have not been effective enough to reach the overall target population (Hawkes, 2012). More comprehensive public awareness should be incorporated into the current prevention measures (Hepatitis C Trust, 2013). This would enhance the uptake of the testing programs and reduce the occurrence of the risky behaviors that act as predisposing factors to HCV. Moreover, the challenges that regard to discrimination of some populations could be solved through enhanced public awareness and re-training the health service providers (Hawkes, 2012). The comprehensive awareness campaigns should target prisoners and South Asian populations and other immigrants that comprise the at-risk population. The department of Public Health England should ensure that these campaigns are better coordinated and also target the low-risk populations (Advisory Council on the Misuse of Drugs, 2009).
The control and prevention strategy for Hepatitis C consists of guidelines that should be followed by the health service providers. However, the Hepatitis C Trust (2013) program reports that there is lack of coordination between the health workers. Some appear to follow the stipulated guidelines while others do not follow them fully (Hepatitis C Trust, 2013). The policy makers should consider re-educating all the health care providers on the treatment guidelines that are already set for HCV prevention (Health Protection Agency, 2012).This would also reduce the delays that characterize the hospitals in initiating the treatment regimes. In summary, the current Hepatitis C Action Plan for England is effective in guiding the prevention and control of HCV in England (Public Health England, 2013). Since the introduction of new preventive measures requires additional funds from the government, it is not a feasible alternative. Therefore, the current prevention strategy should be improved to make sure that the current challenges are addressed.
Perceived challenges in introducing new prevention strategies for HCV
According to the department of Public Health England (2013), it is important to review the current strategies in the prevention of HCV. Despite the guidelines outlined in the Hepatitis C Action plan, the number of cases in the country is still high (Public Health England, 2013). Additionally, the Advisory Council on the Misuse of Drugs (2009) indicates that there is a fundamental disconnect in England with regard to the effectiveness of the prevention and control of HCV and the strategies that the policy makers would like put in place. The major cause of such disconnect is the financial implications that disease has and it is projected to result in higher financial burden if more intervention strategies are incorporated. The Public Health England (2013) states that the health services in England are already financially restricted. Therefore the introduction of new preventive strategies would not be a feasible option. Moreover, introducing new prevention strategies would quadruple the current treatment costs incurred by the government at 43 million pounds per year. Therefore, the government should focus on improving the prevention and control strategies that are already in place. Additionally, there would be less people who progress to the advanced stages of the disease if effective strategies are put in place. If the government improves on the current prevention strategies, the number of patients that progress to advanced disease will be reduced to 12,000 from the current 17,000 (Hawkes, 2012). This has a likelihood of reducing the future burden of the disease in England. In summary, majority of the challenges on the introduction of new prevention strategies identify the financial burden that this would cause. Therefore, modification of the current prevention strategies would be a better option.
Resources
Advisory Council on the Misuse of Drugs. (2009). The Primary Prevention of Hepatitis C Injecting Drug Users. Web.
Department of Health. (2004). Hepatitis C Action Plan for England. London: Department of Health.
Goldberg, D., & Anderson, E. (2004). Hepatitis C: who is at risk and how do we identify them? Journal of Viral Hepatitis, 11(1), 12–18.
Hawkes, N. (2012). Confronting the Silent Epidemic: a Critical Review of Hepatitis C Management in the UK. Web.
Health Protection Agency. (2009). Health Protection Report. Web.
Health Protection Agency. (2012). Hepatitis C in the UK: 2012 Report. United Kingdom: Health Protection Agency.
Hepatitis C Trust. (2013). Hepatitis C in England: The State of the Nation. Web.
National Institute for Health and Clinical Excellence. (2010). Peginterferon Alfa and Ribavirin for the Treatment of Chronic Hepatitis C. London: National Institute for Health and Clinical Excellence.
Patruni, B., & Nolte, E. (2013). Hepatitis C: A Projection of the Healthcare and Economic Burden in the UK. Web.
Public Health England. (2013). Hepatitis C in the UK: 2013 Report. London: Public Health England.
Royal College of General Practitioners. (2005). Guidance for the Prevention, Testing, and Management of Hepatitis C in Primary Care. London: Royal College of General Practitioners.
World Gastroenterology Organisation. (2013). Diagnosis, Management and Prevention of Hepatitis C. World Gastroenterology Organisation.
Chronic hepatitis B is one of the common problems in Chicago, IL. The disease is a chronic infection that affects the liver. The condition leads to the scarring of the organ. It also leads to liver failure and liver cancer (Wu et al., 2014). The condition can lead to death if not treated early enough. According to Wu et al. (2014), the disease can easily be transmitted via body fluids. Such fluids include blood. Statistics show that many people in Chicago, including children and adults, are infected by the disease (Wu et al., 2014). The disease can spread through sex (Chon et al., 2012). It is associated with a number of symptoms. They include, among others, fatigue and poor appetite. Causes of the disease include prolonged use of some medicines, such as isoniazid. Drugs used after an organ transplant can also lead to this disease (Wu et al., 2014).
People with a weak immune system, those living with HIV, and those on medication for cancer are at a high risk of contracting the disease. A section of people in Chicago is affected by HIV. As such, they are predisposed to chronic hepatitis B. The development of the illness is affected by the lifestyle adopted by people in the region. Cancer and liver problems are some of the common health problems associated with lifestyle. Hepatitis B and hepatitis E virus can cause the problem. Blood tests can be used to diagnose the disease (Chon et al., 2012). A liver biopsy can also be used to determine the extent of the problem. Medicines are used to treat the problem. However, according to CDC, the prevalence of the disease has dropped due to increased public awareness.
References
Abramson, M., Puy, R., & Weiner, J. (2013). Is allergen immunotherapy effective in asthma?. American Journal of Respiratory and Critical Care Medicine, 435(1), 10-20.
Chon, Y., Choi, E., Song, K., Park, J., Han, K., Chon, C., & Kim, S. (2012). Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: A meta-analysis. PloS One, 7(9), 174-178.
Gordis, L. (2014). Epidemiology (5th ed.). Philadelphia, PA: Elsevier Saunders.
Lloyd-Sherlock, P., Beard, J., Minicuci, N., Ebrahim, S., & Chatterji, S. (2014). Hypertension among older adults in low-and middle-income countries: Prevalence, awareness, and control. International Journal of Epidemiology, 43(1), 116-128.
Virchow, J., Walker, C., Hafner, D., Kortsik, C., Werner, P., Matthys, H., & Kroegel, C., (2013). T cells and cytokines in bronchoalveolar lavage fluid after segmental allergen provocation in atopic asthma. American Journal of Respiratory and Critical Care Medicine, 18(1), 12-45.
Wu, J., Tsai, W., Tung, Y., Chen, H., Ni, Y., Hsu, H., & Chang, M. (2014). Role of serum dehydroepiandrosterone sulfate level on the clearance of chronic hepatitis B virus infection. Journal of Gastroenterology, 49(5), 900-906.
Infection by Hepatitis B Virus (HBV) has been one of health concerns for a long time. The virus leads to both acute and chronic hepatitis. In 2004, Hepatitis B infection was estimated to affect more than 350 million people in various parts of the world. The virus is said to be spreading in all continents including Asia, Africa, America and Europe (Lok 2002, p. 1685). In the last twenty years there has been great improvement on research on Hepatitis B. The researches have led to a vaccine for preventing acquiring Hepatitis B, better treatment and better management methods to prevent transmission. Despite of this, there are still many challenges on research of HBV, management methods and adoption of effective approaches for treating chronic hepatitis. Hepatitis B continues to contribute to numbers of illnesses and mortality in the world. The review aims at pointing out various important aspects of Hepatitis B.
Background
Hepatitis B refers to inflammation in the liver while Hepatitis B virus is the important cause of Hepatitis. Acute and chronic Hepatitis B is a major health concern and is capable of leading to complications to the liver. HBV is a DNA virus that belongs to the family of Hepadnaviridae. It produces HVB from two regions. There exist eight genotypes of the virus while a number of the virus is able to mutate (Liaw & Chu 2009, P.153). Virus mutation has very several implications including decreased affinity of HBdAg to antibodies and HBsAg (Hepatitis B antigen). Such mutations are evident in infants from HBAAG-positive mothers. Some for the children develop Hepatitis even though they had been vaccinated. Chorionic Hepatitis results from prevalence of HBsAg, HBdAg and hepatitis virus DNA after initial infection with acute Hepatitis. Progress of hepatitis is children are usually silent with most symptoms showing up at adolescence and adulthood.
