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Hepatitis B is a severe infectious affliction that can have a detrimental impact on health. It is associated with considerable liver lesions due to hepatic cell death and further liver dysfunction. The hepatitis B virus has insidious nature that complicates its detection. The discussed infection causes significant health deterioration that exhibits gastrointestinal disturbances, abdominal pain, and jaundice. Liver function tests, specific blood examinations, as well as imaging studies, are commonly prescribed for detecting the virus in the blood and evaluating the impairments caused by it. Antiviral medication and immunoglobulin injections are crucial for treating the disease, thus preventing or minimizing the risks of developing life-threatening implications. Vaccination is vital for decreasing the number of infected individuals and preserving the health of the intact population. Surveillance is crucial for assessing the epidemiological situation and initiating preventive measures for improving it.

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Keywords: hepatitis, infection, health, liver

Evaluation of Epidemiological Problem


Multiple pathogens can induce various impairments and alterations after infiltrating the body. Mostly, they disrupt the normal functioning of vital organs which can result in life-threatening consequences, and hepatitis B is in this category. The discussed disease can drastically interfere with normal occupational activity, deteriorate health conditions, and reduce the quality of life. Sufficient knowledge of viral hepatitis B, its pathogenesis and symptoms, as well as diagnostic and therapeutic modalities along with preventive care can be beneficial to everyone. Moreover, the overview of epidemiological data related to hepatitis B, such as incidence, morbidity, and mortality rates, as well as the population at risk, can contribute to understanding the actuality and importance of the reviewed issue for initiating adequate measures.

Background of Hepatitis B

To begin with, hepatitis B (HBV) is a serious, viral, relatively common systemic disease associated with considerable liver damage. The stated infectious affliction occurs due to hepatitis B virus infiltration, which is characterized as an exceedingly resistant, “partly double-stranded DNA virus of the hepadnaviridae family” and specified by certain serological markers like “HBsAg and anti-HBs, HBeAg, and anti-HBe, and anti-HBc IgM and IgG” (Aspinall, Hawkins, Fraser, Hutchinson, & Goldberg, 2011). The given pathogen severely attacks the liver, though it can remain undetected for a long time due to its insidious nature and capability to tolerate high temperatures and humidity. Apart from that, upon entering the body, the HBV starts damaging hepatic cells, which eventually results in their necrosis and Kupffer cell hyperplasia (McCance & Huether, 2014). Furthermore, mononuclear phagocytes that appear after viral contamination penetrate the liver with variable intensity, thus disturbing hepatic functions. The pathogenesis of the described infection is associated with inflammatory processes that generally traumatize bile canaliculi and cause their obstruction. Such impairments commonly entail cholestasis and jaundice. Severe cases of hepatitis B can ensure massive hepatic damage, severe encephalopathy, and liver failure that can result in deleterious, life-threatening consequences. The incubation period of the scrutinized is primarily within 40 to 160 days, though it can progress within less time on average.

Signs and Symptoms

The reviewed infection can progress asymptomatically or with acute symptomatic development. Hepatitis B generally manifests with persistent, low-grade fever, joint pain, myalgia, reduced appetite, and such gastrointestinal disturbances as vomiting and nausea. Individuals with the stated disorder can complain of abdominal pain located in the right upper quadrant and intermittent epigastric pain of variable extent. Furthermore, the discussed affliction ultimately exhibits “disordered gustatory acuity and smell sensations” (Pyrsopoulos, 2018). Apart from that, patients with hepatitis B are prone to acquiring an aversion to tobacco and food as well. Moreover, they can suffer from sleep disturbances, mental problems, and ascites. In addition, the studied disease is tightly associated with hepatic encephalopathy and coagulopathy. Individuals with fulminant hepatitis are at risk of having gastrointestinal bleeding and coma due to inappropriate liver functioning. It is worth mentioning that patients with chronic hepatitis B and HIV are at tremendous risk of undergoing acute joint pain and ongoing abdominal pain. In this way, they are at risk of having cirrhosis due to inappropriate immune system functioning and deficient immune response.

