Communicable Disease: Hepatitis B Communicable diseases are diseases that can be transmitted via contact, droplet, air/food borne, blood, bodily fluids or congenital infection and cause individuals to become ill. The pathogens invade the body and damage normal cell functions, which could potentially cause death. Hepatitis B has infected over 200 billion people worldwide and killed over one million individuals per year (Centers for Disease Control and Prevention [CDC], 2013). The hepatitis B virus (HBV) can be prevented through education, spreading awareness and getting vaccinated which provides a lifetime of protection.
Description of Hepatitis B
Hepatitis B is a viral infection that is caused by the hepatitis B virus (HBV). It attacks the liver and can cause both acute and chronic disease. Acute HBV lasts less than six months and ones immune system is able to fight and clear the infection. Chronic HBV lasts longer than six months and the immune system is unable to fight the infection leading to liver failure, cancer or cirrhosis. Occasionally chronic HBV can go undetected for years due to a person being asymptomatic (Mayo Clinic, 2011).
Mode of Transmission
In highly infected areas of the world, HBV is most commonly spread from mother to her baby at birth or from person to person in early childhood (World Health Organization [WHO], 2013). The HBV is also spread via parenteral contact with infected blood or blood products, sharing of or accidental needle sticks and having unprotected sex with someone who’s blood, saliva, semen or vaginal secretions are infected and enter your body (Copstead and Banasik, 2010).

Signs and Symptoms
Signs and symptoms of HBV may never appear or appear over a two to six month period. Signs and symptoms include abdominal pain, dark urine, fever, joint pain, loss of appetite, nausea and vomiting, weakness, fatigue and jaundice (yellowing of the skin and or sclera) (Mayo Clinic, 2011).
Complications
Having chronic HBV can lead to serious life threatening complications such as; cirrhosis, liver cancer, failure, hepatitis D infection or kidney failure. Liver cirrhosis occurs when HBV causes inflammation to the liver leading to scaring and formation of fibrotic cell tissue that blocks hepatic blood flow and cell function. This in turn results in overgrowth of new cells attempting to regenerate causing decreased liver function. Liver cancer and failure can occur if a patient has cirrhosis due to being a risk factor (Copstead and Banasik, 2010).
Treatment
Treatment of HBV is supportive. Care focuses on nutrition, hydration and comfort (WHO, 2013). Those who have been infected with acute HBV may not need medical treatment except for management of symptoms. Those infected with chronic HBV may need more invasive treatments like antiviral medications or possibly a liver transplant (Mayo Clinic, 2011). Antiviral medications are used to slow and fight the virus from destructing the liver. Liver transplants are an option if a patient has end-stage liver disease where traditional treatments have not worked and are from a qualified candidate (Copstead and Banasik, 2010).
Demographics
Approximately 60,000 people die every year from HBV (WHO, 2013). There are about 200 billion people living around the world with HBV with an estimated 1.2 million living in the United States (CDC, 2013). In 2011, the United States was estimated to have 18,800 actual new cases of the HBV (CDC, 2013). Those who are at greatest risk for developing HBV are Asian and Pacific Islanders, African Americans, gay and bisexual individuals, those who have multiple sex partners and do not practice safe sex or are intravenous drug users. Gay and bisexual men make up 20% of new HBV cases and 50% Asian and Pacific Islanders are living with HBV (CDC, 2013). Most Asian and Pacific Islanders were infected with HBV as infants or children and 1 in 12 are living with it and are not even aware.
Determinants of Health
Environmental factors such as living conditions, social networks and social support systems are all key drivers for one becoming infected with the HBV. For example, a homeless person who has a poor health status, is uninsured, unemployed and has a lack of education is more likely to be diagnosed with HBV. Also certain races are more likely to be infected with HBV, as stated above, Asian and Pacific Islanders make up 50% of the population living with HBV (CDC, 2013). In addition, there is a lack of resources available to protect, improve and maintain ones health due to the cost and lack of good health services to individuals with low socioeconomic backgrounds. Therefore, focus needs to be made on improving access to care as well as treating the environmental and social factors of health.
Epidemiologic Triangle The epidemiologic triangle is used to analyze the natural history of a disease. It assesses the agent “what”, host “who” and environment “where” (Maurer and Smith, 2013). The biological agent for hepatitis B is a virus. The host’s demographics can range from infancy into adulthood and any race is susceptible to the virus. The body’s defenses are more likely to fight off acute than chronic HBV. A person’s behavior as well plays a large role in one becoming infected. Those who are intravenous drug users or have a history of multiple sex partners are more susceptible to developing HBV. Environmental factors based on social and economic considerations could be direct person-to-person contact of bodily fluids via kissing or sexual intercourse or receiving contaminated blood products from infected individuals. Within the workplace, an individual could accidently prick himself or herself with a contaminated needle increasing their chances of becoming infected. In order to break the chain of infection the nurse needs to stress behavior changes by educating individuals on safe sex practices, ensuring people get vaccinated and needle exchange programs.
Role of Community Health Nurse It is important for the community health nurse to educate and promote prevention of HBV. Teaching risk reduction interventions and strategies such as not having unprotected sex and using condoms can help prevent transmission of hepatitis B. For those who have already become infected with the HBV it’s important to provide timely referrals for sexual health related services to further prevent others from becoming infected. Making the hepatitis vaccinations more accessible and available is an effective way to prevent hepatitis B. Educating health and human service providers about hepatitis B promotes quality of care and awareness as well as reduces chances of transmission. Ensuring adequate resources are available (state and local surveillance) to accurately monitor disease trends, transmission and how effective treatment is can improve and ensure correct data collection. It’s also important that the nurse refers patients to accessible care and treatment facilities so that compliance can be obtained and the rate of transmission, morbidity and mortality can be reduced.