Hepatitis B virus is transmitted via body fluid. It is mainly transmitted through blood contact although it is also transmitted through other body fluids such as saliva and semen. Because of presence of Hepatitis B virus in body fluids, sexual intercourse becomes one of the major ways through which the virus is transmitted. Among the groups that are more venerable to hepatitis B include individuals with multiple sexual partners, individual engaging in unprotected sex, health workers working with hepatitis B patients (Teo & Lok 2007, par 5). Symptoms for Acute hepatitis show up shortly after an individual is infested with hepatitis B virus. Symptoms for chronic hepatitis B however last longer that six month and may not be able to get away completely (Rehermann, Ferrari, Pasquinelli & Chisari 1996, p. 1113).
Clinical Presentation
Hepatitis B infection can either be symptomatic, asymptomatic or, in rare occasions, enteric. In children that receive the virus from their mothers before birth, there are generally no observable symptoms. Only about 5 and 15% of those prenatally infested hepatitis b develop into illness. Symptoms are more evident in older children and adults. Symptoms are evident in about 33 and 50% of those infested with the virus. Symptoms of hepatitis B are close to those of flu. Many individuals with hepatitis b mistake the disease with flu. Some of the symptoms included loss of appetite, fatigue, itching, nausea, jaundice and abnormal stool and urine. Unique symptom of the infection is itching at the liver (Lavanchy 2004, p. 81-82).
Basic presentation of hepatitis B is testing positive in a blood screening for hepatitis B. An adolescent with hepatitis B would test positive for hepatitis virus but fail to show any symptoms such as nausea, abdominal pain or weight loss (Rollins 2007, p.281). According to report by annual surveillance, a child with hepatitis virus may remain asymptomatic for years. Because of this unique nature of hepatitis, sure way of identifying the virus is through routine blood test and evaluation of risk factors. Because of participating in unsafe sexual activities and sharing of gadgets used in drug use, adolescents are at a higher rate of contracting hepatitis b. Apart from adolescent, the other groups that are more venerable to hepatitis B include infants. Infant can acquire the virus from mothers with more that 90% presence of HBeAg-seropositive.
Laboratory Diagnosis
Screening for presence of hepatitis B surface antigen is the basis for laboratory diagnosis. Diagnosis is also carried out using various serologic assays that are highly sensitive, high level of specificity and reproductively. Essays such as ELISA are used to detect presence of HBV marker (Murray, Baron, Jorgensen, Landry, M & Pfaller 2007, P.67). Apart from the above approaches, nucleic acid testing for HBV-DNA is also used. Nucleic acid testing helps in quantifying viral load in the body and measure success of corrective therapies.
Epidemiology
Vaccination and public awareness campaigns have significantly changed epidemiology of hepatitis B. The virus is mainly transmitted through exposure to blood or other body fluids that is infested with the virus. Main risk factors for hepatitis B include unsafe sexual activities, transfusion of unscreened blood, sharing of syringes, and exposure to the virus through working in any health care area or having tattoos (Liaw & Chu 2009, P.157).
The age at which an individual acquires hepatitis B has high influence on development of hepatitis B. Infants that are infested with the virus have about 90% chance of developing chronic hepatitis b. The rate of developing chronic hepatitis drops with increase in age. For example, children that are older than five years have been found to have 25% rate of developing chronic hepatitis after acute hepatitis (Suskind & Rosenthal 2004, P. 126). Epidemiology is also influenced by viral strain, genotype, ethnic background gender and other health factors.
Discussion
Development of a vaccine for Hepatitis B Virus was a major boost to fight against hepatitis B (O’Mackie & Buxton 2009, p. 145). Among the groups that are of high risk of hepatitis B include the adolescent and infants from HBeSg-seropositive mothers. The main approach to fighting hepatitis has been through public awareness for behavior change and has been mainly directed towards the adolescents. Although this approach can lead to success, there is need for increased emphasis on preventing transmission to infants. This is because of the fact that infants are more vulnerable to hepatitis infection as well as other diseases. Public awareness and education is necessary in preventing transmission among youths while new vaccines schedule would help to reduce transmission to infants.
Implication
Increased knowledge on virology of HBV, natural trend of chronic infection and immunology has very significant role in eradicating hepatitis B. Although development hepatitis B vaccine has helped to reduce prevalence of hepatitis B, more effort is required in ensuring responsible behavior among the adolescent. Drug resistance to the vaccines has also been a setback to eradication of hepatitis B (Rehermann & Nascimbeni 2005, P. 217). Better knowledge on the routes and mode of transmission of Hepatitis B virus together with health education can be of positive contribution to prevention of hepatitis B infections.
Treatment
Acute HBV infection has no specific and effective treatment. Chronic HBV infection, however, has some drugs such as lamivudine and adefovir dipivoxil that are used in its treatment. Other treatment approach include liver transplant for patients whose livers are greatly affected.
Conclusion
Hepatitis B is a major health challenge in the world, especially in developing countries. Sexual transmission of Hepatitis B Virus makes the virus easily communicable. Clinical presentation of hepatitis B is one of the challenges to its eradication. Presence of the virus is asymptomatic in many cases making it challenge to take corrective measures. To identify the virus in human body, there is need for frequent blood screening. Vaccination and public awareness and education are necessary in preventing transmission.
Reference List
Lavanchy, D., 2004. Hepatitis B Viral Epidemiology, Disease Burden, Treatment, and Current and Emerging Prevention and Control Measures. Journal of Viral Hepatitis, Vol. 11. No. 2.
Liaw, Y. & Chu, C., 2009, Hepatitis B virus infection. The Lancet, Vol. 373 No 9663, 582-593.
Lok, A., 2002, Chronic Hepatitis B. The New England Journal of Medicine, Vol. 346, No. 22, 1682-83.
Murray, P., Baron, E., Jorgensen, J., Landry, M. & Pfaller, M., 2007, Manual of clinical microbiology. Washington, D.C.: ASM Press.
O’Mackie, C. & Buxton, J., 2009. Hepatitis B, immunization strategies. Canadian Medical Association Journal, Vol.180, No. 2, pp. 196-203.
Rehermann, B. & Nascimbeni, M., 2005. Immunology of Hepatitis B Virus and Hepatitis C Virus Infection. Nature Reviews, Vol.5, pp. 14-18. Web.
Rehermann, B., Ferrari, C., Pasquinelli, C. & Chisari, F., 1996. The hepatitis B virus persists for decades after patient’s recovery from acute viral hepatitis despite of active maintenance of a cytotoxic t-lymphocyte response. Nature Medicine, Vol. 2, pp.1104-08.
Rollins, J., 2007. Investigational vaccine could offer protection for infants against haemophilus influenzae type B and meningococcal disease. Pediatric Nursing, Vol. 33, No. 3, pp. 279-281.
Suskind, D. & Rosenthal, P., 2004. Chronic viral hepatitis. Adolescent Medicine Clinics, Vol. 15, No. 1, pp.145-159.
Teo, K. & Lok, A., 2007. Epidemiology, transmission and prevention of hepatitis B virus infection. Web.
The first accounts of hepatitis, also referred to as epidemic jaundice, can be traced back to Hippocrates. Outbreaks of the disease were recorded in the 17th and 18th centuries, and were mostly associated with military campaigns (Wasley, Gallagher and Grytdal 3). The first epidemiological differentiation between Hepatitis A and B was in the 1940’s. Serological tests to differentiate between hepatitis B and A were developed in the 1970’s and consequently led to the identification of the causative agents (Marler). Maintenance of hygiene and passive protection was the primary preventive measure prior to the development of vaccines. Hepatitis vaccines were developed and consequently licensed in 1995 (Marler). The vaccines provide long-term protection against the causative agent, that is, the Hepatitis A virus (Wasley, Gallagher and Grytdal 4).
Hepatitis A is categorized as a picornavirus. It is a non-enveloped RNA stable virus which has the capability of surviving in the environment for several months. “The virus is stable at moderate temperatures and low pH, but can be deactivated by chemicals, such as chlorine and formalin. In addition, temperatures above 85°C can deactivate the virus” (FitzSimons, Hendrickx and Van Damme 584). Human beings are the only hosts for the virus, although primates have been successfully infected with the virus experientially (Hepatitis A 8). HAV replicates in the liver cells causing inflammation due to the destruction of hepatocytes by natural killer cells and cytotoxic cytokines. The inflammatory process is a consequence of an immune reaction (FitzSimons, Hendrickx and Van Damme 585).
