Term Paper: Hepatitis B Screening for Health

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[. . .] (Joint Advisory Notice, 1987) The diagnosis of the disease is in stages. At the start is the checking of Hepatitis B surface antigen presence in blood tests of the infected individual as the first viral marker. This stays in the only for a period of 1 or 2 months. The next stage, after the appearance of hepatitis B surface antigen is the detection of hepatitis B core antibody or Anti-HBc. This happens within one or two weeks. (Hepatitis B: cancer-symptoms.org) For evaluation of patients at high risk for hepatitis B infection, there is a single test called HBcAb, or Hepatitis B core antibody that is the best. When the results of the test are negative, the patient should receive the vaccination for hepatitis B A positive result indicates the conducting of HBsAg or hepatitis B surface antigen test. If the test for HBsAg is positive, then the patient is infectious. (Hepatitis B: (www.cpmc.org)

The third stage is the finding of hepatitis B surface antibody (Anti-HBs). This is present in both of those who have been immunized and those who have recovered from an infection of hepatitis. The fourth stage is the finding of both hepatitis B surface antibody and core antibody. These stay on indefinitely in blood of patients who have recovered from an attack of hepatitis B The fifth stage is the high levels of liver enzyme or transminase in blood due to liver damage. The sixth stage is low levels of albumin and prolonged time for prothombin due to failure of liver. (Hepatitis B: cancer-symptoms.org) All patients infected with HBV should go through ALT test. This is for measuring the level of alanine aminotransferase, a liver enzyme in the blood. A high level of ALT indicates inflammation of liver. Liver function tests are for albumin, bilirubin, INR or a coagulation test, liver biopsy, HBV DNA QUANTIFICATION, HBeAg or hepatitis B e antigen, anti-HBe or hepatitis B e antibody, anti-HDV or hepatitis delta virus antibody for adults getting HBV, estimation of time or age of acquiring HBV, etc. (Hepatitis B vaccination in public service current: Scientific Working Group on Viral Hepatitis Prevention, 1996)

Other important tests are for HBV Core and PreCore mutant; HBV Genotype; and YMDD mutant in patients on lamivudine if HBV DNA is elevated. (Hepatitis B: (www.cpmc.org) Exposure prone procedures should not be done by health care workers when they are HBV DNA or hepatitis B e antigen (HBeAg) positive. These persons have greater risks in exposure prone procedures as individuals who have 'e' antigen face a greater risk from infection than others who are HBsAg positive but HBeAg negative. (Duties of Care, 1998) Patients with hemophilia and thalassaemia major, and require a blood transfusion can get hepatitis B vaccination with effect from 1 January 1992 by appointment. They can be referred to VHPS. Like health care workers they are also to get pre-vaccination screening and post vaccination tests. (Hepatitis B vaccination in public service current: Scientific Working Group on Viral Hepatitis Prevention, 1996)

Health departments and health care providers face two important challenges in the maintenance of high screening rates among pregnant women for HBsAg, and giving immunoprophylaxis to new born infants. (Prevention of Perinatal Hepatitis B through Enhanced Case Management -- Connecticut, 1994-95, and United States, 1994) Routine screening for hepatitis B is now done for pregnant women as it is a reportable disease and this has led to more accurate figures coming out. It is now known that one in a thousand pregnant women is chronic carriers of hepatitis B (General Health Encyclopedia: Hepatitis B) Pregnant women are now being screened at a high enough rate, but the present efforts of determining and tracking infants born to HBsAg positive mothers are not enough. The progress in prevention of pre-natal HBV transmission will succeed only on improved health department identification and tracking. (Prevention of Perinatal Hepatitis B through Enhanced Case Management -- Connecticut, 1994-95, and United States, 1994: MMWR Weekly 1996, p. 585) According to OSHA, employers have to offer hepatitis B vaccine free of charge to workers regularly exposed to blood and similar infectious materials in their duties. The regular serologic testing, for checking of antibody concentrations when the series of three doses is complete, has not been recommended by OSHA. (Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices, 1997)

