Mandy Hotz

April 25, 2010

Communicable Disease Peds Paper-Hepatitis B

Hepatitis B is a viral infection of the liver caused by the Hepatitis B virus. Hepatitis basically means
inflammation of the liver. HBV is a known threat to health care workers and each year in the U.S.,
an estimated 12,000 health care workers contact Hepatitis B from their patients. About 300 people
die each year of this illness or its long-term consequences and may result in a range of health
outcomes. After a two- to six-month incubation period, HBV can lead to acute hepatitis. Most
individuals are able to recover completely from an acute infection. However, if the body is unable to
mount an effective immune response, a patient may become a chronic carrier of hepatitis B virus.
Chronic carriers are more at risk for developing cirrhosis and hepatocellular carcinoma, a serious
liver cancer. All carriers, whether or not they have active symptoms, have a 12 to 300 times greater
risk of developing primary liver cancer than non-carriers.

Hepatitis B follows a similar mode of transmission as HIV virus. Both are transmitted through
exposure to infected blood or blood products, sexual contact and from mothers to infants primarily
at birth. Hepatitis B is threatening for a variety of other reasons. In addition to the ways in which
HIV is spread, hepatitis B appears to be spread by casual contact. It can be acquired by close contact
within families, or from person to person through contact with open skin lesions. The virus may
possibly be spread by exposure of mucous membranes to saliva, but you cannot get it from food or
water, sneezing or coughing, breastfeeding, handshakes, hugs or casual contact.

Symptoms and signs of hepatitis B can range from none to minimal in the early stages of the illness,
to jaundice, nausea, abdominal pain, fever, and malaise in the acute phase. Appetite loss, fatigue,
itching, dark urine and pale stools are some common symptoms. After the initial infection, carriers
of hepatitis B usually have few symptoms. Diagnosis of hepatitis B is based upon examination of the
blood for characteristic antigens and antibodies associated with the disease.

Treatment of HBV depends on if it is acute, meaning short lived or chronic. If you know you've been
exposed to the hepatitis B virus and notify your doctor immediately you may receive an injection of
hepatitis B immune globulin within 24 hours of coming in contact with the virus and it may help
protect you from developing hepatitis B. If your doctor determines that your hepatitis B infection is
acute it will go away on its own and you may not need treatment. Your doctor will work to reduce
any signs and symptoms you experience while your body fights the infection. Your doctor may
recommend follow-up blood tests to make sure the virus has left your body. If you've been
diagnosed with chronic hepatitis B, your doctor may recommend antiviral medications help fight
the virus to slow its ability to damage your liver. If the liver has been severely damaged, a liver
transplant may be an option. During a liver transplant, the surgeon removes your damaged liver
and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a
small number come from living donors.
Client Teaching for Hepatitis B may include efforts to prevent the disease by focusing on
vaccinating people in high-risk groups (intravenous drug abusers; heterosexuals with multiple
partners; homosexual men; health care workers; and children born to immigrants from China,
Southeast Asia, and other areas where hepatitis B is very common) and recommending vaccinating
all children and adolescents. It is recommended that all infants receive hepatitis B vaccine as part
of their childhood immunization schedule. Three doses of vaccine are required to achieve effective
immunization and will induce adequate antibody in 80 - 95 percent of persons who get three doses.
The vaccination schedule most often used is three intramuscular injections, with the second and
third doses administered at one to six months after the first.

The nurse would instruct the patient with HBV to prevent infections by encouraging them to cover
open wounds, not to share needles, toothbrushes, razors or manicure tools other items that could
bear contaminated blood, practice safe sex and to notify their partner(s) that they have HBV, limit
alcohol intake and to never share IV drug needles or other drug equipment. Patient must know that
if they become pregnant to tell her doctor, this way the baby can be treated as soon as it is born.
We would recommend changing their diet to high carbohydrate intake and moderate to high fat
intake to help preserve the protein in the body and prevent muscle wasting, restrict protein and
salt, and avoid taking Vitamin A and B supplements.

Sources:

http://www.healthscout.com/ency/68/513/main.html#QuestionsToAskYourDoctorAboutHepatiti
sB

http://emedicine.medscape.com/article/964662-overview