Parenteral contact with contaminated blood and other bodily fluids is the major mode of infection transmission. The individuals can acquire the described infection as a consequence of contact with infected needles and having unprotected sexual intercourse with an infected partner. Hepatitis B transmission can occur from an infected mother to a child which is defined as mother-infant vertical transmission or perinatal one that mostly prevails in endemic countries (Copstead & Banasik, 2014). Furthermore, the horizontal mode implicates the virus transmission from child to child, whereas the parenteral one signifies “percutaneous or per mucosal exposure to infected blood or body fluids” (Aspinall et al., 2011). It is worth mentioning that modes of HBV transmission geographically vary. In this way, it is asserted that sexual contact and injecting drug use are the primary modes of acquiring hepatitis B virus in adulthood in low prevalence areas, while the perinatal mode is the predominant mode of HBV transmission in high prevalence areas.

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Current Incidence and Prevalence Rates

HBV disorder remains a significant health concern worldwide, including in the United States, due to drastic consequences as well as high morbidity and mortality rates associated with it. It is estimated that around 600,000 clinical cases of hepatitis B are annually registered in the United States, while approximately 2 million individuals live with chronic hepatitis B (Pyrsopoulos, 2018). Epidemiological studies allowed asserting the fact that the highest incidence of acute hepatitis B accounts for young people aged 25–44 years old, whereas the lowest incidence is among children younger than 15 years of age (Kim, 2009). Despite 3.5% of the global population suffering from chronic HBV, the incidence of this infection is reducing due to promoted vaccination programs and appropriate antiviral therapy. The prevalence rate ultimately depends on geographical criteria. However, multiple surveys and studies allowed us to discover the fact that hepatitis B is prevalent among the Hispanic and African-originated populations. Chronic hepatitis B prevails among migrants compared to the general or local population. In addition, the researchers differentiate low, intermediate, and high prevalence areas of HBV infection. It is estimated that South East Asia, China, South America, Alaska, and sub-Saharan Africa relate to the areas of high HBV prevalence, whereas most parts of North America, Europe, as well as Australia have low prevalence rates of the described disease (Aspinall et al., 2011). In this way, incidence and prevalence rates of HBV infection are high, though they are geographically variable.

Surveillance Methods

Surveillance is critical for maintaining control of the spread of hepatitis B. It largely depends on the involved surveillance methods. At present, infection disease officers apply such modalities as case-based passive surveillance, laboratory-based and active surveillance, hospital-based reporting, and surveillance indicators monitoring. The represented methods of investigation are necessary for identifying “IgM anti-HBc– and HBsAg-positive” individuals (Centers for Disease Control and Prevention, 2018). Apart from that, they assist in revealing HBV virus carriers as well as infected individuals that, consequently, allow to take adequate measures for disrupting further HBV transmission and spread by initiating vaccination and other preventive actions.

Epidemiological Analysis

Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality worldwide. According to the World Health Organization (WHO), approximately “2000 million people worldwide are infected with HBV, and 350 million” have a chronic infection (Aspinall et al., 2011). It is estimated that 65 million HBV chronic patients are under threat of dying from liver disease, or they can develop liver cirrhosis or hepatocellular carcinoma due to long-term viral contamination (Aspinall et al., 2011). It is evident that individuals with a compromised immune system, undergoing blood transfusions, or having hemodialysis treatment are at risk of acquiring HBV infection. The people who take immunosuppressive medication or acupuncture therapy are also in the group at risk. Multiple sex partners, homosexual relations, divorced or separated marital status, drug abuse, and low educational level are social determinants of acquiring the discussed disease. Furthermore, infants born to HBV-infected mothers are at greater risk of exposure to HBV infection. Medical experts state that it depends on the HBeAg status of the mother. Thus, there is a 90% chance of developing hepatitis B in the case of positive HBeAg status. If it is negative, then the risk of viral contamination is less. In addition, improper hygiene, sharing, contacting contaminated needles and syringes, working in healthcare facilities, tattooing, or traveling to high prevalence areas of HBV infection ultimately increase the risk of having the infection under discussion.

