Running head: HEPATITIS B PREVENTION 1

Hepatitis B Prevention in Pasco County

Natalie Drass

University of South Florida

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Hepatitis B in Pasco County

Hepatitis B is an infection of the liver caused by the Hepatitis B virus. Hepatitis B can

become a chronic infection and cause serious health problems, like liver cancer or cirrhosis

(CDC, 2015). When these health problems occur, there is not a lot of treatment options available.

Pasco County is having an increasing number of people being diagnosed with Hepatitis B.

Vaccination is a simple way to prevent people from getting Hepatitis B.

Overview of Pasco County

Pasco Country is a combination of rural and urban areas. Pasco has a population size of

492,513. The geographic size of Pasco is 746.89 square miles (U.S. Census Bureau, 2016).

Population per square mile is 622 people. Three major employers are Pasco County School

District (10,344 people), Pasco County Government (3,851 people, and healthcare (2,794)

(Largest Employers, n.d.). Regional Medical Center Bayonet Point, Medical Center of Trinity,

and Morton Plant North Bay Hospital are the three major healthcare systems available in the

Pasco county area.

Comparison of Local vs. State Findings

Pasco County has a lower percentage of families below the poverty level than the state

percentage. Pasco has 9.9% of families that are under the poverty line and Florida has 11.9%.

Pasco County also has a lower percentage of people over the age of 25 without a high school

diploma than the state average. Pasco County is at 12.5% and the state average is 13.5%. The

percentage of people over the age of five that do not speak English is also lower than the state

average. Pasco has 4.4% of the population that does not speak English and the state average is

11.7% (Florida Charts, 2014).

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Pasco is below the state average when it comes to healthcare availability. The state

average for licensed physicians per 100,000 is 259.3 and Pasco County has 153.3. For family

practice, Pasco has 15.9 and the state average is 19.1 per 100,000. For OB/GYN physicians, the

rate is 4.7 for Pasco compared to the state average of 10.2. For pediatric physicians, Pasco has 7

per 100,000 and Florida has 18.1. There are 261 hospital beds in Pasco County per 100,000 and

317 hospital beds per 100,000 for the state average (Florida Charts, 2014).

Analysis and Interpretation of Data

The rate of adults with any type of health coverage in Pasco County is higher than the

state average. Pascos rate of insured is 83.3% compared to the state average of 77.1%. This

statistic is significant because the amount of people who have health coverage directly affects the

overall health of the county. The rate of adults that reported that their overall health was good

or excellent is close to the states average. Pasco has 79.6% and Florida has 83.3% (Florida

Charts, 2014). People without coverage will, generally, not want to get medical help or go to

their doctors appointments because of the costs. Around 80 million people, around 43% of

America's working-age adults, did not see a doctor or access other medical services last year

because of the cost (Luhby, 2013).

Another strength of Pasco County is early prenatal care. Floridas average rate of early

prenatal care in 2014 was 79.8%. Pasco Countys rate of early prenatal care in 2014 was 82.2%

(Florida Charts, 2013). Healthy People 2020 recommends a rate of at least 77.9. Early prenatal

care will result in healthier babies and in the future will contribute to a healthier younger

population.

Pasco County has a lower rate of people that are below the average state poverty rate.

Pasco's per capita poverty rate is 13.9% compared to Floridas 16.3%. It is possible that the
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wealthier population will have a higher probability of obtaining health insurance. The higher per

capita income of Pasco County supports a healthier community.

A weakness noted in Pasco County is that it has a 10.94% per capita rate for acute

hepatitis B as compared to Florida all together per capita rate for acute hepatitis B of 1.9%. In

2005, Pascos rate was 0.71%. In 2011, the rate was 1.5%. In 2012, the rate jumped to 5.3%.

Then in 2013, the per capita rate increased to 8.19%. In 2014, the rate rose to 10.94% (Florida

Charts).

In addition, the incidence rate of smoking is Pasco County is above the state average.

Pascos rate of individuals who smoke, is 24% while Floridas per capita average smoker rate is

16.8%. It is an established fact that smoking can have detrimental effects on health. Secondhand

smoke can also cause health problems for people that do not smoke. The less smokers there are,

the healthier the population can be.