The chances of getting hepatitis B from a blood transfusion have decreased due to the screening of all donated blood. The first of these screens is the requirement that blood donors now have to fill out a questionnaire regarding the activities in sex and drug use. When the individual is in high risk group, the blood is not used. There are tests to screen collected blood for hepatitis B virus. (Jonnalagadda, 2004) There is still controversy regarding screening of patients with chronic HBV infection for hepatocellular carcinoma through use of alpha-fetoprotein measurement, or ultra-sonography. After development of chronic infection, the development of hepatocellular carcinoma may still take 25 to 30 years, though it may some times happen faster. There have been no random trials of patients with chronic HBV infection to check the effect on mortality due to early detection and resection of tumors of hepatic origin. Thee is however a recommendation from American Association for the Study of Liver Disease, or AASLD for screening of hepatic tumors every six months. This is more for men older than 45 years with chronic HBV infection, or patients with biopsy proven cirrhosis, and with patients who have a family history of hepatocellular carcinoma. They have also noted that low risk patients for hepatocellular carcinoma should have annual screening, if desired. (Lin; Kirchner, 2004, p. 76)

The U.S. Preventive Service Task Force has also recommended screening of pregnant women in health care workers for hepatitis B virus during their first prenatal visit. The Task Force has decided on this based on the evidence that pre-natal screening for HBV infection, using hepatitis B surface antigen or HBsAg has substantially reduced pre-natal transmission of HBV. This also stopped subsequent development of chronic HBV infection. The Task Force has not agreed to routine screening of the general population for chronic hepatitis B virus infection. According to their studies, they have not found any evidence of this screening to improve dangers from cirrhosis, hepatocellular carcinoma, or mortality. The general rate of HBV infection is not high, and large sections of even infected individuals do not end up with chronic infection, cirrhosis or HBV related liver disease. There are harms of the screening ending up labeling, but the dangers from this are yet to be determined. In sum total, the Task Force concluded that the possible harms of screening the general population will be more than the benefits. (U.S. Preventive Services Task Force, 2004)

The presence of health care workers infected with hepatitis B is a general risk. For prevention of horizontal transmission of their disease to their patients, they should observe restrictions. The chances of infection come mainly from the consequence of direct blood to blood exposures during surgery. Except in cases where the patient has a proven immunity to hepatitis B, it is ethically compulsory for the health care worker to inform the patient of the possibility of transmission. The worker should then take up the procedure only with the consent of the patient. During the actual procedure, the worker has to take all possible precaution.

References

Duties of Care" (1998) Retrieved at http://www.safetyline.wa.gov.au/institute/level2/course20/lecture81/l81_07.asp (Accessed: 2004, 16 August)

General Health Encyclopedia: Hepatitis B" Retrieved at http://www.healthcentral.com/mhc/top/000279.cfm (Accessed: 2004, 16 August)

Hepatitis B" Retrieved at http://cancer-symptoms.org/hepatitis-b.htm (Accessed: 2004, 16 August)

Hepatitis B" Retrieved at http://www.cpmc.org/advanced/liver/patients/topics/hepb.html (Accessed: 2004, 16 August)

Hepatitis B Seronegative Commonalties in Health Care Workers. Running Head: Seronegative Commonalties" University of Detroit Mercy. Retrieved at http://www.htm. s.com/fhorvat/thesis3.htm (Accessed: 2004, 16 August)

Hepatitis B vaccination in public service current. Scientific Working Group on Viral Hepatitis Prevention" (1996, April) Hong Kong. Retrieved at http://www.info.gov.hk/hepatitis/download/papers/ann4.pdf (Accessed: 2004, 16 August)

Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (1997, December 26) MMWR Weekly. Volume: 46 (RR-18) pp: 1-42

Joint Advisory Notice. (1987, October 19) "Protection against Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)" Department of Labor, Department of Health and Human Services

Jonnalagadda, Sreeni. (2004, February 25) "Medical Encyclopedia." Retrieved at http://www.nlm.nih.gov/medlineplus/ency/article/000279.htm (Accessed: 2004, 16 August)

Lin, Kenneth W; Kirchner, Jeffrey T. (2004, January 1) "Hepatitis B" American family Physician. Volume: 12: No: 1; pp: 75-86

Mac Arthur, Barbara. (April 23, 2001) "Understanding Viral Hepatitis" Health Care Review, Volume: 14, No: 2; pp: 37-45

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"Hepatitis B Screening for Health."  Essaytown.com.  August 16, 2004.  Accessed May 21, 2019.
https://www.essaytown.com/subjects/paper/hepatitis-b-screening-health/2426973.