It is obvious that competent therapists, infectious disease specialists, and gastroenterologists mostly assist HBV-infected patients in combatting the reviewed affliction. Apart from that, they can help develop adequate preventive plans for patients or individuals who are at greater risk of being exposed to the discussed infection. Competent actions of gynecologists in conjunction with infectious disease experts can minimize risks of transmitting viruses to infants from contaminated mothers or during sexual intercourse. In this way, nursing and medical proficiency are critical for providing education to patients who remain vulnerable to developing hepatitis B.

Lastly, HBV infection incurs essential health burdens due to several diseases associated with it. Substantial costs are related to hospitalizations of the infected patients, their screenings and health assessment of the high-risk individuals, pharmacotherapy, and the development of novel medicines for eradicating the virus. Treatment of the diseases that commonly progress due to HBV infiltration also entails considerable expenses as well as charges for liver transplant surgeries. Therefore, health decline caused by HBV contamination can result in reduced occupational and social activities that ultimately incur economic losses.

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Diagnostic Modalities

Diagnosis is critical for revealing abnormalities and initiating adequate therapeutic actions required for coping with hepatitis. Thorough physical examination, complete blood count, and blood chemistry are the most common laboratory tests for identifying abnormal processes in the body. The physical examination can reveal visual alterations inherent in hepatic dysfunction, whereas palpation can detect splenomegaly and hepatomegaly typical of liver injury. Healthcare providers generally prescribe such specific blood evaluations as liver function tests. Namely, they are “aspartate transaminase (AST) and alanine transaminase (ALT)” which are the serum aminotransferase values that reflect the liver condition (Pyrsopoulos, 2018). Apart from that, the laboratory tests for defining alkaline phosphatase levels, gamma-glutamyl transpeptidase levels, total and direct serum bilirubin levels, albumin levels, ammonia levels, and erythrocyte sedimentation rate can assist in revealing abnormal alterations that occur in the liver during hepatic infection or inflammation (McCance & Huether, 2014). Moreover, serologic tests that are designed for identifying “hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B core antibody (anti-HBc), immunoglobulin M(IgM), anti-HBc IgG, hepatitis B e antibody (anti-HBe), hepatitis B virus (HBV) deoxyribonucleic acid (DNA)” can ultimately help reveal pathologic changes in the liver functioning (Pyrsopoulos, 2018). Abnormal indications of the given tests are associated with considerable liver damage. In addition, such imaging studies as abdominal ultrasonography, abdominal computed tomography (CT), and abdominal magnetic resonance imaging (MRI) can be beneficial for asserting the discussed disease diagnosis. It is estimated that well-identified and “verified serum and liver biopsy diagnostic markers” can significantly assist in assessing “the disease severity, viral replication status, patient risk stratification and treatment decisions” (Yuen et al., 2018). Therefore, competent diagnostic procedures and laboratory tests assist in discovering serious hepatic impairments as well as structural and cellular alterations that are critical for further therapeutic interventions.

Prevention and Screening

Prevention is crucial for improving the epidemiological situation, and decreasing HBV incidence and prevalence, morbidity, and mortality rates. Prompt vaccination against HBV can effectively prevent the acquisition of HBV, preclude its transmission or development, and reduce the chances of having hepatocellular carcinoma (McCance & Huether, 2014). Such preventive measure is mostly recommended to neonates as well as any individuals of different age. However, immunization is particularly vital to the patients from earlier reviewed high-risk groups, medical and nursing people who commonly contact and interact with the infected persons. Furthermore, HBIG and HBV vaccines can effectively shield from contamination after exposure to the HBV virus if they are administered without long-term delays (Copstead & Banasik, 2014). Apart from that, they can provide “protective immunity” (McCance & Huether, 2014). In addition, hepatitis B immunoglobulin is ultimately helpful for boosting the immune system for protecting against HBV infection after contact with contaminated materials, fluids, and individuals. Screening tests are important for evaluating the disease severity and its phase. Finally, adherence to vaccination programs and repetitive vaccinations if required can reduce the incidence and morbidity rates of HBV infection.