The course of the disease after infection depends on age. Children can develop unapparent hepatitis A and portray no signs or symptoms. Serological or biochemical tests are the only methods to diagnose asymptomatic hepatitis A, other patients develop icteric hepatitis and show symptoms ranging from mild acute to severe chronic; the patients can either recover fully or die as a result of fulminant hepatitis (Marler). The incubation phase is the first stage and lasts from 10 to 50 days. At this stage, the patient is asymptomatic. In the second stage, known as the preicteric phase, the patient shows signs of nausea, vomiting, fatigue, loss of appetite and abdominal pain and mostly lasts from several days to weeks (Wasley, Gallagher and Grytdal 12). The third phase is the Icteric phase; at this stage the patient has massive liver necrosis and has severe abdominal pain, jaundice and hepatic encephalopathy that may result in seizures and consequently coma. Mortality is high at this stage. The last phase is the convalescent period; at this phase, the patient recovers from the disease or it may relapse in 3-20% of all patients. Patients who fully recover develop lifetime immunity. Conclusively, the symptoms of the illness include nausea, dark urine, loss of appetite, abdominal pain, fatigue, jaundice and fever (FitzSimons, Hendrickx and Van Damme 586).
Diagnosis is primarily through assessment of liver function biochemically. The method is favored as acute hepatitis manifests itself in a similar manner as other hepatitis viruses. As such, it cannot be differentiated from other forms of the disease. The disease is diagnosed by demonstrating the existence of Anti-HAV antibody. The presence of the antibody can be detected 5-10 days prior to the onset of illness. There is no treatment of therapy for the disease. Treatment is supportive in nature while symptomatic treatment focuses on patients with high risk of developing fulminant hepatitis A. Infection can be prevented through vaccination. Persons handling the patient should be vaccinated to avoid contracting the disease (FitzSimons, Hendrickx and Van Damme 588).
Works Cited
FitzSimons, David, Greet Hendrickx and Pierre Van Damme. “Hepatitis A and E: Update on Prevention and Epidemiology.” Vaccine 28.3 (2010): 583-588. Print.
Hepatitis A. PFD file. 2014. Web.
Marler, Billy. ” Publisher’s Platform: All About Hepatitis A”. Food Safety News. 2012. Web.
Wasley, Annemarie, Kathleen M Gallagher and Scott Grytdal. “Surveillance for Acute Viral Hepatitis, United States.” 2006.Web.
Hepatitis C is an infectious viral disease. It depicts itself in an individual through swelling of the liver. Although the disease is usually asymptomatic (do not show symptoms early enough), it is a dangerous infection and when not handled appropriately, it damages the liver greatly causing Cirrhosis. The virus is transmitted through blood-to-blood contact. The disease is curable when noted during the early stages. Hepatitis C is an increasing public health concern and it has claimed many lives, young and aged (Preidt par 3). This piece of paper looks into the various issues that surround Hepatitis C.
Causes and Diagnosis and Risk Factors
The major cause of Hepatitis C is the Hepatitis C virus (HCV). It is transmitted through blood and other bodily fluids and it could get into an individual through sexual intercourse or any other contact for instance injection.
Hepatitis C is diagnosed through blood tests. The blood test is capable of revealing the type of Hepatitis C an individual is suffering from, for instance, chronic Hepatitis C. In case chronic Hepatitis C is suspected, the doctor may undertake a liver biopsy to check the extent of liver damage. Other tests that could be done include EIA assay and Hepatitis C RNA to detect Hepatitis C antibody and virus levels respectively. Some of the risk factors include having been on long-term kidney dialysis, drug injections and sharing of needles, receiving blood or organs from an infected individual as well as being born to a Hepatitis C infected mother among others (Hepatitis Foundation International par 4).
Symptoms
Just like any other disease, Hepatitis C is characterized by some symptoms. They include swollen stomach and ankles, jaundice (yellowing of the eyes and skin), inability for blood to clot, fatigue, stomach upset, loss of appetite, breast enlargement in men, weight loss, dark yellow urine, diarrhea, light-colored stools, and easy bruising among others. It is however unfortunate that the symptoms may not appear until the liver gets damaged an issue that could take quite a long period of time (Hepatitis Foundation International par 6).
Treatment
There is no vaccine to prevent Hepatitis C. However, it could be cured if noted early enough. It is nonetheless amazing that the infection is not treated unless it becomes chronic. Here, drugs that work through slowing or stopping the HCV from damaging the liver are used. A Combination of peginterferon and ribavirin drugs is used and work by attacking the virus. The treatment takes 24-48 weeks. In case of liver failure, a liver transplant is done. The medication provided could be associated with numerous side effects for instance nausea and vomiting, fever, and thinning of hair (E! Science News par. 2).
Conclusion
From the above discussion, it is evident that Hepatitis C is a tragic infection and can easily lead to the death of an individual. This is especially due to the fact that the symptoms do not appear early enough and therefore it is difficult to take early treatment measures. It is therefore advisable that people take preventive measures for instance knowing the status of their sexual partners and avoiding blood and other body fluids contact. Vaccination for Hepatitis A and B is also recommended. Meanwhile, more accurate tests are being developed in an effort to detect even smaller amounts of the virus to avoid going to the chronic stage.
Due to the results of the laboratory tests (HBsAg positive, HBsAb negative, HBcAb positive), it is clear that Laura is suffering from hepatitis B. According to Trépo, Chan, and Lok (2014), HBsAg is “the hallmark of the infection” (p. 2055); it is positive at the beginning of acute infection and is persistently positive if the patient has a chronic infection. HBsAb, or anti-HBs, is the marker of immunity to hepatitis B (Trépo et al., 2014, p. 2055). Finally, HBcAb, or anti-HBc (both IgG and IgM), appear over one or two weeks after the HBsAg emerge; furthermore, it is known that anti-HBc IgG is present during both chronic and acute infection, whereas anti-HBc IgM is not present during chronic infection, except for the case when there are serious exacerbations of it (Trépo et al., 2014, pp. 2055-2056).
Therefore, it is unclear whether Laura has acute infection, chronic infection, or an exacerbation of a chronic infection of hepatitis B. Thus, a test for anti-HBc that differentiates between anti-HBc IgG and anti-HBc IgM could be recommended (Trépo et al., 2014).
Furthermore, it is not known whether Laura has hepatitis B with or without a delta agent (i.e., hepatitis D infection). Hepatitis D only develops in patients who have hepatitis B, and its treatment differs from that of hepatitis B (Noureddin & Gish, 2014). Therefore, tests for hepatitis D should be run for establishing a precise diagnosis.
HDV RNA viral load should be checked, with tests such as qRT-PCR (Noureddin & Gish, 2014, pp. 3-4). It is important that hepatitis D antibodies test might often be falsely negative (Noureddin & Gish, 2014, p. 3); so, in case of a negative test, it might be better to retake the test at a later date, perhaps in a different laboratory.
Additionally, those who have hepatitis B are advised to test for hepatitis C (which has not been disproved yet) and HIV as well, and also to assess the severity of the liver condition (Trépo et al., 2014, p. 2058).
Possible Diagnoses
From the currently present results of tests, the diagnosis is one of the following: 1) B16.1 – acute hepatitis B with delta-agent (coinfection) without hepatic coma, 2) B16.9 – acute hepatitis B without delta-agent and without hepatic coma, 3) B18.0 – chronic viral hepatitis B with delta-agent, 4) B18.1 – chronic viral hepatitis B without delta-agent.
Hepatic encephalopathy (or, in its advanced stages, hepatic coma) is “a neuropsychiatric complication of chronic liver failure” (Ahboucha et al., 2012, p. 48). Clearly, Laura has no hepatic coma.
Primary Diagnosis
B16.9 – Acute hepatitis B without delta-agent and without hepatic coma.
Treatment Plan: Hepatitis B
Further Tests and Diagnostics
Tests for anti-HBc that differentiate between IgG and IgM, to check if anti-HBc IgM are present;
Test for HBV DNA concentration to determine whether Laura requires antiviral therapy (Trépo et al., 2014, p. 2060);
Test for HBeAg (Trépo et al., 2014, p. 2060);
qRT-PCR for hepatitis D RNA to detect the presence of hepatitis D and its viral load. If unavailable, then tests for antibodies to hepatitis D. Should the latter test be negative, it ought to be retaken in two weeks, possibly in a different laboratory (Noureddin & Gish, 2014).
