1. Hepatitis B What You Need To Know

2. Hepatitis B and AA & NHOPIs Seattle-King County Refugee Data
What is the Liver?
What is Hepatitis B?
Transmission
Global/Local Impact
Hepatitis B and AA & NHOPIs
Seattle-King County Refugee Data
Test, vaccinate, treat!
Living with Chronic Hepatitis B
FAQ
Resources

3. What is the Liver? Where is the liver? What does it do?
Cleans your blood
Helps you digest food
Helps your body fight infections
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4. What is Hepatitis? “Hepatitis” = liver inflammation Hepatitis A
Hepatitis B
Hepatitis C
Cause
Hepatitis A virus (HAV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Most Common Modes of Transmission
Eating or drinking food or water that has been contaminated by an infected person’s stool
Mother to child
transmission
during childbirth
Unprotected sex with an infected person
Exposure to blood on contaminated needles or medical equipment
Exposure to blood on other things like toothbrushes and razors
Vaccine Available
Yes No
“Hepatitis” = liver inflammation
Briefly go over hepatitis A, B, and C

5. How is Hepatitis B Spread?
From a mother passing the hepatitis B virus to their baby during birth

6. How is Hepatitis B Spread?
By having unprotected sex with a person who has the hepatitis B virus
By using unsterilized needles for tattoos, body piercings, injection drug use, or acupuncture
By sharing shaving razors, toothbrushes, or other personal items that may come into contact with blood

7. How Hepatitis B is NOT Spread
It is NOT spread from hugging, holding hands, sharing food, breastfeeding, kissing, or living with an infected person

8. Acute vs. Chronic Hepatitis B
Acute: initial infection with the hepatitis B virus
Chronic: the hepatitis B virus remains in the blood for more than 6 months
The younger a person is first exposed to the hepatitis B virus, the more likely they’ll develop chronic hepatitis B1
Percent of Acute Hepatitis B Cases Developing Chronic Hepatitis B 2
Infants
90%
Children
50%
Adults
5-10%
Stress the importance of preventing at an early age!
1 Asian Liver Center. FAQ about Hepatitis B. Available at: Accessed Jan
2 Hepatitis B Foundation. Acute vs. Chronic Hepatitis B. Available at: Accessed Jan

9. Why Do We Care About Chronic Hepatitis B?
Liver cirrhosis
Liver failure
Liver cancer
25% of those with chronic hepatitis B end up with liver cirrhosis and/or cancer without proper management
60-80% of primary liver cancer worldwide is caused by chronic hepatitis B1
1Asian Liver Center. FAQ about Hepatitis B. Available at: Accessed Jan

10. Chronic Hepatitis B is a Silent Threat
Half of all people with chronic hepatitis B show no symptoms1
People who have the hepatitis B virus may infect others without knowing it
People often find out they have the hepatitis B virus after they get really sick, when it’s usually too late or difficult to treat the infection
There is no cure, but there are effective treatments available
Transition into global and local impact to explain why we’re focusing on hepatitis B in this presentation
1 Centers for Disease Control and Prevention. Hepatitis B. Available at: Accessed May 21, 2004.

11. Hepatitis B is Serious – Global Impact
It’s a common disease!
Over 350 million people in the world have chronic hepatitis B1
Refer to map as visual. Although the U.S. is green, hepatitis B is important because of the large immigrant and refugee populations in the states
1 Centers for Disease Control and Prevention. Hepatitis B FAQs for Health Professionals. Available at:
Accessed January 28, 2010.
2 World Health Organization. Hepatitis B. Available at:
Accessed June 1, 2004.

12. Hepatitis B is Serious – Global Impact
Chronic hepatitis B is one of the top 10 causes of death worldwide1
The hepatitis B virus is 100 times more infectious than HIV2
1 Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures.J Viral Hepatitis. 2004;11:
2 Hepatitis B Foundation. Hep B Statistics. Available at: Accessed December 29, 2009.