Immunizations are another factor that can affect the overall health of the population. The

percent of two-year-old children that were fully immunized in 2015 was 68.8% compared to

Floridas overall 85.5%. Immunizing children is important to a child's future health. If children

are not fully immunized by the time they reach school age, they could easily contract a disease

that is fully preventable.

Priority Health Issue

The Mobile Medical Unit in Pasco County has been giving Hepatitis B vaccines to as

many people as possible. The rate of hepatitis B is increasing at a fast pace. Pasco has the

highest rate of hepatitis B than any other county in Florida. In 2014, Pasco had a 10.9%

incidence rate of hepatitis B compared to Floridas overall incidence rate of 2.1%. Hepatitis B is

a preventable and treatable condition. Hepatitis B vaccination is highly efficient in preventing

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HBV (Hepatitis B Virus) infection and is suggested for all infants, adolescents, and adults at risk

for HBV infection. Individuals at risk would be: sexually active individuals with multiple sex

partners; homosexual men; household and sexual contacts of carries; intravenous drug users;

health care workers; haemodialysis patients; patients requiring blood; and patients with chronic

liver disease (Dooley, Lok, Burroughs, & Heathcote, 2011).

Acute HPV infection can lead to chronic HBV. Patients with chronic HBV infection are

at risk of developing cirrhosis, liver failure and hepatocellular carcinoma (Dooley et al., 2011).

A big problem with HBV infection is that most patients with chronic HBV infection will not

show symptoms until their liver disease is at an advanced stage. Dooley et al., (2011) states that

most people with chronic HBV infection will not develop these complications, but 15-40% of

these people will. Roughly 500,000 people die from chronic HBV complications every year.

At this point, it is evident that Pasco County needs to screen at-risk individuals for early

diagnosis in order to avoid severe health complications resulting from preventable HBV

infection. While it may be too late to reverse the damage by the time someone is screened,

education and vaccinations can decrease the number of individuals that contract HBV infections.

Other places in the United States have experienced Hepatitis B outbreaks and dealt with

them in similar ways. Harris et al. (2016, p. 50), responded to Hepatitis B infection outbreaks in

Kentucky, Tennessee, and West Virginia with evidence-based prevention strategies, including

increasing hepatitis B vaccination coverage, testing and linkage to care activities, and education

campaigns targeting persons who inject drugs. These strategies can be used in Pasco County to

effectively provide education, testing, and vaccinations.

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Impact of Community Health Model

The Determinants-of-Health Model helps community health nurses develop interventions

that address a population by identifying what factors are affecting an individuals health

(Truglio-Londrigan & Lewenson, 2013). Contributing factors to the priority health issue of

hepatitis B in Pasco County are lifestyle, environmental, biological, or related to healthcare.

Biological factors that contribute to the incidence of the hepatitis B virus is a mother with

hepatitis B that gives birth to a baby. This can cause the baby to have Hepatitis B and it is a non

modifiable factor (CDC, 2015). Environmental factors would be people that work in healthcare.

Healthcare workers are exposed to blood in their daily environment. Needle sticks can cause a

healthcare worker to be infected with the virus. Unvaccinated people have a 6 to 30 % chance of

contracting Hepatitis B from an accidental needle stick (CDC, 2015). Worldwide it has been

estimated that in 2000 alone, percutaneous injuries led to 66,000 cases of hepatitis B (Prss-

Ustn, Rapiti, & Hutin, 2005). Lifestyle factors would be the decision to have unprotected sex,

participating in IV drug use, or living with an infected person (Lawrence & Rosenthal, 2013).

Having knowledge of these factors will allow the nurse to develop interventions that address

these issues.

Population Diagnosis

Young adults and older adults are at risk for developing hepatitis B due to being not up to

date with vaccinations or having no knowledge about the risk factors of hepatitis B. The rate of

cirrhosis is getting worse in Pasco County. The percentage of death that have been caused by

cirrhosis of the liver in Pasco County is 16.1%. The state average is only 11.2% (Florida Charts,

2014).
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Community/Population-based Interventions

The Levels of Prevention Model includes three categories of prevention that is used to

decrease the risk of getting a certain disease or health condition. The purpose of primary

prevention is to protect the individual from the disease before it can even occur Secondary

prevention occurs when the disease is present. Screening and early treatment occur in this level

of prevention. The purpose of tertiary prevention is to avoid getting to the advanced stage of the

disease and prevent further complications. (Truglio-Londrigan & Lewenson, 2013).