Tests for antibodies to HCV and for HCV RNA to disprove the presence of hepatitis C (Webster, Klenerman, & Dusheiko, 2015, p. 1126).
Non-invasive tests for liver fibrosis, such as FibroTest (de Lédinghen et al., 2013);
Test for hepatocellular carcinoma (liver cancer) (Trépo et al., 2014, p. 2058). However, this may be assessed by using the α-fetoprotein test (Bird et al., 2016).
Medication
Rx: Viread (tenofovir disoproxil fumarate) 300 mg. Sig: 1 tablet daily. Disp: #30. Refill: #3 (Pereira et al., 2016; Jindal, Kumar, & Sarin, 2013, p. 167; Aleman, van den Berk, Franssen, & de Fijter, 2015).
Conservative Measures
It is necessary for the patient to avoid further unprotected sexual contacts to avoid catching other infections and to avoid infecting her partners (Goroll & Mulley, 2014). Alcohol should be avoided so as not to harm the liver further (Trépo et al., 2014).
Education
The patient should be educated about the ways hepatitis B and HIV are transferred, and the necessity to use condoms during sex, as well as about the need to ensure that invasive instruments and needles (such as ones on syringes or tools for making tattoos) are sterile. It should be explained that the patient should restrain from consumption of alcohol and foods that harm the liver (Trépo et al., 2014, p. 2058).
Referrals
Laura should consult with a gastroenterologist/hepatologist. She should be admitted to the hospital, for she has jaundice (Buttaro et al., 2013, p. 675).
Follow-Ups
Laura should be observed in the long term, regularly test her viral loads, and visit a physician at least once every two months (Buttaro et al., 2013).
Diagnosing the Patient: Jaundice
Diagnosis: Unspecified jaundice (R17).
The rationale for this diagnosis is the color of the patient’s skin (“slightly jaundiced”), and certain symptoms that are typical of jaundice: satiety and decreased appetite, seizures, and weight loss (Abbas, Shamshad, Ashraf, & Javaid, 2016). The fact that Laura has some form of hepatitis B further increases the likelihood of jaundice.
Further Tests and Diagnostics
To ensure that Laura has jaundice, and to identify the type of jaundice (pre-hepatic, hepatic, or post-hepatic), it is needed to take blood tests for bilirubin (both conjugated and unconjugated), and urobilinogen in the serum (Abbas et al., 2016, p. 1316). In addition, the tests for alkaline phosphatase, alanine transferase, and aspartate transferase will be normal if the jaundice is pre-hepatic (Abbas et al., 2016, p. 1316), which allows for supposing that Laura has pre-hepatic jaundice because ALT and AST tests were normal.
Treatment Plan: Jaundice
Medications and Procedures
Jaundice is usually treated by addressing its causes (Buttaro et al., 2013, p. 693; Abbas et al., 2016). However, it is possible to reduce the levels of bilirubin by using phototherapy (Abbas et al., 2016, p. 1316). Therefore, Laura should attend phototherapy sessions.
Prescription
1) Laevolac (lactulose) 10 g / 15 ml (oral solution sachets). Sig: 2 sachets three times per day. Disp: #30. Refill: #3. This will reduce the levels of ammonia in the blood and safeguard Laura from encephalopathy (Buttaro et al., 2013, p. 693).
Referrals
Laura should see a gastroenterologist and a pathologist, as well as a surgeon; in addition, she should be admitted to the hospital (Buttaro et al., 2013, p. 693).
Conservative Measures
Laura should use a diet that is low in fats and high in water (Abbas et al., 2016).
Patient Education
The patient should be educated about the causes of jaundice, as well as about the prevention of these causes (in Laura’s case, it is likely to be hepatitis B, at least partially). She needs to avoid OTC drugs which are harmful to the liver, and comply with her diet; she also should stop consuming alcohol (Buttaro et al., 2013, p. 693; Abbas et al., 2016).
Follow-Up Plan
Laura should be observed in the long term due to her hepatitis B (Buttaro et al., 2013). After the discharge from the hospital, she needs to visit her physician at least once every two months. The physician needs to monitor her liver function, in addition to the viral load of HBV.
References
Abbas, M. W., Shamshad, T., Ashraf, M. A., & Javaid, R. (2016). Jaundice: A basic review.International Journal of Research in Medical Sciences, 4(5), 1313-1319. Web.
Ahboucha, S., Talani, G., Fanutza, T., Sanna, E., Biggio, G., Gamrani, H., & Butterworth, R. G. (2012). Reduced brain levels of DHEAS in hepatic coma patients: Significance for increased GABAergic tone in hepatic encephalopathy. Neurochemistry International, 61(1), 48-53. Web.
Aleman, J., van den Berk, G. E. L., Franssen, E. J. F., & de Fijter, C. W. H. (2015). Tenofovir disoproxil treatment for a HIV-hepatitis B virus coinfected patient undergoing peritoneal dialysis: which dose do we need? AIDS, 29(12), 1579-1580. Web.
Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). Beijing, China: Wolters Kluwer.
Jindal, A., Kumar, M., & Sarin, S. K. (2013). Management of acute hepatitis B and reactivation of hepatitis B. Liver International, 33, 164-175.
This research paper explores hepatitis in the United Arab Emirates, UAE, with a focus on several elements like historic background, etiology, prevalence, risk factors and management strategies among others.
Hepatitis is a major health problem in the United Arab Emirates. While type B and C are commonly known to occur in Asia, UAE has always been threatened by hepatitis D. This has seen the country erect some measures to deal with the problem, including the listing of hepatitis C among deportable diseases in the year 2008. From July 1, 2008, hepatitis C joined other diseases like hepatitis B, HIV and tuberculosis, which gained the status after becoming a major health problem in the region (Travel Doctor, 2012). Based on this condition, the government further endorsed the testing of visitors while applying for labor and residency visas to curb cases of new infections. This directive was to affect the Ministry of Health of Dubai and Abu Dhabi and was to affect every new person with the intention of visiting the country. Furthermore, it was noted that those found positive were to be deported. This decision caused a lot of panic among patients with thalassemia, a blood disorder that requires constant blood transfusion for survival. It had also been found that several patients in UAE had contracted hepatitis C through contaminated blood needles (Abro, Al-Dabal & Younis, 2010).
It is however important to note that the United Arab Emirates initiated blood screening in the year 1993 in response to WHO requirements. Following the 2008 decision, some people argued that thalassemiapatients deserved screening exemption due to their dependence on blood from other individuals. This was based on the fact that thalassemia patients were likely to get infected without their knowledge, through contaminated blood, donated by infected citizens. Moreover, minimum research has been done concerning the distribution of hepatitis in most Middle East countries like the UAE (Abro, Al-Dabal & Younis, 2010). Nevertheless, type D has been found to be common in the region. Female patients in UAE are highly affected by this virus since most of them originate from Egypt, where it is predominant.
Etiology
As mentioned before, hepatitis is commonly caused by contaminated food and water. This does not exclude the United Arab Emirates, where type D has been found to be rampant. Importantly, hepatitis A mainly occurs when a person is infected with the hepatitis A virus. This results from the consumption of substances with a minute and contaminated particle of fecal matter. As a result, patients experience inflammation of liver cells, which may lead to improper functioning of the liver and other related health complications. On this basis, the virus can be transmitted through a number of ways, including but not limited to the handling of food with contaminated hands, especially after using the toilet and consumption of impure water. Additionally, type A virus can be contracted from feeding on raw shellfish, which have been obtained from water that may have been contaminated with sewage. It is also important to note that infected patients can pass the virus to healthy individuals through close contact, even in the absence of physical manifestation of the disease (CDC, 2012). Lastly, the hepatitis A virus can be passed to another person through sexual intercourse.
Similarly, hepatitis B virus is caused by getting in contact with body fluids like blood, vaginal fluid and semen, from a person who has been tested positive, even when there are no signs and symptoms of infection. HBV shares transmission modes with HIV even though the former is approximately 50 to 100 more communicable. Additionally, the hepatitis B virus has the capability of surviving outside the human body for almost seven days, distinguishing it from HIV, which cannot survive outside. It is essential to note that the virus remains active during the seven days and can cause equal harm when it enters the body of a healthy person (CDC, 2012). Although contact with infected blood is the commonest cause, there are several modes of transmission, especially in developing countries. These include but are not limited to sexual contact, risky injection practices, perinatal and blood transfusion. On the contrary, transmission modes in developed countries are slightly different, with sexual activity among young adults being a risky causal factor. Due to its mode of transmission, HBV is a major occupational hazard for most medical practitioners.
