Hepatitis B virus (HBV) infection is a noteworthy global public health issue that continues to prevail despite the availability of an operative vaccine in addition to the development of active antiviral treatments. Approximately 250 million individuals were chronically infected with HBV worldwide by the end of 2018, with the highest prevalence experienced predominantly in Asia, sub-Saharan Africa, as well as the Paciﬁc Islands (Shepard et al., 2018). Additionally, about 15% to 40% of patients suffering from chronic HBV develop serious health complications during their lifetime, such as cirrhosis, hepatic decompensation, as well as hepatocellular carcinoma (HCC) (Shepard et al., 2018). Yearly, a projected 650,000 individuals die from complications of chronic HBV, with 40% of these deaths occurring in persons living in Global Vaccine Alliance countries (Shepard et al., 2018). As Governments and other global healthcare stakeholders continues to strive towards improving the health standards of individuals around the world, there is a need to comprehend the Hepatitis B ailment to better work on reducing its effects.
Hepatitis B is a global epidemic. However, the disease is rampant in Asia, Africa, as well as the Western Pacific Region. As explained by Dienstag (2018), chronic Hepatitis B virus (HBV) is currently the ninth leading cause of death worldwide. In the U.S.,approximately 1.2 million individuals are suffering from HBV, causing roughly 17,000 hospitalizations as well as 5,500 deaths yearly (Dienstag, 2018). However, according to the World Health Organization’s (WHO) records, these figures show that only 0.7% duffer from the ailment. The Western Pacific where 6.2% and African Regions (6.1%), have the highest number of Hepatitis B cases in the adult population (Rehermann & Nascimbeni, 2015). Likewise, the Eastern Mediterranean (3.3%), South-East Asia (2.0%), and European areas (1.6%) have an estimated of the entire population is infected, correspondingly. The wide range in the occurrence of patients with chronic Hepatitis B virus in different parts of the world is significantly related to dissimilarities in the age at infection, which is directly related to the risk of chronicity. The rate of infection progression from acute to chronic Hepatitis B virus infection is approximately 90% for per-initially acquired infection, 20 to 50% for infections between the age of one and five years in addition to less than 5% for adult-acquired infection (Seeger & Mason, 2000). Environmental factors are clearly implicated in HBV pathogenesis. Alcohol as well as aflatoxin are two significant factors that influnce the progression of chronic hepatitis B. As indicated by (Seeger & Mason, 2000), alcohol consumption increases the severity of liver disease and increases the risk of developing liver decompensation from cirrhosis.
Signs and Symptoms
Acute infection with the Hepatitis B virus is associated with general ill health. This includes; mild fever, dark urine, nausea, itching, vomiting, loss of appetite, as well as body aches. As the ailment progresses, it may take the form of jaundice. Commonly, the indications persist for a few weeks, later progressively improving in most affected individuals.Among some patients, the symptoms may be more severe subsequently resulting in death. According to Trépo, Chan, and Lok (2014), acute infection with the Hepatitis B virus may be entirely asymptomatic hence it may go unrecognized leading to cirrhosis over a period of several years. Persons suffering from chronic Hepatitis B virus are recommended to refrain from consuming alcohol as it may augment their risk of contracting cirrhosis as well as liver cancer. Notably, the Hepatitis B virus is allied with the advance of the Membranous glomerulonephritis
The spread of the Hepatitis B virus results from exposure to contaminated blood or body fluids such as saliva. According to Seeger and Mason (2000), transmission often results from recycling of unclean medical needles as well as syringes, unprotected sexual interaction, blood transfusions, in addition to vertical transmission from mother to child during child delivery. Without intercession, a mother who tests positive for HBsAg has an estimated 20% risk of infecting her infant child at the time of birth (Seeger & Mason, 2000). Additionally, this risk may go as high as 90% if she correspondingly tests positive for HBeAg (Seeger & Mason, 2000). Since the start of the century, studies by Liaw and Chu (2018) have also stated that HBV can be transmitted amongst family members within households, possibly when they come inclose contact with each other thus exchanging body fluids such as saliva containing HBV.
Chronic Hepatitis B infection does not require treatment since most adults clear the infection naturally. However, this is not the case for all patients. Early antiviral treatmentmay only be necessaryfor less than 1% of patients, whose infection takes a belligerent course (fulminant hepatitis) or who are immunocompromised (Liaw & Chu, 2018).Therapy in the form of combination of liver enzymes such as Ornithine, carbamyltransferase, malate dehydrogenase, glutamate dehydrogenase, isocitrate dehydrogenase, sorbitol dehydrogenase, as well as guanase help in the diagnosis of viral hepatitis (Liaw & Chu, 2018). Additionally, Bilirubin values of 2.5–3.0 mg/dl or more establish the presence of the icteric phase of hepatitis. In addition, Bilirubin levels in exciding 30 mg/dl suggest hemolysis (Liaw & Chu, 2018). Liver biopsy is generally not necessary, but should be considered if the diagnosis is uncertain (Liaw & Chu, 2018). Liver biopsy should be performed if there is an atypical clinical course, or the clinical course is prolonged. It should also be undertaken if clues of chronic liver disease are present, or if complications such as encephalopathy or fluid retention develop.
