Hepatitis B, Research Paper Example

Introduction

The Hepatitis B virus was first discovered in 1966. It was found to have infected more than 360 million people throughout the world. The disease accounts for over 1 million deaths per annum and the viral infection is considered to be amongst the leading causes of Hepititus, cirrhosis and hepatocellular carcinoma. The research into the molecular biology of the virus has resulted in a number of successful vaccine treatments. Successful treatment options resulted in Dr. Barach Blumberg getting the Nobel Prize in Medicine in 1976. The World Health Organization estimated that in 2000 there were over 400 million carriers of the virus. In the United States is has been estimated that over 1.25 million are affected. (Lee, W.M. 1997)

Causes Incidences and Risk Factors

The Hepatitis B infection is caused by contact with bodily fluids that come from a carrier of the virus. This could be from such items as blood, semen, vaginal fluids etc. In addition you may also be at risk of the infection from blood transfusions where inappropriate screening has taken place; contact with infected blood in healthcare settings, sexual transmission from a person having the virus, the use of infected needles – those frequenting tattoo parlours and drug abusers are at particular risk. Other items may include sharing razors or toothbrushes with an infected person. Risk factors are increased by being infected with HIV, use of different sexual partners or coming into contact with people from those areas considered to have a high rate of infection e.g. Caribbean, Asia and Africa. A new genotype F of the virus has recently been discovered in Central America. (Robertson, B.H. 2003)

Symptoms of the Disease

Symptoms of Hepatitis B may not manifest for days or weeks after coming into contact with the virus. Sometimes a healthy immune system is able to fight off and defeat the disease. Although others are not able to fight off the disease where it is referred to as chronic Hepatitis B and symptoms may not fully show for up to 6 months but may include:

• The loss of appetite
• Fatigue
• Nausea and vomiting
• Muscle and joint aches
• Low Fever
• The yellowing of skin owing to jaundice or appearance of dark urine

Those people diagnosed with chronic HBV will require proper medical counselling in order to make lifestyle changes and deal with the prevention of transmission of the disease. This will also require ongoing monitoring particularly of the liver functions. Liver damage is monitored by examination of the Albumin Levels, Liver function tests and Prothombin time. In addition various core Hepatitis antibodies will be examined together with blood tests. (McMahon, B.J. 2007).

Treatment Options

In the first instance no immediate treatment may be required other than careful monitoring of the liver and other body functions by taking periodic blood tests. In addition the infected person should take plenty of rest, regular consumption of fluids like water and eat a healthy diet. In rare cases you may get liver failure and in this instance a liver transplant will be required. This diagnosed with chronic Hepititis B may be treated with a combination of antiviral drugs or medication termed peginterferon . These drugs are designed to reduce the amount of hepatitis in the bloodstream and lessen the risk of cirrhosis or liver cancer. Those with chronic HBV are at increased risk of developing cancer. A treatment algorithm has been designed by an panel of experts in the USA. This has been based on early detection of HBV DNA and the provision of antiviral therapy. There are a range of different drug options available but the front line or preferred treatment drugs are peginterferon, tenofovir and alfa2A. (Martin, P. et al 2008).

Potential Complications

There can be side effects from the use of the treatment drugs and in rarer cases there may be liver failure in which case the only treatment option is to have a liver transplant.

Prevention Options

Prevention is by far the best option and this should begin at birth with the child receiving the first hepatitis B vaccine. This consists of three shots administered over 6 month’s intervals. Other people who are classified as high risk occupations should also receive a vaccine. Mothers who have the virus should ensure that their children acquire the vaccine shots within 12 hours of birth. Historically, in third world and poorer countries there was a lack of screening blood donations and transmission happened through transfusions. (Diemstag, 2008)

This has all but been eradicated in the USA now. As this is a mandatory disease reporting it has enabled more efficient screening and tracking of the disease. As this is a global problem the World Health Authority has been instrumental in helping to improve the global screening process. This has helped in improving the prevention options in developing and third world countries. (McMahon, B.J. 2007).

Preventing transmission of the Virus

If diagnosed with chronic HBV it is important that you take all preventable measure to prevent any further spread of the disease. For example:

• Ensure that you do not donate or pass on HBV contaminated materials
• You should use condoms with your sexual partners;
• Formal assessment for HBG should take place with your sexual partner
• Ensure other active partners are assessed for HBV immunity and immunization;
• Never share materials like needles or other sharps if taking drugs.
• Ensure that all sharp instruments are only for your personal and exclusive use. (e.g., toothbrushes, scissors, razors, or nail clippers) with others;
• Ensure tatoos or body piuercing parlours use hygiene and sterlised products.
• Pregnant women need to keep their healthcare provider fully informed
• Ensure any open wounds or sores are covered.

How does HBV become Chronic ?

According to the World Health Organization this will depend on the age when that person becomes infected with the virus. Young people are the most likely to developm chronic infections, probably because the immune system is not fully developed. For example about 90% of infants who get HBV find that it turns to becoming chronic. It is estimated that there is a 25% morbidity rate of Adults who get chronic HBV and this turns to liver cancer.