In the same manner, type C causes swelling of the liver, which in turn affects the normal functioning of the organ. HCV is responsible for hepatitis C infection and may be transmitted through an array of channels. For instance, one can contract the virus through contact with contaminated blood, unprotected sexual intercourse, risky injection behaviors, close contact with an infected person and receiving donations from hepatitis C patients, including blood, organs or blood products (CDC, 2012).
Lastly, hepatitis D, also known as delta agent, only occurs among patients with hepatitis B. As a result, it has been found that HDV may worsen the observed signs manifested by patients diagnosed with HBV. Additionally, the virus may be seen through symptoms, even though one may not have shown the symptoms while suffering from hepatitis B (CDC, 2012). The virus affects up to fifteen million people globally and can be passed to healthy individuals through blood transfusion, unprotected sexual intercourse and abusive injection of drugs. These factors expose people to contracting the disease, even though the presence of HBV is a major predisposing factor.
Prevalence and incidence in the world
In the understanding of the occurrence of hepatitis across the world, it is paramount to note that different regions of the world register different statistics, due to a number of factors like the economic status of a country among others. Additionally, the four types of hepatitis occur variably due to their predisposing factors. Research indicates that the prevalence of hepatitis is currently high and the situation is likely to worsen in the next two decades. Importantly, more than 75% of cases are caused by hepatitis B and C. According to World Health Organization, over 4.3 million people are infected with hepatitis B in the Eastern Mediterranean region while over 800,000 with type C every year (World Health Organization, 2009). Moreover, most of these cases are acquired in medical set-ups, with over 17 million having been diagnosed with chronic HCV. As a result, treatment of type B and C has become more challenging compared to the cost of establishing prevention programs in the region. Globally, approximately 361 million people in the world live with chronic hepatitis B, which increases the risk of developing liver complications. WHO further estimates that up to 0.6 million people die annually as a result of HBV or related diseases.
Prevalence and incidence in the U.A.E
The distribution of hepatitis in the United Arab Emirates has not been well captured by most researchers. However, the region equally faces the challenges posed by different types of hepatitis. For instance, Abro, Al-Dabal and Younis found out that hepatitis occurs among UAE nationals and expatriates. According to the 2010 survey, HAV was found to have the highest prevalence percentage of 40.3% among patients, followed by type C with 34.9% of patients. Type A and C were also found to be common among drug abusers, with 42.1% and 58% respectively (Alfaresi et al., 2010). On the other hand, patients with a record of blood transfusion registered a high prevalence of type A and C, while type 1 (42.5%) and 4 (40.2%) occurred among adults 40 years and above. Additionally, it was found that 42.6% of hepatitis cases are caused by risky IV drug abuse while sexual activity contributed 32.7% of recorded cases (Alfaresi et al., 2010). Other factors included tattoo marks at 21.5% while surgery and blood transfusion registered 19.2%. It is also important to note that most patients in the UAE contract hepatitis disease because of their exposure to different risk factors. Nevertheless, it was found that all the risk factors contribute to the high levels of type D occurrence. As noted above, type D was common among UAE females since most of the patients who were tested were of Egyptian origin, where the virus is common.
Identified risk factors
There are several factors, which have been identified as predisposing factors for the four types of hepatitis. For instance, people who work or travel in regions with a high prevalence of type A are likely to contract the disease. Additionally, research indicates that gay men are more prone than their counterparts that are non-gay. The presence of HIV has also been identified as a risk factor for type A. This is to say that the likelihood of an HIV-positive person contracting HAV is much higher compared to that observed among HIV-negative people (Alfaresi et al., 2010). The use of IV drugs by people further exposes patients and individuals to a higher probability of getting infected with HAV. In essence, such injection activities are risky as they may lead to contact with contaminated body fluids like blood.
With regard to HBV, people who have multiple sexual partners are at a higher risk of developing the disease than those who have one partner or practice safe sex. The risk of getting infected is significantly higher especially in cases where one of the partners is infected with the virus. Additionally, the presence of sexually transmitted infections predisposes the disease, with gonorrhea and chlamydia being considered as major contributors. Job opportunities equally expose people to being infected, i.e. working in areas that are prone to HBV or getting exposed to contaminated blood (World Health Organization, 2009).
On the other hand, people who are exposed to kidney dialysis for a long time have a higher likelihood of contracting hepatitis type C. Other risk factors include exposure to contaminated blood, unprotected sexual intercourse with infected people, receiving blood from patients with HCV and mother-to-child transmission. Lastly, patients who abuse IV injections are likely to contract type D with a lot of ease (Alfaresi et al., 2010). In addition, HDV can be passed to the developing fetus, when a pregnant mother gets the virus. It has also been found that the presence of HBV is a major risk factor for type 4. Like other types of hepatitis, numerous blood transfusions and sexual contact with infected people are recognized as predisposing factors.
Possible risk factors still under study
In order to combat this health threat, researchers have identified other risk factors, which are still under study. Their study is essential in order to establish their role in predisposing hepatitis viruses. One of the factors being studied is gender. For instance, in a survey carried out among UAE patients in 2010, it was found that females registered higher disease prevalence because of their originality. This was attributed to the fact that most of them were from Egypt, where type D, is common. In addition, research is underway to determine whether genetic factors and tattoo marks are responsible for the occurrence of the disease in some parts of the world (Muslim, 2008).
General treatment and management strategies
One important fact is that most types of hepatitis, which occur in the world, are preventable in a wide range of ways. For instance, vaccination against HAV and HBV is highly recommended. This guarantees an individual a long-term immunity. Additionally, type A can be managed through abstinence from substance abuse like alcohol drinking and proper medication. Good hygienic standards are also essential in preventing type A. Other ways include eating well-cooked foods and drinking safe water (CDC, 2012).
For type B, treatment is through enough rest and a balanced diet, rich in proteins and carbohydrates to allow faster repair and protection of the liver. Prevention strategies include safe sex, good use of IV injections, vaccination and use of sterilized equipment. On the other hand, type C is treated using interferon alfa-2b, while prevention strategies include covering of wounds, safe sex, use of sterilized equipment, proper use of IV needles and limited alcohol intake (CDC, 2012). Currently, there is no treatment for types D and E. However, D can be prevented by preventing type B, since the latter is a predisposing factor. Lastly, type E can be prevented through proper hygiene, eating well-cooked meals and consuming purified water.
Treatment and management strategies in UAE
There are several strategies, which have been adopted by the Abu Dhabi authorities to manage the issue of hepatitis. A good example is the Hepatitis awareness campaign, which was organized by the Al Jazira Sports and Health Foundation. The aim of the campaign was to eliminate social stigma against hepatitis patients (Absal, 2007). Additionally, it promoted physical fitness and a good lifestyle among school children. Moreover, there are vaccination programs, aimed at ensuring that UAE residents gain immunity against common types of hepatitis. Another important strategy is the screening of visas for Abu Dhabi residents (HAAD, 2012). This condition requires all expatriates who are above eighteen years to receive a fitness certificate from the authorities. This qualifies one to apply for the renewal or a new visa. Lastly, the deportation rule was adopted in Abu Dhabi in 2008 to lower infection cases of hepatitis B and C (Muslim, 2008).
Conclusion
From the above analysis, it is evident that hepatitis is a major health problem, affecting developed and developing countries. In UAE, the problem is equally evident, with several strategies having been put in place to deal with the scourge. It is also important to note that management of hepatitis solely depends on the change of lifestyle approaches.
References
Abro, A., Al-Dabal, L., & Younis, N. (2010). Distribution of Hepatitis C virus genotypes in Dubai, United Arab Emirates. Journal of the Pakistan Medical Association, 60 (12), 987-990.
Absal, R. (2007). Hepatitis Awareness Campaign in Abu Dhabi. National Aids Treatment Advocacy Project. Web.
Alfaresi et al. (2010). Hepatitis B virus genotypes and precore and core mutants in UAE patients. Virology Journal, 7 (160), 1-8.
CDC. (2012).Viral Hepatitis. Centers for Disease Control and Prevention. Web.
HAAD. (2012). Visa Screening for residence in Abu Dhabi. HAAD. Web.
Muslim, N. (2008). UAE adds Hepatitis C to list of deportable diseases. Gulf News. Web.