Primary Level of Prevention

The community should receive education and/or vaccination. This can be done

throughout the community. Providing immunizations and reducing exposure to health risks are

interventions for the primary level of prevention (Truglio-Londrigan & Lewenson, 2013).

Education would include safe sex practices, drug use and avoidance of needle sharing, and

mother to child transmission. Condoms can protect nonimmune sex partners from acquiring

hepatitis B (CDC, 2015). Nurses and doctors could hold health fairs to reach the high-risk

populations that Hepatitis B can affect. Vaccines and educational materials could be provided to

individuals in the community. High-risk groups include mothers infected with Hepatitis B,

intravenous drug users, individuals that participate in unsafe sex, and healthcare workers (Dooley

et al., 2011). Hepatitis B vaccinations can be started at any age. Most vaccines begin in

childhood. Adults should be vaccinated if they have never received the vaccine or are in a high-

risk group.

Secondary Level of Prevention

Screening and early treatment is important to keep a disease from progressing. This can

be done on an individual basis. Screening should be done for pregnant woman so that women
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with Hepatitis B can be treated to reduce the risk of passing on the disease to their children. HB

immune globulin (HBIG) can be given at birth for babies that are at risk for Hepatitis B

(Komatsu, 2014). There is medication available that can reduce the risk for severe liver damage.

Testing for Hepatitis B is recommended for pregnant women, infants born to Hepatitis B positive

mothers, sex partners of Hepatitis B positive persons, healthcare workers, and individuals

infected with HIV (CDC, 2015). To protect the liver from further harm, Hepatitis B positive

persons should seek treatment from a provider that knows how to manage hepatitis B (CDC,

2015). Community health nurses should be able to identify risk factors for getting Hepatitis B

and provide education and screening for people. A community health nurse should ask patients if

they fall into a high-risk group and screen them for Hepatitis B. If they are positive, the nurse

could refer them to a doctor that can provide treatment options. Community health nurses could

offer free Hepatitis B vaccines at certain clinics.

Tertiary Level of Prevention

The prevention during this level should be on an individual basis with patients that have

developed chronic Hepatitis B. The nurse should evaluate the infected patient for the progression

of the infection. It is important for the nurse to assess for disease activity so that the correct

interventions can be implemented in relation to disease progression. Serological, biochemical,

and virological tests should be conducted to obtain a baseline (Rotman, Brown, & Hoofnagle,

2009). A liver biopsy would be used to find out the prognosis and monitor for the development

of hepatocellular carcinoma. Alcohol should be avoided at this time due to the negative effects

that alcohol has on the liver. Treatment programs can be offered if treatment is needed for

alcohol abuse.
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Development of Health Policy

Health policies have a big effect on the health of the community. Health policies work

with healthcare to make goals and develop interventions to improve the health of the whole

community. Decrease the incidence of Hepatitis B in young adults and older adults in Pasco

County will be the focus of this health policy. Primary prevention should be the focus to achieve

this goal. By preventing the disease, the transmission will be decreased. Health classes could

educate students about Hepatitis B and the risk factors. Students may possibly tell their parents

and maybe their parents will be motivated to be vaccinated. These students have already been

vaccinated but they can help decrease the incidence of Hepatitis B with education. Health

education in school could include sex education, the risk of AIDS, the dangers of drug use and

smoking, and the benefits of a healthy diet, and the delivery of other adolescent vaccines,

including meningococcal vaccine and human papillomavirus vaccine (Lawrence & Rosenthal,

2013). Health care providers will need to suggest hepatitis B vaccination if the child has not been

vaccinated in childhood. Health fairs could help educate the whole community and provide a

place where nurses and doctors could identify high-risk individuals and provide them with

resources. It will be difficult for people to admit that they are in the high-risk category because of

the intravenous drug use and sexual context. Public officials could provide free vaccinations to

the community in case people refused the vaccination in the past due to cost. The Department of

Health in Pasco County has vaccinations and nurses available that can go out into the community

to offer free vaccinations. Nurses could be stationed at mobile medical units and doctor offices to

reach as much of the community as possible. To get this policy started, it is important that the

schools educate students about hepatitis B and the risk factors. By decreasing the incidence of
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hepatitis B, the community will have a reduced risk of liver cancer, cirrhosis, and other

complications.

