April 26, 2011
Hepatitis: A Pandemic Predicament
Viral hepatitis could be considered a disease of “antiquity” when Hippocrates described his infectious icterus findings 2400 years ago (Schmid, 2001). It is unclear what type of liver disease infiltrated the population at the time. However, by many historical accounts, the Middle Ages were inflicted by outbreaks commonly referred to as “campaign or epidemic jaundice” and were related to wars, famines, and natural disasters (Schmid, 2001, p. 718). The historic timeline of hepatitis worldwide is hazily documented. During the Napoleonic campaigns in Russia and Egypt, jaundice was well known to inflict soldiers and civilian populations. Officials in the American Civil War noted approximately 70,000 soldiers were affected by viral hepatitis. In fact, the common areas of care for such patients at the time were referred to as “camp jaundice” (Dooley, 2005, p. 71). During World War II, military researchers began a concentrated investigation of the pandemic predicament, its origin, method of transmission, and best treatments. Their search for answers would lead to many more questions, taking doctors and researchers on a circuitous mind quest toward finding a remedy to a virus that has shrouded itself in mystery for generations. “Viral hepatitis is a systemic, viral infection in which necrosis and inflammation of liver cells produce a characteristic cluster of clinical, biochemical, and cellular changes” (Smeltzer & Bare, 2004, p. 1093). Hepatitis with its known five classifications (A, B, C, D, & E) has become a public health concern in modern time due to the increase of infections. The virus merits worldwide attention because of the ease of transmission and high morbidity. Researchers have estimated that 60% to 90% of cases of hepatitis are unreported due to mild symptoms and misdiagnosis (Smeltzer & Bare, 2004). Hepatitis A (HAV) was once referred to as infectious hepatitis. The disease is caused by an RNA virus of the Enterovirus family. Transmission of this virus is exposure to infected feces and is often transmitted by consuming contaminated food or water (Smeltzer & Bare, 2004). Hepatitis A often manifests in patients without jaundice or symptoms. If a patient experiences symptoms, it can often be mistaken for a mild flu-like illness with perhaps an upper- respiratory infection and low grade fever (Smeltzer & Bare, 2004). The majority of the patients recover fully. This form of hepatitis rarely causes cirrhosis of the liver or death. While assessing a patient with hepatitis A, the liver and spleen may be enlarged as well as the hallmark sign of jaundice. Beyond these findings, there are few physical signs that point to hepatitis A (Smeltzer & Bare, 2004). Hepatitis A antigens may be found in the stool and serum when symptoms are presented (Smeltzer & Bare, 2004). A vaccine is available to prevent Hepatitis A. For those not vaccinated an intramuscular injection of globulin during the incubation period or within two weeks of exposure will assist in suppressing symptoms and promoting active immunity (Smeltzer & Bare, 2004). Hepatitis B (HBV) is referred to as serum hepatitis and can be transmitted through intimate contact. The disease may be spread through sexual activity or blood exposure. The hepatitis B virus has been found in blood, saliva, semen, and vaginal secretions (Smeltzer & Bare, 2004). Hepatitis B is a virus of concern for healthcare workers because of their increased potential exposure to infected patients. For that, healthcare workers are encouraged and sometimes required to receive the vaccine. Greater than 90% of people infected with hepatitis B will develop antibodies and recover within six months. The treatments for HBV are two antiviral medications, lamivudine (Epvir) and adefovir (Hepseral). Bed rest is also recommended for patients until hepatic enlargement subsides and elevated serum bilirubin...