13. Hepatitis B is Serious – U.S.
Chronic hepatitis B causes 4,000 to 5,500 deaths a year in the U.S.1
Hepatitis B in the United States2
Percent Ever Infected (acute & chronic)
4.3% - 5.6%
Number of Persons Living with Chronic Infection
800,000 – 1.4 million persons
Annual Number of Chronic Liver Disease Deaths associated with Viral Hepatitis
3,000
1 Centers for Disease Control and Prevention. Hepatitis B and the vaccine. Available at: hepb/q&a.htm. Accessed June 1, 2004.
2 Centers for Disease Control and Prevention. Available at Accessed February 20, 2010.

14. Hepatitis B and AA & NHOPIs
AA & NHOPIs account for
78% of the 350 million people worldwide with chronic
hepatitis B1
More than 50% of the chronic hepatitis B cases in the U.S. (estimated 750,000)2
1 in 10 AA & NHOPIs in the United States are positive for chronic hepatitis B1
Asians have the highest liver cancer rates of any ethnic group3
What is the impact of hepatitis B on Asian Americans?
Even though people of Asian descent make up only 4 percent of the population of the United States, they account for more than half of all cases of chronic hepatitis B in this country.1,2
Since most Asian Americans with chronic hepatitis B are infected during childhood, 1 in 4 will develop cirrhosis or liver cancer.2
Liver cancer is much more common in Asian Americans than in Caucasian Americans.
6 times more common in Chinese American males1
8 times more common in Korean American males1
13 times more common in Vietnamese American males1
Because Asians are usually infected as babies or young children, they tend to develop liver cancer at a younger age -- usually in their 30s and 40s.3
The risk of liver cancer is the biggest health difference between Asian Americans and Caucasian Americans.2
1 Asian Liver Center at Stanford University. Statistics. Available at:
lang=eng&page=statistics. Accessed June 1, 2004.
2 Asian Liver Center at Stanford University. Hepatitis B in Asian Americans. Available at:
stanford.edu/index2asp?lang=eng&page=hepinasians. Accessed June 1, 2004.
3 Nguyen MH, Keeffe EB. Chronic hepatitis B and hepatitis C in Asian Americans. Rev Gastroenterol
Disord. 2003;3:
*Relocate. Include slide for non-APIs and other high-risk groups.
1 Stanford School of Medicine. Hep B Education FAQ. Available at:
2 Asian Liver Center at Stanford University. Hepatitis B in Asian Americans. Available at: Accessed June 1, 2004.
3 International Agency for Research on Cancer. GLOBOCAN Available at: Accessed June 1, 2004.

15. Hepatitis B in Washington State
15,296 cases of chronic hepatitis B were reported between Dec 2000-September 20081
King County (64%)
Snohomish County (7%)
Pierce County (7%)
1272 new chronic hepatitis B cases are reported annually1
More than 28,000 Washingtonians are currently living with chronic hepatitis B2
These numbers may be underestimates due to barriers (lack of access to testing, inconsistent reporting practices by health care providers)
The county rates may be influenced by various factors (extent of resources dedicated to hepatitis B surveillance, actual prevalence, demographics, etc)
WithinReach Hep B Screening Data –
Between September 2006 – September 2008, 574 unduplicated API individuals (Chinese, Korean, Vietnamese, Cambodian, and Filipino) in King, Pierce, and Snohomish counties) were tested for HBV
32.2% (n=185) of this sample needed vaccination,
55.4% (n=318) people were protected either by vaccination or resolved infection
8.7% (n=50) needed retesting
3.7% (n=21) were chronically infected (surface antigen positive)
1 Washington State Department of Health. Washington State Chronic Hepatitis B and Chronic Hepatitis C Surveillance Report.
Available: Accessed Jan
2 communication from DOH Public Health staff