Diagnosticians and healthcare providers prescribe various screening tests. Hepatitis B surface antigen test, a hepatitis B core antibody test and a hepatitis B surface antibody test are among them that are designed for revealing infection if a person has ever been contaminated. HBsAg screening test is a species that is commonly prescribed for detecting HBV infection in the blood. In the case it is positive, it signifies that a person is currently infectious and can potentially transmit the infection. If the test remains positive after 6 months, the disease is considered chronic. The discussed screening test can reveal the virus after 4 to 10 weeks after exposure which characterizes it as reasonably sensitive. Patients with chronically elevated ALT and AST tests or individuals at increased risk of acquiring the infection are commonly recommended to have regular screening (Aspinall et al., 2011). Moreover, pregnant women are also advised to go through this testing given the high jeopardy of passing the virus to newborns. Finally, the reviewed screening test is not costly that allows one to have it regularly in case of increased risks.


Healthcare providers involve pharmaceutical and non-pharmaceutical treatment modalities for coping with HBV disease. Smoking and alcohol cessation, health, vitamin-rich dieting, lifestyle modifications, duly done vaccination, and reducing the extent of other deleterious blood-borne viruses are the primary non-pharmaceutical options in the HBV infection treatment. Furthermore, pharmacotherapy is extremely crucial for eliminating “hepatitis B DNA from the blood,” thus improving liver function tests, providing sufficient immune response after exposure, as well as retaining from developing hazardous, health-related consequences (Copstead & Banasik, 2014). It is known that the administration of interferon alfa-2b can largely assist in combatting the discussed infection, particularly after being exposed to the hepatitis B virus. It is one of the efficient drugs designed for boosting the immune system that can fight or suppress the infection under review. The physicians involved in antiviral therapy for treating hepatitis B. In this way, such medications like “lamivudine, adefovir, entecavir, tenofovir, and telbivudine” can help inhibit or eradicate the virus or decrease its detrimental effect on the liver (Copstead & Banasik, 2014). Moreover, they relate to nucleoside analogs that are capable to disrupt DNA of the hepatitis B. All represented drugs can provide sufficient outcomes, though they differentiate by efficiency, adverse effect profiles, and tolerability. In the most severe cases, the healthcare providers are enforced to resort to liver transplant surgery; however, it is associated with other risks and possible complications. In dealing with HBV-infected patients, it is critical to initiate lifestyle and dietary modifications that can improve responsiveness to the involved medication. It is impossible to achieve positive treatment outcomes without involving appropriate antiviral therapy. Medical practice has shown that entecavir and lamivudine are the most efficacious in retaining the disease under scrutiny. The interferon-? injections can improve and strengthen the immune system that can be able to fight hepatitis B infection. Thus, serologic testing along with liver function tests and imaging studies are important for evaluating the efficiency of prescribed indications and involved therapies.


All in all, hepatitis B is a serious contagious disease that can cause severe liver damage and lead to life-threatening consequences. It is caused by a specific virus that can result in hepatic dysfunction and hepatic cell necrosis. The discussed affliction manifests with low-grade temperature, gastrointestinal disturbances, jaundice, and abdominal pain. According to the conducted research and surveys, a considerable number of the world population is affected by HBV infection despite initiated vaccination programs and preventive care. Furthermore, case investigations, laboratory testing, hospital-based reports, and active surveillance are critical for controlling the disease and prevent from its rapid transmission and spread. Apart from that, various screening tests are beneficial for revealing infection in high-risk groups, and HBeAg is one of them. Vaccination can protect from contracting the disease or minimize the chances of acquiring it. Liver function tests, specific blood tests, and imaging studies are the primary diagnostic tools for detecting the reviewed medical condition, thus specifying its severity and phase. Interferon-?, antiviral therapy, and appropriate lifestyle and dietary modifications can assist in eradicating the HBV infection.

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