2. What is hepatitis B? Hepatitis B is a virus that infects the liver.

3. Liver: “King of Organs” Largest solid organ Performs many important functions Breaks down and storage of fats and sugars Detoxifies (cleans) body all drugs, alcohol and toxins are processed by the liver!

4. Why does hepatitis B matter? Can lead to serious liver illness Scarring Liver cancer Liver failure It is contagious (can be given to others) 100X more infectious than HIV

5. Fastest growing racial population in the US in terms of percentage growth 3.7 million in 1980 15.2 million* in 2006 About 66% are foreign born C alifornia 4.5 million API 1 in 8 Californians is API Potentially 360,000 with chronic HBV Without diagnosis and treatment, up to 80,000 API in CA will die of liver disease or liver cancer*including part-APIs

6. Hepatitis B is one of the most neglected pandemics One in 20 people (350 million) worldwide have chronic HBV infection – (Compare with 33 million living with HIV) Without appropriate treatment or monitoring – As many as 1 in 4 will die of liver cancer, cirrhosis or liver failure

7. Hepatitis B Is a Global Problem 7  8% =High* 2-7% =Intermediate* <2% =Low Adapted from: Centers for Disease Control and Prevention. Morb Mortal Wkly Rep. 2008;57:1-16. *Individuals born in locations with intermediate or high prevalence should be routinely screened for HBV infection Prevalence of HBV Infection*

8. Hepatitis B is One of the Most Neglected Global Epidemics 1 CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htmwww.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm 2.WHO. Available at: www.who.int/csr/disease/hepatitis/en/ 1 out of every 10 Asian Americans has hepatitis B

9. 9 Untreated Hepatitis B Can Cause Liver Cancer Hepatitis B virus is second only to tobacco smoke in causing cancer deaths globally Liver cancer caused by chronic hepatitis B is the 2 nd leading cause of cancer death for Asian men in the US The incidence of liver cancer is 9 times higher in Asian American men than their white counterparts Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009. Hepatitis B-Associated Liver Cancer Destroying Normal Liver Image from netterimages.com

10. 10% of Asians, including Asian-Americans, affected compared to 0.1% of US general population Especially High Risk Populations: Filipino – 1 in 6 Vietnamese - 1 in 8 Chinese - 1 in 10 Korean - 1 in 12

11. Transmission Revisited Birth Blood Sex Toothbrushes Cuts / Wounds Mother to Child

12. Vertical Transmission (Mother to Child) Most Asians with Chronic Hepatitis B Were Infected at Birth or Early Childhood 1 12 Razors/ Needles Unprotected Sexual Contact with HBV+ Transfusion/ Organ Transplant Other Routes of Transmission Include 2 Contact with Infected Fluids 1.Lin SY, et al. Hepatology. 2007;46:1034-1040. 2.Centers for Disease Control and Prevention. Hepatitis B FAQs. http://www.cdc.gov/print.do?url=http%3A//www.cdc.gov/hepatitis/B/bFAQ.htm%23overview. Accessed April 1, 2009. 12

13. Clarifying Myths About Transmission of Hepatitis B Not Hepatitis B is Not Transmitted by Sharing Food, Water, Utensils, Glasses MosquitoesTears, Sweat, Urine, or Stool 13 Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.

14. 14 Clarifying Myths About Transmission of Hepatitis B I’m Too Young to Be Tested WRONG! I’m Too Old to Be Tested WRONG! Hepatitis B Can’t Be Treated WRONG! Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.

15. 15 Clarifying Myths About Transmission of Hepatitis B Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009. If I Have it, I’d Have Symptoms WRONG! I Was Diagnosed Years Ago so I Shouldn’t Worry WRONG! Hepatitis B Can’t Be Prevented WRONG, HBV can be prevented with vaccination!

16. How do I know if I have hepatitis B? A simple blood test is the only way to be sure Most people do not experience any symptoms until it is too late! 70% of people with chronic hepatitis B have no symptoms

17. Blood Test Results Hepatitis B Surface Antigen (HBsAg) POSITIVE (+) result means: you have hepatitis B NEGATIVE (-) result means: you do NOT currently have hepatitis B Hepatitis B Surface Antibody (Anti-HBs) POSITIVE (+) result means: you are protected against hepatitis B NEGATIVE (-) result means: you are NOT protected Two tests are used to determine hepatitis B status

18. What next? It depends on what your test results are! Hepatitis B Surface Antigen POSITIVE (+) You have hepatitis B Next Step: Follow up with your doctor now to get regular monitoring Hepatitis B Surface Antibody NEGATIVE (-) You are not protected from hepatitis B Next Step: Begin the 3 dose hepatitis B vaccine series now Hepatitis B Surface Antibody POSITIVE (+) You are protected from hepatitis B Next Step: Encourage your friends and family to get tested!

19. Tell me more about the vaccine Hepatitis B vaccine Complete 3 shots in six months for life-long protection 12 3

20. What if I have chronic hepatitis B? Get regular check-ups with your doctor Eat healthy Avoid alcohol Tell your doctor which over-the-counter medications or herbal supplements you take Protect others by preventing blood contact Tell your family to get tested or vaccinated

21. Global Need A Comprehensive Strategy to Prevent and Control Hepatitis B Prevent new infections Vaccination Safe injections Education Early detection, education and access to treatment for persons who are chronically infected to reduce– Mortality and morbidity risks Socio-economic burden caused by premature death Transmission to unprotected persons

22. San Mateo Hep B Free 1 CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htmwww.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm 2.WHO. Available at: www.who.int/csr/disease/hepatitis/en/ CAMPAIGN GOALS To create public and healthcare provider awareness about the importance of testing & vaccinating Asian Pacific Islanders (API) for hepatitis B. To promote routine hepatitis B testing and vaccination within the primary care medical community. To ensure access to treatment for chronically infected individuals.

23. San Mateo Hep B Free 1 CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htmwww.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm 2.WHO. Available at: www.who.int/csr/disease/hepatitis/en/ HBV is common in our community HBV infection is quick and easy to detect; all you need is a simple blood test for HBsAg If you do not have hepatitis B, you should get vaccinated If you have hepatitis B, make sure you have routine follow-up appointments to manage your disease It's everyone's responsibility to spread the word about HBV – Make sure you and your loved ones are tested

24. Questions/Comments/Concerns? christine@smhepbfree