16. Hepatitis B and Refugees (Seattle-King County)
The four largest refugee communities in were from Bhutan (29%), Burma/Myanmar (24%), former USSR (12%), and Iraq (12%)1
Health screenings include but is not limited to testing for hepatitis B
1 Public Health – Seattle & King County – Refugee Health Screening Report

17. Hepatitis B and Refugees (Seattle-King County)
Near East/South Asia
Caribbean/
Latin America
Africa
Soviet Union/
East Europe*
Other
SE Asia
Caribbean/
Latin America
Africa
Soviet Union/
East Europe*
Other
SE Asia
Near East/South Asia
A greater percentage of refugees came from the Near East/South Asia region in 2009
A smaller percentage of refugees came from the Soviet Union/East Europe region in 2009
Note that While 25% and 12% of the refugees were from Soviet Union/East Europe in 2008 and 2009 respectively, these communities were not tested for hepatitis B during their health screenings
Check on another computer – do the percentages overlap in the charts?
*CDC recommends testing refugees from countries with a prevalence of HBsAG+ of 2% or greater. Eastern European refugees are not screened.
1 Public Health – Seattle & King County – Refugee Health Screening Report

18. Hepatitis B and Refugees (Seattle-King County)
Number of Hepatitis B Positive Cases by Country (2008)
Country
No. Positive Cases (HBsAG+)
No. Screened Cases
Percent Positive (HBsAG+)
Burma/Myanmar 24
263
9.1%
Somalia 5
111
4.5%
Eritrea 2 19
10.5%*
Burundi 11
18.2%*
Iraq
117
1.7%
Total 35
(2.93% of total cases screened)
521
Some of the denominators may be too small to draw accurate conclusions about percentages/rates
*No. screened may be too small to draw accurate conclusions
Public Health – Seattle and King County

19. Hepatitis B and Refugees (Seattle-King County)
Number of Hepatitis B Positive Cases by Country (2009)
Country
No. Positive Cases (HBsAG+)
No. Screened Cases
Percent Positive (HBsAG+)
Burma/Myanmar 20
358
5.6%
Somalia 9
118
7.6%
Bhutan 3
446
0.7%
Iraq 2
175
1.1%
Vietnam 17
11.8%*
Eritrea 1 82
1.2%
Ethiopia 18
5.6%*
Total 38
(2.49% of total cases screened)
1214
*No. screened may be too small to draw accurate conclusions
Public Health – Seattle and King County

20. Protect Yourself And Your Family!
Hepatitis B can infect EVERYONE, regardless of age
By getting tested and vaccinated, you can protect your family
If you test positive, ask your doctor about your treatment/management options
Prevention is the best approach to hepatitis B.

21. Importance of Testing
The only way to know if you are infected with the hepatitis B virus is to get tested!
Not all routine blood panels test for hepatitis B
- Ask your doctor for the tests specific to chronic hepatitis B
People of all ages should be tested, especially if you’re from areas of high prevalence
Early detection can help:
- Prevent spread of the hepatitis B virus
- Identify appropriate treatment options
- Reduce risk for developing liver cancer

22. Importance of Prevention
The most effective means of preventing hepatitis B infection is through vaccination!
Children born before 1992 in the U.S. and those born overseas probably did not receive the vaccine
You need all 3 shots to be protected
It is okay to finish the last shot at anytime after 6 months from the 1st shot
1st shot –
at any time
2nd shot –
1 month
after the 1st
3rd shot –
6 months

23. Importance of Prevention
Other ways to prevent exposure to the hepatitis B virus include:
Receiving vaccination at birth
Practicing protected sex
NOT sharing needles or personal care items that may come into contact with blood (toothbrushes, razors, etc)
Knowing your status!