Travel Doctor. (2012). United Arab Emirates. Travel Doctor. Web.
World Health Organization. (2009). The growing threats of hepatitis B and C in the Eastern Mediterranean Region: a call for action. WHO. Web.
Though hepatitis B can hardly warrant the title of the scourge of the 21st century, it clearly has a very negative effect on the health rates all over the world (Centers for Disease Control and Prevention, 2012a). The disease quickly develops into a chronic one, thus, creating premises for more health issues to emerge in the next few years. The residents of Chicago are no exception to the rule; also stricken by the disease, numerous denizens of the local population need urgent help. By analyzing the issue closer and identifying the factors causing the increase in the number of hepatitis B patients, one will be able to locate the means of addressing the problem.
Problem Background
A lot has been done over the past few decades in order to address the issue regarding the hepatitis problem in the United States in general and in Illinois in particular. Unfortunately, the measures undertaken to address the issue of chronic hepatitis B rates are still high in the Chicago area. One must admit that, compared to the nationwide statistics, Illinois in general and Chicago, in particular, have shown rather impressive results, the rates of HBV having dropped by 30% from 2007 to 2011 (Centers for Disease Control and Prevention, 2012a). According to the statewide statistics, the rates of chronic hepatitis B development have risen significantly over the past few years (Illinois – 2013 state health profile, 2013). Nevertheless, the instances of HBV contraction are still very numerous, especially among children and infants (Centers for Disease Control and Prevention, 2012a).
Figure 1. Hepatitis B rates in Illinois 2008–2012
According to the data in Fig. 1 above, the number of instances of hepatitis B contraction in Chicago dropped significantly in 2009 and has been comparatively stable since then; the specified change can be attributed to the promotion of vaccine against HBV suggested in 2008 (Centers for Disease Control and Prevention, 2012). Nevertheless, the fact that the Chicago residents saw a rather sharp increase in the number of HBV contractions in 2012 proves in a quite graphic manner that the problem of HBV is yet to be solved.
Traditionally defined as “an extremely infectious virus that is spread when infected blood, semen, or another body fluid enters the body of a non-infected person and can also be spread from mother to infant at birth” (Alatrakchi, 2015) and also known as HBV, chronic hepatitis B poses a huge threat to the patient’s wellbeing and affects the liver, resulting in cirrhosis (Alatrakchi, 2015). HBV is a blood-borne virus and, therefore, can be transmitted in five ways, which are 1) contact with infected blood; b) from a mother to a baby; c) from sexual intercourse; 4) from sharing needles; 5) from blood transfusion (Centers for Disease Control and Prevention, 2012).
By taking a closer look at the contraction of hepatitis B in the Chicago area, one will realize that the disease affects the Asian population for the most part (Hepatitis B among U.S. Asians, 2014). According to a recent study, the Chinese denizens of the state population are in the greatest jeopardy at present, as the chart below says. However, the recent programs, such as the Hepatitis Education and Prevention Program, which the Asian Health Coalition (AHC) has developed (Chandrasekar, Kaur, Song, & Kim, 2015), allow for keeping the HBV rates in the designated area low.
Figure 2. Rates of hepatitis B contraction among the Asian population of the Chicago citizens
As far as the age of the people affected by the disease and living in the specified area is concerned, children and the people born before the vaccine for hepatitis B prevention was provided (Surveillance for viral hepatitis – the United States, 2011) seem to be facing the greatest threat at present:
The risk for chronic HBV infection decreases with increasing age at infection. Of infants who acquire HBV infection from their mothers at birth, as many as 90% become chronically infected, whereas 30%–50% of children infected at age 1–5 years become chronically infected. This percentage is smaller among adults, in whom approximately 5% of all acute HBV infections progress to chronic infection. (Surveillance for viral hepatitis – United States, 2011, par. 12).
Therefore, it is highly desirable that the measures to be undertaken to address the situation should be designed with the fact that the target population consists primarily of children, teenagers, adolescents and young adults.
Current National Standards: Diagnosing, Screening, and Prevention
According to the U.S. nursing standards listed by the Center for Disease Control and Prevention (CDC), the process of identifying the victims of hepatitis B starts with a series of tests. However, the process of testing is often hindered by the fact that HBV has a comparatively long incubation period, which may last 1–4 months. Consequently, the results delivered by the test that was carried out at the earliest stages of the disease development may not be as precise as they must be so that efficient treatment could be administered to the patient (Haryanto et al., 2012).
Typically, a series of tests are run to identify the disease. Particularly, the hepatitis B surface antigen (HBsAG) helps identify whether the viruses in the patient’s body are covered with protein (Centers for Disease Control and Prevention, n. d.). Next, the hepatitis B surface antibody (anti-HBs) test is run to check whether the patient has developed any antibodies to fight HBV (Demirören, Kocamaz & Doğan, 2015). Finally, the total anti-hepatitis B core (anti-HBc, IgM and IgG) is taken to locate IgM and IgG, as well as make sure that the specified antibodies fight the core antigen created by the HBV (Demirören et al., 2015).
The treatment of the problem starts with a series of immunization shots (The liver, 2015). However, the process of treatment traditionally starts only after specific problems with the liver, such as flaws in its functioning, can be identified. Therefore, it is essential to supervise patient care in order to prevent the possible aggravation of the situation. It should also be borne in mind that specific medicine, such as “interferon and nucleoside reverse transcriptase inhibitors (NRTIs)” (The liver, 2015, par. 17) must be provided to the patients so that the process of recovery could begin.
As far as the prevention of the disease is concerned, the current policy of spreading awareness in the Chicago area seems to be somewhat flawed. Despite the attempts of local nurses to enhance patients’ enthusiasm in learning about hepatitis B and how to avoid it, the target denizens of the population remain just as ignorant about the issue as they were several decades prior. Therefore, a new approach as opposed to the current one needs to be designed. Currently, the prevention measures such as consistent screening and testing are viewed as the most reasonable choice. Apart from the traditional warnings concerning the exposure to the threat of HBV in the workplace, the information regarding sexually transmitted diseases and Hepatitis B has been issued by CDC (Centers for Disease Control and Prevention, 2015). It seems that the latter information needs to be spread among the target population, as it may be the key cause for the disease to spread further.
Addressing Hepatitis B in Chicago Area: A Plan
When it comes to identifying major problems with the promotion of nursing services for people with HBV, a complete lack of awareness regarding the subject matter is the first detail to notice. Therefore, launching a major campaign for increasing awareness on the subject matter must be viewed as the first step towards addressing the issue of HBV rates among the Chicago residents. As soon as the target denizens of the population realize the significance of the issue and learn to identify the primary symptoms in order to address the appropriate nursing facility, the corresponding services must be provided. Specifically, the screening tests should be made available to all those with the symptoms of HBV or suspected to have developed the disease. Since research have shown that the representatives of the Latino population are mostly affected by the disease, it will be reasonable to suggest providing the required information in both English and Chinese. Thus, key knowledge will be available to all those concerned. Moreover, it is highly advisable that the staff in the corresponding facilities within the Chicago area should be instructed on how to provide relevant information to those needing it.
Afterward, the need to administer vaccines to the target population is essential for the successful treatment and prevention of the issue. Seeing that hepatitis B injections have been available since 2008 (Viral hepatitis surveillance – the United States, 2009), it is crucial that the target denizens of the Chicago population should be provided with full access to the vaccines in question. Thus, one may prevent hepatitis B from spreading any further.
Additionally, the vaccination process must be carried out not in the traditional manner, but with the incorporation of the hepatitis B immunoglobin vaccine (Cao et al., 2015). The specified precaution measure is essential for addressing the needs of one of the target population groups. As has been stressed above, infants, children and teenagers are in the risk zone due to the underdevelopment of their immune system and the exposure to a variety of diseases (Cao et al., 2015). Consequently, the incorporation of the safety measures against attacks on their immune system by viruses and the ones against the development of HBV are essential to the wellbeing of the target denizens of the Chicago population.
Additionally, the necessity to cater to the needs of young children and teenagers deserves to be mentioned as the essential detail defining the nursing strategy. It is crucial that the information provided to the target population in the course of the awareness campaign should be simple and concise; moreover, the fact that some of the target patients may be unable to reach the corresponding facility due to their young age and the lack of awareness among their parents needs to be brought up. Thus, nurses will have to provide domiciliary services to patients aged 0–15 years. Consequently, the Chicago nursing facilities will need the equipment that can be moved around the city, as well as the vehicles that will have room for the staff and the above-mentioned equipment. Hence, developing a detailed cost strategy for purchasing the necessary equipment and vehicles will be the next step of the plan. Finally, the quality of communication between patients and nurses must be improved so that the potential suspects for HBV could be identified quickly and diagnosed accordingly. The use of modern media as the key tool for raising awareness regarding the threats of HBV (Samkange-Zeeb, 2013) should also be viewed as a potentially successful idea.