The treatment objectives for chronic hepatitis B infection aim to suppress the replication of the virus, improvement in hepatic necroinflammation, as well as the reduction in the likelihood of long-term sequel of HBV infection, for instance, cirrhosis and hepatocellular carcinoma .
Interferon alfa-2b is currently the only FDA-approved medication for chronic Hepatitis B. The suggested prescription is 5 million units taken 5 times weekly for 4 months (Liaw & Chu, 2018). The prescription is linked with histological benefit primarily individuals who suffer from a loss of serum HBeAg. Nevertheless, a majority of patients do not lose either HBeAg or HBsA
Table 1: Treatment of Special Patients Groups
|Children||A majority of children are in an immune-tolerant phase and should not be treated.|
|Liver cirrhosis:||All cirrhotics should be treated with any detectable viraemia.|
|Liver transplantation||All HBV patients should be treated before transplantation regardless of ALT and HBV DNA levels. HBV DNA must be undetectable at transplantation. After transplantation, long-term medication should be adopted comprising a combination of NUCs and anti HBsimmunoglobulin (HBIG).|
|Co infection with hepatitis C||Often HCV dominates the treatment with pegyltaed interferon and ribavirin to sustain edvirological response. HBV can reactivate and thus the need to be closely monitored. It should be treated with NUCs.|
|Co infection with HIV||Treatment targets both viruses. However, defovir and Telbivudine are agents with no activity on HIV reproduction.|
|Pregnancy||Antiviral treatment is to be avoided until the third trimester of pregnancy. Lamivudine decreases the danger of intra-uterine as well as after birth communication of Hepatitis B virusif givenwith HB IG and vaccination within the first day of birth. The treatment enables a mother to breastfeed her child without the risk of infecting them.|
In accordance with the guidelines set by the National Board of Nursing (AANP) Nurses taking care of individuals suffering from HBV provide an essential point of contact for the coordination and management of screening, assessment, treatment of people with viral hepatitis. The first responsibility for nurse practitioner in treatment of Viral Hepatitis B is to create a link between primary care practitioners, treatment centers, and related health practitioners. As indicated by Liaw & Chu (2018), nurse practitioner develop as well as work within an established model of care-allowing flexibility within particular regions, encouraging shared care and demonstrating best practice. Additionally, they facilitate the development of effective networks with general practitioners such as practice nurses, doctors as well as nurses in correctional or drug and alcohol treatment facilities, in addition to related health professionals to form a multidisciplinary approach to patient management. In doing so the nurses are able to document each cases of Hepatitis B, prepare a patient care as well as follow up centers.
Hepatitis B virus (HBV) infection is the ninth leading cause of death in terms of global epidemics with a mortality of an estimated 650,000 individuals yearly. This alarming statistic exists despite the availability of an operative vaccine as well as the development of active antiviral treatments. While Hepatitis B is a global epidemic, the disease is rampant in Asia, Africa, as well as the Western Pacific Region. An acute hepatitis B virus infection is associated with general ill-health. However, in distinct cases, it may progress to jaundice or even lead to death if left untreated. Transmission of the Hepatitis B virus traditionally comes from exposure to contaminated blood or body fluids containing blood. Chronic Hepatitis B infection does not require treatment since most adults’ immune systems clear the infection naturally. Notably, various patients require various forms of treatment due to resistance characteristics such as resistance to specific drugs and strategies.
Dienstag, J. L. (2018). Hepatitis B virus infection. New England Journal of Medicine, 359(14), 1486
Liaw, Y. F., & Chu, C. M. (2018). Hepatitis B virus infection. The lancet, 373(9663), 582-592.
Rehermann, B., & Nascimbeni, M. (2015). Immunology of hepatitis B virus and hepatitis C virus infection. Nature Reviews Immunology, 5(3), 215-229.
Seeger, C., & Mason, W. S. (2000). Hepatitis B virus biology. Microbiol. Mol. Biol. Rev., 64(1), 51-68.
Shepard, C. W., Simard, E. P., Finelli, L., Fiore, A. E., & Bell, B. P. (2018). Hepatitis B virus infection: epidemiology and vaccination. Epidemiologic reviews, 28(1), 112-125.
Trépo, C., Chan, H. L., & Lok, A. (2014). Hepatitis B virus infection. The Lancet, 384(9959), 2053-2063.