24. Living with Chronic Hepatitis B
Chronic hepatitis B requires management, just like diabetes!
Ask your doctor about…
Getting regular blood tests
Whether or not you need treatment or ultrasounds
Be informed!
Understand your test results
Get the hepatitis B vaccine
Avoid drinking alcohol and smoking
Help prevent transmission to others
Talk to your friends and family!
Make sure your loved ones have been tested and vaccinated
Develop a support system for yourself
ALT (Alanine transaminase) to test for liver damage and AFP (alpha-fetoprotein) to screen for liver cancer.
Get help: Not all people chronically infected with hepatitis B need treatment. However, if your blood levels of ALT are elevated ongoing liver damage may be occurring. Appropriate management can reduce the risk of further liver damage and liver cancer.
Get Informed: People chronically infected with hepatitis B can enjoy completely normal lives, but need to take some necessary precautions. To prevent transmission to others, do not share toothbrushes, razors, injection or tattoo needles because they may be tainted with blood. Also, ensure that all members of your household are tested and vaccinated if they are not already immunized. If you are uncertain whether your partner is protected, the proper use of latex condoms is recommended. Pregnant women infected with hepatitis B must make sure the newborn receives hepatitis B immunoglobulin (HBIG) plus the first dose of the hepatitis B vaccine at birth, and then follow-up with the second dose at 1-2 months, and the third dose at 6 months. This will be 97% effective in protecting the newborn from becoming a carrier. Take control of your own health, learn about the management and treatments available for hepatitis B. Don't be fooled by advertisements for unproven methods of prevention and treatment.
Asian Liver Center. For Hepatitis B and Liver Cancer Patients. Available at:
Accessed Jan

25. There is Treatment for Chronic Hepatitis B!
Pills, shots, or a combination of both
Not everyone with chronic hepatitis B needs treatment immediately
If you have hepatitis B, you should see your family doctor, who can refer you to a specialist if needed
Treatment with either lamivudine, adefovir or entecavir (a pill taken once a day) or a course of interferon shots may be appropriate in this situation. These are the only four FDA-approved pills for chronic hepatitis B.

26. Frequently Asked Questions (FAQ)
Why is hepatitis B more common in some places than in others?
Infected mothers often unknowingly pass on the virus to their children. Unfortunately, most countries do not have the money to provide vaccines to babies at birth, making hepatitis B more common in some places.
How long does the hepatitis B virus survive outside of the body?
The hepatitis B virus can live for 7 days outside of the body.
I already got tested/vaccinated when I immigrated to the U.S. Do I still need to get tested again?
Yes, another test may be necessary. Different countries have different policies about hepatitis B so we can’t be sure you received the test or vaccination. Knowing your status is important!

27. Frequently Asked Questions (FAQ)
My doctor already tested my blood during my checkup. Shouldn’t that be enough?
No, typical routine blood tests usually don’t include the hepatitis HBsAg and anti-HBs tests needed to test for chronic hepatitis B. Having your blood drawn does not guarantee you were tested! Please double check with your doctor.
I am chronically infected with the hepatitis B virus. Do I still need a vaccine?
No, vaccines are only effective for those who have not yet been exposed to the hepatitis B virus. You do not need a vaccine if you are chronically infected.
What does it mean when I’m a carrier?
Being a carrier means you are chronically infected with hepatitis B and can transmit the virus to others.

28. Frequently Asked Questions (FAQ)
What are the common signs/symptoms of hepatitis B?

29. If an infected person does have symptoms, they might include:

30. Resources Hepatitis B Coalition of Washington - http://www.hepbwa.org/
WithinReach -
Association of Asian Pacific Community Health Organizations -
Hepatitis B Facts - m
Hepatitis B Foundation -
Asian and Pacific Islander American Health Forum -
Add: Studies Chia is involved in. Testing site list.

31. Resources
International Community Health Services (ICHS) -

32. Acknowledgements
This presentation was inspired in part by 26 community conversations (18 Talking Circles and 8 one-on-one interviews) with community members and organizations in Washington state
Additionally, staff and volunteers from the Hepatitis B Coalition of Washington State and International Community Health Services, including AmeriCorps team members contributed to this presentation.

33. Questions?? Hepatitis B