Conclusion

Hepatitis B is a vaccine preventable disease. By getting vaccinated, people will not have

an increased risk of liver cancer and cirrhosis. There are many risk factors that can contribute to

the acquisition of hepatitis B. High-risk individuals would be; sexually active individuals with

multiple sex partners; homosexual men; household and sexual contacts of carriers; intravenous

drug users; health care workers; patients requiring blood; and patients with chronic liver disease

(Dooley et al., 2011). Pasco County has a high rate of hepatitis B and the rate is getting

increasingly worse. A way to prevent the communitys rate of hepatitis B to increase would be to

focus on vaccination. It would be beneficial to vaccinate before the risky behaviors that can lead

to hepatitis B begins.

At my community site, I see many patients with Hepatitis B. It is getting so bad that the

health department is getting involved closely with the mobile medical unit in order to reduce the

incidence of Hepatitis B in any way. Patients do not know if they have Hepatitis B or do not

know how to avoid transmitting the virus. Education has helped the community immensely. It

keeps community members safe by educating patients about the risks and transmission and it

keeps healthcare workers like myself safe. We do blood sugar checks and blood draws all the

time and we may not know if our patients Have hepatitis B. The free vaccinations from the

health department do not come as often as they should. It would be great for vaccinations to be

available everywhere in the community.

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References

Dooley, J. S., Lok, A. S., Burroughs, A. K., & Heathcote, J. (Eds.). (2011). Sherlock's diseases

of the liver and biliary system (12th ed.). Chichester, West Sussex: Blackwell Publishing.

Florida Charts. (n.d.). Retrieved September 18, 2016, from floridacharts.com/charts/QASpecial

Harris, A. M., Iqbal, K., Schillie, S., Britton, J., Kainer, M. A., Tressler, S., & Vellozzi, C. (2016,

January 29). Increases in Acute Hepatitis B Virus Infections Kentucky, Tennessee,

and West Virginia, 20062013. Morbidity and Mortality Weekly Report, 65(3), 47-50.

http://dx.doi.org/10.15585/mmwr.mm6503a2

Komatsu, H. (2014). Hepatitis B virus: Where do we stand and what is the next step for

eradication? World Journal of Gastroenterology: WJG, 20(27), 89989016.

http://doi.org/10.3748/wjg.v20.i27.8998

Largest Employers. (n.d.). Retrieved October 20, 2016, from http://www.pascoedc.com

Lawrence, S., & Rosenthal, S. (2013). Hepatitis B Virus Infection In Sexually Transmitted

Diseases 2nd edition (pp. 353-368). London: Elsevier

Luhby, T. (2013, April 26). Millions can't afford to go to the doctor. Retrieved September 28,

2016, from http://money.cnn.com/2013/04/26/news/economy/health-care-cost/

Prss-Ustn, A., Rapiti, E., & Hutin, Y. (2005, November 18). Estimation of the global burden

of disease attributable to contaminated sharps injuries among health-care workers.

American Journal of Industrial Medicine, 48(6), 482-290. doi:10.1002/ajim.20230

Rotman, Y., Brown, T. A., & Hoofnagle, J. H. (2009). Evaluation of the Patient with Hepatitis B.

Hepatology (Baltimore, Md.), 49(5 Suppl), S22S27. http://doi.org/10.1002/hep.22976

Truglio-Londrigan, M., & Lewenson, S. (2013). Public health nursing: Practicing population-

based care. Burlington, MA: Jones & Bartlett Learning

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U.S. Census Bureau. (2016, October 20). Quickfacts: Pasco County, FL. Retrieved October 20,

2016, from http://www.census.gov/quickfacts/table/PST045215/12101

Viral Hepatitis - Hepatitis B Information. (2015). Retrieved from

http://www.cdc.gov/hepatitis/hbv/index.htm