National Organization The World Hepatitis Alliance is a non-profit international umbrella non-governmental organization that represents every region of the world with viral hepatitis. They raise awareness, reduce the stigma associated with viral hepatitis, work with the WHO and provide preventive care as well as support and access to treatment. Their goal is eradication of HBV and HCV. They plan on achieving this goal by providing more countries with a complete hepatitis strategy in place, regional patient organizations in all WHO regions, on going support for global hepatitis groups, acceptance at a global level of HBV and HCV, increased alliance and a more diversified funding base for the alliance.
Conclusion
There are two billion people worldwide that are infected with HBV and more than 350 million infected with chronic liver infections, which increases their risk of death significantly (Maurer and Smith, 2013). Fortunately, there is a vaccine for hepatitis B but has not become easily accessible for those in developing countries. This is a virus that can be prevented if individuals are educated on causes and risks as well as ways to protect themselves. It is up to the healthcare providers to spread awareness and makes patients are more knowledgeable surrounding the types of communicable disease in the world so that they can make healthy choices.

References
Centers for Disease Control and Prevention. (2013). Retrieved Novemeber 29th, 2013, from http://www.cdc.gov/hepatitis/Populations/index.htm
Copstead, Lee-Ellen and Banasik, L. Jacquelyn. (2010). In Como D. (Ed.), Pathophysiology (4th ed.). 11830 Westline Industrial Dr. St. Louis, Missouri 63146: Elsevier.
Maurer, A. Frances and Smith, M. Claudia. (2013). Community/Public health nursing practice (5th ed.). 3252 Riverport Lane St. Louis, Missouri 63043: Elsevier.
Mayo Clinic. (2011). Hepatits B. Retrieved Novemeber 29th, 2013, from http://www.mayoclinic.com/health/hepatitis-b/DS00398
World Health Organization. (2013). Hepatitis B. Retrieved Novemeber 29th, 2013, from http://www.who.int/mediacentre/factsheets/fs204/en/
World Hepatitis Alliance. (2013). Retrieved Novemeber 29th, 2013, from http://www.worldhepatitisalliance.org/en/annual-reports-and-accounts.html