2 Hepatitis B and AA & NHOPIs Seattle-King County Refugee Data What is the Liver?What is Hepatitis B?TransmissionGlobal/Local ImpactHepatitis B and AA & NHOPIsSeattle-King County Refugee DataTest, vaccinate, treat!Living with Chronic Hepatitis BFAQResources
3 What is the Liver? Where is the liver? What does it do? Cleans your bloodHelps you digest foodHelps your body fight infectionsPicture does not appear unless you click with the mouse.
4 What is Hepatitis? “Hepatitis” = liver inflammation Hepatitis A Hepatitis BHepatitis CCauseHepatitis A virus (HAV)Hepatitis B virus (HBV)Hepatitis C virus (HCV)Most Common Modes of TransmissionEating or drinking food or water that has been contaminated by an infected person’s stoolMother to childtransmissionduring childbirthUnprotected sex with an infected personExposure to blood on contaminated needles or medical equipmentExposure to blood on other things like toothbrushes and razorsVaccine AvailableYesNo“Hepatitis” = liver inflammationBriefly 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 virusBy using unsterilized needles for tattoos, body piercings, injection drug use, or acupunctureBy 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 virusChronic: the hepatitis B virus remains in the blood for more than 6 monthsThe younger a person is first exposed to the hepatitis B virus, the more likely they’ll develop chronic hepatitis B1Percent of Acute Hepatitis B Cases Developing Chronic Hepatitis B 2Infants90%Children50%Adults5-10%Stress the importance of preventing at an early age!1 Asian Liver Center. FAQ about Hepatitis B. Available at: Accessed Jan2 Hepatitis B Foundation. Acute vs. Chronic Hepatitis B. Available at: Accessed Jan
9 Why Do We Care About Chronic Hepatitis B? Liver cirrhosisLiver failureLiver cancer25% of those with chronic hepatitis B end up with liver cirrhosis and/or cancer without proper management60-80% of primary liver cancer worldwide is caused by chronic hepatitis B11Asian 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 symptoms1People who have the hepatitis B virus may infect others without knowing itPeople 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 infectionThere is no cure, but there are effective treatments availableTransition into global and local impact to explain why we’re focusing on hepatitis B in this presentation1 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 B1Refer to map as visual. Although the U.S. is green, hepatitis B is important because of the large immigrant and refugee populations in the states1 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 worldwide1The hepatitis B virus is 100 times more infectious than HIV21 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.1Hepatitis B in the United States2Percent Ever Infected (acute & chronic)4.3% - 5.6%Number of Persons Living with Chronic Infection800,000 – 1.4 million personsAnnual Number of Chronic Liver Disease Deaths associated with Viral Hepatitis3,0001 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 for78% of the 350 million people worldwide with chronichepatitis B1More than 50% of the chronic hepatitis B cases in the U.S. (estimated 750,000)21 in 10 AA & NHOPIs in the United States are positive for chronic hepatitis B1Asians have the highest liver cancer rates of any ethnic group3What 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.1,2Since most Asian Americans with chronic hepatitis B are infected during childhood, 1 in 4 will develop cirrhosis or liver cancer.2Liver cancer is much more common in Asian Americans than in Caucasian Americans.6 times more common in Chinese American males18 times more common in Korean American males113 times more common in Vietnamese American males1Because 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.3The risk of liver cancer is the biggest health difference between Asian Americans and Caucasian Americans.21 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 GastroenterolDisord. 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 20081King County (64%)Snohomish County (7%)Pierce County (7%)1272 new chronic hepatitis B cases are reported annually1More than 28,000 Washingtonians are currently living with chronic hepatitis B2These 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 HBV32.2% (n=185) of this sample needed vaccination,55.4% (n=318) people were protected either by vaccination or resolved infection8.7% (n=50) needed retesting3.7% (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 Jan2 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%)1Health screenings include but is not limited to testing for hepatitis B1 Public Health – Seattle & King County – Refugee Health Screening Report
17 Hepatitis B and Refugees (Seattle-King County) Near East/South AsiaCaribbean/Latin AmericaAfricaSoviet Union/East Europe*OtherSE AsiaCaribbean/Latin AmericaAfricaSoviet Union/East Europe*OtherSE AsiaNear East/South AsiaA greater percentage of refugees came from the Near East/South Asia region in 2009A smaller percentage of refugees came from the Soviet Union/East Europe region in 2009Note 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 screeningsCheck 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)CountryNo. Positive Cases (HBsAG+)No. Screened CasesPercent Positive (HBsAG+)Burma/Myanmar242639.1%Somalia51114.5%Eritrea21910.5%*Burundi1118.2%*Iraq1171.7%Total35(2.93% of total cases screened)521Some of the denominators may be too small to draw accurate conclusions about percentages/rates*No. screened may be too small to draw accurate conclusionsPublic Health – Seattle and King County
19 Hepatitis B and Refugees (Seattle-King County) Number of Hepatitis B Positive Cases by Country (2009)CountryNo. Positive Cases (HBsAG+)No. Screened CasesPercent Positive (HBsAG+)Burma/Myanmar203585.6%Somalia91187.6%Bhutan34460.7%Iraq21751.1%Vietnam1711.8%*Eritrea1821.2%Ethiopia185.6%*Total38(2.49% of total cases screened)1214*No. screened may be too small to draw accurate conclusionsPublic Health – Seattle and King County
20 Protect Yourself And Your Family! Hepatitis B can infect EVERYONE, regardless of ageBy getting tested and vaccinated, you can protect your familyIf you test positive, ask your doctor about your treatment/management optionsPrevention is the best approach to hepatitis B.
21 Importance of TestingThe 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 BPeople of all ages should be tested, especially if you’re from areas of high prevalenceEarly 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 vaccineYou need all 3 shots to be protectedIt is okay to finish the last shot at anytime after 6 months from the 1st shot1st shot –at any time2nd shot –1 monthafter the 1st3rd shot –6 months
23 Importance of Prevention Other ways to prevent exposure to the hepatitis B virus include:Receiving vaccination at birthPracticing protected sexNOT 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 testsWhether or not you need treatment or ultrasoundsBe informed!Understand your test resultsGet the hepatitis B vaccineAvoid drinking alcohol and smokingHelp prevent transmission to othersTalk to your friends and family!Make sure your loved ones have been tested and vaccinatedDevelop a support system for yourselfALT (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 bothNot everyone with chronic hepatitis B needs treatment immediatelyIf you have hepatitis B, you should see your family doctor, who can refer you to a specialist if neededTreatment 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 - mHepatitis B Foundation -Asian and Pacific Islander American Health Forum -Add: Studies Chia is involved in. Testing site list.
31 ResourcesInternational Community Health Services (ICHS) -
32 AcknowledgementsThis 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 stateAdditionally, staff and volunteers from the Hepatitis B Coalition of Washington State and International Community Health Services, including AmeriCorps team members contributed to this presentation.