1. Hepatitis B in People of African Origin
An Educational Resource

2. Hepatitis B in People of African Origin
Today’s Agenda
Hepatitis B
About the virus
Disease burden
Prevention and management

3. Hepatitis B

4. Why are we talking about hepatitis B?
Hepatitis B is very common among African immigrants
Most people who are infected are not aware
The disease continues to spread, but it can be prevented and treated

5. What is my liver? A large and important organ in your body
Lies behind the lower-right part of your ribs

6. What does the liver do? Regulates the body’s energy Helps digest food
Builds muscle
Produces blood clotting factors
Breaks down toxins
Stores vitamins and minerals
Helps fight infections
Helps process
drugs

7. What is hepatitis? Inflammation of the liver
Causes: viruses, obesity, alcohol
Some common hepatitis viruses are hepatitis A, B, and C
The only thing they have in common is that they can infect the liver!
Hepatitis can lead to scarring of the liver (fibrosis, cirrhosis), liver cancer, and liver failure
Image from web search

8. What is hepatitis B virus (hep B)?
Cause of the most common and most serious liver infection in the world
Can cause acute (short-lived) or chronic (long-term) infection
There is no cure for chronic hep B, but there are treatments!
Hep B is preventable with a safe and effective vaccine

9. What are acute and chronic hep B?
The first 6 months after someone is exposed to hep B
Chronic
When the hep B remains in the person’s body for over six months

10. Who has chronic hep B?
About 2 million people living in the US have chronic (lifelong) hep B infection
People from Africa or Asia are much more likely to have hep B infection
People with hep B might not look or feel sick
People who have chronic hep B infection can spread the virus B to others, even if they feel well
CDC. Viral hepatitis statistics & surveillance. Accessed October 22, 2014.
Kowdley KV et al. Hepatology. 2012;56(2):

11. High infection rates in Africa!
Where is hep B found?
Worldwide:
2 billion infections (1/3 of all people)
High infection rates in Africa!

12. How do you get hep B? From mother to child Sexual transmission
During the labor and delivery process due to blood exchange
Most common route worldwide
Sexual transmission
Direct blood contact
Sharing needles; piercing; tattooing
Unsterile medical equipment
Household contact— sharing razors, toothbrushes, earrings, or nail clippers with an infected person
Traditional scarification or circumcision
Hepatitis B is NOT transmitted by hugging; coughing; sneezing; urine; tears; breast milk; eating food prepared by an infected individual; sharing utensils, cups, or bowls; or casual contact.

13. What are the symptoms? 70% of infected individuals have NO symptoms
The other 30% might have:
Fever
Tiredness
Loss of appetite
Abdominal pain
Diarrhea
Dark urine
Light-colored stools
Jaundice (yellow skin and eyes)
Photo from web and CDC
Not everyone has symptoms. A person can still have liver damage or pass the virus to others even without symptoms.

14. What happens with chronic hep B?
Hep B infection causes up to 700,000 deaths each year across the globe
Hep B-related deaths are primarily due to:
Cirrhosis (scarring of the liver)
Primary liver cancer
Liver failure
Up to 25% of chronically infected individuals can die early from hep B-related liver disease.

15. Do African immigrants have hep B?
In some African communities in the US, between 5% and 18% of people have chronic hep B
Most do not know that they are infected
This is due to the silent nature of the disease, lack of disease awareness, and lack of testing for hep B
Not knowing your status puts you at a much greater risk for cirrhosis or liver cancer if you are infected!

16. Why haven’t I heard about hep B?
Because it is difficult to collect health information in many areas of Africa, the entire epidemic is not well understood
Nevertheless, it is estimated that there are more than 50 million people chronically infected in Africa
12 million will die prematurely from hep B-related liver disease
Most infections are acquired in childhood (under 5 years)

17. How can we prevent hep B infection?
Get tested for hep B
Get vaccinated against hep B
The 3-dose vaccine is safe and effective
It will prevent someone from getting hep B if they are not already infected
If you are infected, seek testing and vaccines for children and close family members
Spread the word about the importance of being tested!

18. Is hep B treatable? Yes. There is no cure, but there are treatments
The treatments, taken as a daily pill, slow down the virus in the blood and can help prevent liver damage— great news!
Every infected person needs routine care by a knowledgeable provider
This includes regular (every 6 to 12 months) checkups to look at liver health and how much virus there is and to screen for liver damage and liver cancer

19. Meet Olu
Olu is 32-year old man who immigrated from Nigeria 4 years ago
He has not seen a doctor since arriving in the U.S.
He attends a health fair and takes a simple blood test for hepatitis B
Two weeks later, he receives a letter in the mail informing him that he tested positive for chronic hepatitis B

20. Meet Olu Olu just received his test results in the mail
He had no symptoms and was not aware of anyone in his family having hepatitis
Not knowing much about hepatitis, he put the results away to research later
The health care workers from the fair contact Olu through the local African community center
They explain the long-term outcomes of hep B, and the options for care and treatment
Olu does not have insurance, but the health workers connect him with a local free clinic for his first appointment

21. Meet Olu
Olu does not need treatment today, but he does need regular follow-up appointments to make sure his liver remains healthy
He also needs to take care of his liver by eating better, resting more, and avoiding alcohol
Olu brings in his family to be tested for hep B and vaccinated, if necessary
Olu schedules his next appointment for six months later
Now that Olu knows his status, he can take better care of himself and his family members.

22. How can I be tested?
Most doctors do not screen their high-risk patients for hepatitis B because they are not aware of the risks
If you or your parents come from Africa, you should ask to be tested
If you don’t have a doctor, visit the website for the Health Resources and Services Administration (HRSA) :
Or talk to us about getting tested at a local health event or local health clinic
Photo from CDC pamphlet
The HRSA site will help people get into the health system. They will also take people who are uninsured or undocumented.
By knowing your status, you can stay healthy and get treatment if you need it!

23. Thank you!