Finally, the issue regarding sanitation should be brought up. According to the information that has been recently made public, the lack of control over the sanitation issue in several nursing homes in Chicago has led to infecting a number of people with hepatitis B with dirty needles:
According to news reports, the owner of the facility (GlenCare of Mount Olive) claims that the Division of Public Health investigators told him that the outbreak stems from five medical technicians who had reused diabetes pens when checking patients’ blood sugar levels. (Griffin, 2010, par. 2)
On the one hand, the above-mentioned issue may turn out to be an isolated case of medical negligence; on the other hand, when unattended, the issue under analysis may grow out of proportions, therefore, leading to an even greater problem concerning the increase in the number of HBV patients. Thus, it is strongly suggested that regular audits should be conducted to check compliance with the existing sanitary norms. Moreover, the latter may be enhanced to the point where the needles used in the process of administering injections to the patients should be disposable.
The measurement of the outcomes will be possible as soon as the results of the above-mentioned actions are quantified. First and most obvious, the increase in the number of people, who have addressed the corresponding nursing facilities in an attempt to learn about the subject matter or to screen for the disease, needs to be mentioned as the key characteristic. Moreover, the number of HBV patients recovering successfully must be calculated to identify the progress. The number of cases of unsanitary conditions also needs to be taken into account as the key measure of progress. Finally, the number of feedbacks received from the patients, as well as the number of instances of successful communication with patients, will be used as another parameter for measuring success.
Conclusion
Despite the recent strategy aimed at reducing the threat of hepatitis B development in the residents of the Chicago area, the problem remains just as topical as it used to be several years before. Transmitted through blood, sexual intercourse and during childbirth from a mother to a child, the disease affects the body in a drastic way, causing cirrhosis and other disorders. Being exposed to a range of risk factors triggering the development of hepatitis B, the residents of the Chicago area need a special intervention program, which will help raise awareness on the subject matter and help the victims of hepatitis B.
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Presently in Australia, an estimated 31% percentage of the population is infected with the hepatitis virus. The hepatitis A virus (HAV)-infected individuals are heterogeneous and encompass individuals infected through contaminated medical equipment particularly injection needles and eating food or drinking water contaminated with the virus through feces. A significant percentage of diagnosed cases involve vulnerable population subgroups such as the Aboriginal people and the immigrants. The management of viral hepatitis A involves various drug therapy measures, dietary management and interventions that reduce alcohol and substance abuse.
Hepatitis A: Treatment and Diagnosis
The hepatitis A virus is a major cause of the liver disease with an estimated 1.4 million people infected with the disease globally. In Australia, the prevalence rates of HAV among young children under the age of five in Queensland were 10 and 264 per 100 000 people in non-Indigenous and Indigenous populations respectively between 1999 and 2002. Hepatitis A is leading cause of hepatocellular carcinoma or liver failure especially among children in Indigenous Australian populations.
Diagnosis of hepatitis A is through serological tests. A blood test that confirms the presence of IgM anti-HAV in blood serum indicates the diagnosis of Hepatitis A infection. The IgM antibodies indicate recent HAV infection and can remain detectable in the blood for over 6 months. On the other hand, the occurrence of anti-HAV IgG antibodies in the blood serum confers prolonged immunity in the patient. Infection by HAV normally confers effects on the patient that range from absence of symptoms to fulminant hepatitis that is often fatal. The likelihood of developing these effects increases with age. In children below 6 years old, the majority of the new infections (>60%) do not show any symptoms. In adults, new infections are symptomatic, with the most common symptom being jaundice (>70% of patients). After a four-week incubation period, majority of the HAV-infected individuals develop initial non-specific symptoms such as nausea, anorexia, vomiting and fatigue, followed by gastrointestinal discomfort, jaundice and dark urine in adults. The onset of symptoms normally occurs within the first two months of infection and serves as an indication for diagnosis.
An immune response to HAV takes place in the asymptomatic phase of the infection. HAV immunoglobulin M antibodies (IgM anti-HAV) are elevated prior to the onset of symptoms, before declining to levels undetectable by most diagnostic tests (3 to 5 months). The HAV igG antibodies (igG anti-HAV) are elevated after the IgM anti-HAV and confer long-term immunity years after infection. Following a new infection, IgM and IgA anti-HAV are detectable in urine, feces, serum and saliva. These two antibodies (antibodies produced against capsid proteins) serve as primary markers of HAV infection.
Besides the serological tests, saliva tests are used as alternative diagnostic tests for anti-HAV due to ease of sample collection especially during epidemiological studies and outbreaks. However, the sensitivity of saliva tests is lower than that of serological tests. The serological tests include enzyme-linked immunisorbent assay, dot blot immunogold filtration and radioimmunoassay. The assays are able to detect total anti-HAV (IgM and IgG antibodies). The absence of IgM anti-HAV antibodies and the presence of total anti-HAV indicate current and past infections respectively. Molecular diagnostic methods that detect HAV RNA in the blood or stool are also used in diagnosis. Nucleic acid sequencing and nucleic acid amplification methods have been used to establish the level of relatedness of HAV strains during the acute phase of the disease.
Hepatitis A has no treatment; infected individuals normally recover without treatment, 2 to 3 weeks after infection. The prevention strategies against HAV involve vaccines that confer life-long protection against HAV infection. Vaccination significantly lowers the disease incidence and the transmission of the infection. Widespread childhood hepatitis A vaccination involving the indigenous populations has significantly reduced the hepatitis A incidence and changed its epidemiology. In addition, childhood vaccination appears to prevent the cyclical nature of hepatitis A among the Australian indigenous populations. Hepatitis A vaccination strategies target at-risk groups including travelers and children living in areas with high infection rates of the disease. Routine immunization of the children has been effective in reducing transmission and outbreaks of the disease.
Recent Epidemiology of Hepatitis A in Australia
The HAV virus is usually transmitted through contaminated drink or food. As such, the incidence rates are high in areas with poor hygiene, low standards of living and densely populated areas. The disease largely confined to young children as most adults are immune. In Australia, the infection is less common in children following the widespread and routine immunization. The HAV transmission occurs readily in childhood services and households; as the children, the primary source of the infection, are often asymptomatic while adult caregivers are symptomatic. Outbreaks of the infection in Australia arise from the consumption of contaminated foods and through nasocomial transmission. Widespread childhood vaccination programs introduced in Australia have significantly reduced the incidence rates of the disease. In north Queensland, the introduction of the HAV vaccine in 1999 targeting the indigenous populations nearly eliminated HAV in these communities and reduced the incidence rates by 92% in the larger community. In 2005, the Aboriginal and Torres Straight Islanders were also included in the childhood immunization program.
In Australia, the incidence rates of Hepatitis A has declined dramatically in the recent past; from about 13, 000 cases in 1960s to only 270 cases in 2008. In 1997, the incidence of HAV reported in the Northern Territory were among the highest (52 per 100, 000 persons). However, in 2006, following the immunization program, the rates declined to 1.4 per 100,000. In New South Wales, the incidence rate declined from a high of 46.7 % in 1991to 15.4% in 2005 while in Queensland the rate decreased from 25.1% to 15.4% over the same period. In 2009, the rates increased dramatically in South Australia and Victoria (200 cases); however, this has been associated with the consumption of contaminated dried tomatoes. Between 1998 and 2000, 8 fatalities associated with HAV infection were reported nationally and 236 cases were reported in eastern Sydney between 1997 and 1999, attributed to illicit drug use, homosexual contact and consumption of contaminated foods. Hepatitis A has been the leading cause of death of children of indigenous communities in northern Queensland. Severe HAV is common among indigenous children than non-indigenous children due to the disparity in living standards. Between 2003 and 2006, the incidence rates for indigenous and non-indigenous populations were 8.1% and 1.7% respectively.