The most common prevailent areas of the disease is in China and other parts of Asia. Liver cancer being one of the main causes of death in both men and women. High rates of chroniocinfections have also shown up in South America, Central Europe, India and the Middle East. Where Hepititis B (HBV) is diagnosed as being acute it means there are very little treatment options. Liver cancer is generally fatal and most people die within a few months of being diagnosed in some cases surgery and chemotherapy can extend life for a few years. (World Health Authority, 2012). An interesting observation is that HBV has been described as being 100 times more infectious than that of HIV. WHO has classified the disease as being of particular danger as an occuptational hazard to healthworkers.

Management of Hepatitis B in China | a Case Study

According to the World Health Authority there are about 2 billion people that have been infected with some form of hepititis. Of this number it has been estimated that between 350-400 million cartry thew chronic HBV virus. In China the virus is highly endemic an in 2006 a research study indicated that the carrier rate in China was around 7% of the entire Chinese Population. This equating to that of 93 million chinese HBV carriers and some 30 million patients diagnosed with chronic HBV. A survey carried out in Shanghai stated that this imposed a terrible burden on the financial impact of Chinese families. Statistics reported:

• Chronic HBV cost each patient around $3000 US
• Liver Cirrhosis cost around $5,100 US (Hui, Z. 2009)

This is particularly alarming from a cost perspective because the disease can be prevented. It was not until 2005 that the Chinese Government introduced a free vaccine program. This has helped at decreasing the rate of HBG virus infection in young children.

The World Health Authority working with the Chinese administration has set a target to reduce the infection rate to less than 2% by the end of 2012. This has been given one of the highest priorities for disease control in China. There is an urgent need for the Chinese medical system to acquire and promote anti-viral treatment. This is the best treatment for getting long term suppression of the disease and helping those with chronic HBG to have some quality of life. Regretablymany of the Chinese physicians are still using herbal remedies to treat the disease. This was estimated to be as high as 73% of the Chinese physicians.

A lack of a general education program on HBG has failed to inform the public on the dangers of the disease, how appropriate preventative measures may be taken and the different treatment options available. This has resulted in a lot of discrimination towards HBG patients and the use of fake drug advertisements. In more recent years the antiHBV drigs have become in more wider circulation but thewre is a lack of education in the medical practitioners in terms of understanding the benefits of these antiviral drugs. The main strategy of stopping the spread of HBG has been based upon the universal immunization of newborns and getting them vaccinated at birth.

Research has shown that there are higher incidents of HBG in the rural areas as opposed to that of the urban areas. In a survey covering 5 chinese provinces it as found that the HBG infection rate in the population was 42.6% and that infection rates in Children tend to peak between the ages of 5-9 years of age. They have also noted a strong clustering of the infection in families which suggests spread of the infection amongst family members. The early vaccination of newborns has shown to be having some positive effects in reducing the spread of contagion amongst young children. (Yao, G.B. 2008)

Conclusions

The following key points are applicable in the overal determination of HBG:-

• The research into the molecular biology of the virus has resulted in a number of successful vaccine treatments
• Successful treatment options resulted in Dr. Barach Blumberg getting the Nobel Prize in Medicine in 1976
• The World Health Organization estimated that in 2000 there were over 400 million carriers of the virus
• In the United States is has been estimated that over 1.25 million are affected
• The Hepatitis B infection is caused by contact with bodily fluids that come from a carrier of the virus. This could be from such items as blood, semen, vaginal fluids etc.
• Those people diagnosed with chronic HBV will require proper medical counselling in order to make lifestyle changes and deal with the prevention of transmission of the disease. This will also require ongoing monitoring particularly of the liver functions.
• Prevention is by far the best option and this should begin at birth with the child receiving the first hepatitis B vaccine. This consists of three shots administered over 6 month’s intervals. Other people who are classified as high risk occupations should also receive a vaccine.
• High rates of chroniocinfections have also shown up in South America, Central Europe, India and the Middle East. Where Hepititis B (HBV) is diagnosed as being acute it means there are very little treatment options
• According to the World Health Authority there are about 2 billion people that have been infected with some form of hepititis

References

Diemstag, J. (2008). Hepatitis B Viral Infection. New England Journal of Medicine Vol 359, 1486-1500.

Lee, W. M. (1997). Hepatitis B Virus Infection. New England Journal of Medicine Vol 337, 1773-1745.

Martin, E. k. (2008). A treatment algorithm for the management of chronic hepatitis. Clinical Gastroenterology and Hepatology, 1315-1341.

McMahon, A. L. (2007). Chronic Hepatitis B. Hepatology Vol 45 (2), 507-527.

Robertson, P. A.-R. (2003). Genotype H : A new amerindia genotype of Hepititis B revealed in Central America. Journal of General Virology Vol 83(8), 2059-2073.

Worlkd Health Authority. (2012, 6 2). Hepatitis B. Retrieved from World Health Authority: http://www.who.int/mediacentre/factsheets/fs204/en/#

Yao, G. (2008). Importance of perinatal versus horizontal transmission of hepatitis B virus infection in China. Journal of gastroenterology and hepotology , 1136.

Z.Hui, L. F.-M. (2009). Management of Hepititis B in China. Chinese Medical Journal Vol 122(1), 3-4.