Since most childhood cases are asymptomatic, children play a significant role in transmission of HAV and a source of infection to adults (4, 34). In a study involving newly infected adults, 57% of their households had a child below five years, associated with transmission of HAV in the households. Thus, most Australian HAV cases (11-16%) a rise from children-adult transmission during outbreaks. Another frequent source of transmission is sexual contact with HAV-infected person (9-12%). In the US, about 2% of cases are associated with contaminated food sources while 4-6% of new infections involve international travelers. Cyclic outbreaks occur among drug users using injections and through homosexual contact.
The HAV incidence rates in Australia vary depending on socioeconomic status and race. The highest rates involve the indigenous populations; the Aborigines and the Torres Straight Islanders, while the non-indigenous populations have the lowest incidence rates. The racial differences in incidence rates reflect the risk factors that predispose vulnerable groups to infection. Disparities in socioeconomic levels, low standards of living and contact with travelers from hepatitis-A endemic areas contribute to the high rates among these groups. Serologic evidence indicates that about a third of the Australian indigenous population have prior hepatitis A infections. Additionally, in Australia, the HAV infection patterns vary regionally based on epidemiological characteristics such as childhood infections and temporal infection patterns. Regions such as Northern Territory and Queensland predominantly occupied by indigenous communities have the highest incident rates nationally.
Communities with high incidence rates of HAV typically experience epidemics every six to ten years. Usually, peak incidence involves over 700 cases per 100,000 people with majority of the infections involving children less than six years of age. Sero-prevalence data indicate that, globally, about 40% of children below five years from vulnerable communities get infected with HAV. These communities are defined geographically and culturally and include indigenous, migrant and religious communities. In contrast, intermediate rates often involve populations in large metropolitan areas such as Sidney. In these populations, the infections are not age-specific; they involve adults, children and adolescents indicating widespread infections especially during outbreaks. Additionally, high rates during communitywide outbreaks may result from high infection rates among homosexuals and injecting drug users. Low incidence rates relate to international travels. It accounts for 10-12% of infected cases, which, however, do not contribute significantly to transmission within the community. HAV vaccination programs in high incidence rate communities target the children (school-age and pre-school children). The impact of vaccination in Australia has been modest; often targeting high risk age groups, who may not constitute the majority of the cases.
Public Health Measure/Control for HAV in Australia
Public health control measures in Australia involve vaccination and prophylaxis and HAV surveillance. The goals of HAV vaccination include:
reducing the incidence rates;
eliminating transmission;
protecting individuals from new infections.
Highly effective vaccine Avaxim and Havrix are used in Australia to mitigate the risk of HAV infection. The risk of HAV infection is reduced through the promotion of childhood vaccination.
The Government of Western Australia Department of Health has issued guidelines for the management of Hepatitis A in HAV endemic areas such as the Northern Territory. The guidelines require an evaluation of water treatment plants and food processing facilities following an HAV outbreak. Another approach involves childhood vaccination by Hepatitis A vaccine (NHIG). Unvaccinated adults attending to the children in child care centers and family members also undergo vaccination during outbreaks. Additionally, the guidelines require the public health units to institute surveillance for hepatitis symptoms in households near the outbreak facility, 50 days after the outbreak.
The goal of HAV surveillance is to identify cases that may need post-exposure prophylaxis, to monitor the disease incidence rates, detect outbreaks and to assess the effectiveness of HAV vaccination. New HAV infections identified through surveillance are reported to local or state public health departments. HAV surveillance in Australia is maintained at local level to ensure that the various vaccination strategies are implemented accordingly and their effectiveness assessed both at local and national levels. Surveillance, involves the examination of food handling practices, drinking water and minimizing the risk of exposure to infection during social activities and international travels. To ensure a reduction in HAV incidence rates nationally, widespread and routine immunization of children is important. The surveillance data is used to assess the states or communities with elevated HAV rates for immunization and other control strategies.
Community Cost and Burden of Hepatitis A
Case investigation following an outbreak usually starts a day after notification of a confirmed case. In Australia, the public health unit (PHU) staff collaborates with other healthcare providers in the investigations. The doctors, laboratories and hospitals notify the local Public Health Unit of new HAV cases. The general practice (GP) visits involve the PHU practitioners who visit patient’s family and childcare centers to identify the contacts exposed to new infection. The GP personnel follow special guidelines when attending to HAV-infected cases at work or in a child care facility, and in food distribution sites. Their role involves case management, contact management and control of the environment. They identify the cause of HAV-outbreak and implement the appropriate control and preventive measures.
The response procedure following a confirmed HAV infection involves case investigation. The visits by the PHU staff are very important in case management and prevention of further spread of the infection; they confirm the symptoms and the onset of the infection, confirm the results from serological tests or recommend the tests to be conducted to determine the likely cause of the infection and assess the cases that require prophylaxis. Control of the environment involves the examination of the water supply, food facility and childcare centers. Specialist visits play a role in immunization (passive and active) and antibiotic prophylaxis. In active immunization, a single dose of hepatitis vaccine (NHIG) offers a two-week protection to patients. However, a two-dose course is important for an effective and long-term protection. Individuals given a single dose normally complete the course through their GP. Specialized visits also involve the interpretation of follow-up serologic results. In the US, vaccination encompasses persons with chronic liver disease and persons traveling or working in other countries.
The economic burden associated with HAV infection is huge due to the high mortality and morbidity caused by liver disease or cirrhosis. In the US, the cost-analysis of the HAV infection indicate that about 1.2 million people, with majority being immigrants from HAV endemic regions, carry the HAV virus. About a third of this population develops symptoms or clinical complications of the disease. In one study, the cost of healthcare for HAV-patients was higher compared to that of the control patients. The healthcare costs tend to escalate with the severity of the infection. In one study, the average cost of hospitalization was estimated at USD 8464 in 1999. The costs cover immunization and specialized treatment. Over 50% 0f HAV-infected persons in the US have no specified risk factor. In Australia, indigenous communities, age-specific factors and food-borne factors predispose individuals to infection. Additionally, in Australia, the sources of infections include injection-drug users, children centers and contaminated food. In developing countries, most HAV infections go unnoticed but are largely due to contaminated foods.
Mortality and morbidity arising from fulminant hepatitis A or liver failure has significant economic costs. In the US, about 100 people die from HAV-related liver failure. The CDC estimates that about 0.3% of adults above 50 years old with chronic liver disease are at a high risk of developing fulminant hepatitis A. In addition, the HAV infection economic costs are substantial; about 10-22% of HAV-infected cases are hospitalized. In case of adults, lost work days and wages may affect the living standards of the family and that of the larger community.
In Latin America, a region considered to be endemic to HAV, childhood infection is very high. An epidemiological study conducted recently in the region established the highest anti-HAV prevalence rates in Dominican Republic and Mexico. The same study established that 30% of children between 6 and 10 years in Chile are infected by the disease. The greatest risk factors for infection in Latin American and Africa relates to water and food contamination. In Asia, Japan, China and Taiwan have low endemicity of HAV while Pakistan, Philippines, Malaysia, Thailand amongst others have the highest endemicity. In Australia, over 3000 serum samples obtained in 1998, 41% tested positive for HAV. In Europe, countries such as Slovakia and the Czech Republic have intermediate endemicity while Poland, UK and Russia have the lowest endemicity.
Globally, the control measures for HAV infection include health education, proper HAV surveillance, management of outbreaks and improvement in personal hygiene. Other approaches used include prophylaxis immunization with vaccines and immune globulin serum. HAV vaccine is highly effective with regard to its immunogenic properties. However, countries usually consider the cost-effectiveness of a vaccination strategy prior to implementation. A study conducted in Germany to analyze the economic impacts of vaccination of HAV and HBV established that the vaccination of older children 11-15 years old is the most cost effective strategy. However, this strategy would leave a large proportion of at-risk individual unprotected. Most countries adopt an expensive hepatitis vaccination program to ensure maximum epidemiological impact. In the US, an analysis of cost-effectiveness of vaccination proved that vaccination strategy is cost-effective. In Israel, immunization program involving children nationally was found to be cost-effective with optimal medical outcomes.
The HAV screening and vaccination have an impact on the healthcare facilities and the community in general. Outbreaks in care facilities can result to infection of caregivers. HAV transmission through nasocomial means has been observed in intensive care units because of infected blood transfused to infants who in turn transmit it to hospital staff and other people. Hospitalization of HAV-infected patients occurs after the onset of jaundice because the patients at this point are not infective . HAV outbreaks and subsequent hospitalization/isolation disrupt the family/community’s way of life. In the US, the prevalence of HAV in elementary and secondary schools reflect the transmission rate of the infection within the community.
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