Hepatitis B and Our Community

1. Hepatitis B and Our Community David Huang and Stephen Ku

2. Who are we? • Hepatitis B Consultants for the Asian Pacific Islander Health Parity Coalition (APIHPC) • APIHPC is a group of 26 diverse local organizations that have an interest in health disparities that affect the API community • We are both 4th year UCSF medical students with extensive experience in Hepatitis B education and advocacy • (logos of APIHPC and UCSF)

3. Why are you here? • To learn about hepatitis B • We believe hepatitis B is an important issue in our community and by the end of this presentation we hope you agree

4. What do you know about Hepatitis B? • Volunteers? • What is liver?

5. What is hepatitis B? • An infection of the liver that can sometimes lead to liver failure and/or liver cancer • It is caused by a virus • Talk about what liver does? • Acts as a filter • Detoxifies substances that are harmful to the body • Processes medications that we take

6. Why does hepatitis B matter? • It can cause cancer or liver failure and ultimately death • It is easily preventable! (if you don’t have hep B, you should get protection) • If you do have Hepatitis B there are effective treatments

7. But why should I care? • Because Hepatitis B is an important problem in the API community • Asian Americans are 100 times more likely to have hepatitis B than caucasians • 1 in 10 Asian Americans has hepatitis B • 1 in 12 Korean Americans • 1 in 10 Chinese Americans • 1 in 8 Vietnamese Americans • 34% of San Francisco’s population is API • Your organization serves many members of the API community • (AND Many of you belong to the API community) • Globally?

8. Why API? • Key factor is area of origin • Hepatitis B is much more prevalent in Asian countries • The main way Hepatitis B spreads is from mother to child during birth • Few vaccination programs are in place to prevent this • Scarce resources -> things like reusing needles • Many Asians unknowingly infected with hepatitis B migrate to the US (therefore, target recent immigrants) • (no genetic component) • High prevalence of hepatitis B in Eastern Europe and Sub-saharan Africa • Prevalence is lower in U.S., but if you are recently immigrated, then your risk is like that of your home country

9. How else can you get Hep B? • Three B’s: • Blood • Bed (aka sex) • Birth already mentioned

10. Ways you CANNOT get Hep B • Sharing food and water • Sharing chopsticks or other utensils • Coughing or sneezing • Casual contact • Kissing on cheek • Shaking hands • Hugging or holding hands • Eating food prepared by infected person

11. If I get hepatitis B, then what? • Short term • Feel bad (flu like symptoms with fatigue, malaise, joint and muscle pain) with fever for week or two • If very bad, may develop jaundice (yellow eyes and skin) • Most people will recover from this short term illness, but many will not completely eliminate from system leading to chronic hepatitis B • Long term • You feel fine, but your liver is slowly deteriorating • Significant risk of liver failure/cancer

12. How Do I know if I have hepatitis B? • Some may have symptoms • Nausea • Poor appetite • Tiredness, weakness • Dark urine (tea color) • Swollen belly from liver damage • Yellow eyes/skin • Most with Hepatitis B do not have obvious symptoms, so blood test is the only way to be sure • The test is a simple, one-time blood draw

13. What does the blood test tell me? • Possible results • #1: you are protected! • You do not need vaccination or treatment • #2: you are not protected! • You should get vaccinated • #3: you have chronic hepatitis B =(

14. How does vaccination work? • Three shots • Now • One month later • Six months later • 90-95% effective if you get entire series • COST • AWESOME TIMELINE HERE (see actual presentation)

15. What if I have chronic hep B? • For most, it takes over 20 years for hepatitis B to cause severe liver damage/cancer • Blessing and curse • You have a long time to discover it and get treatment • It is an insidious disease – you might not know about it until too late • You should seek care from your doctor • Monitor liver for damage with ultrasound and blood tests regularly • Decide whether to start medication • No cure yet, but many effective treatments • Be healthy! (good diet, no alcohol!/smoking) • Test family members and vaccinate them • Don’t share your toothbrush

16. Handout Time! • List of places to get tested/screened and vaccinated • Encourage using CPHC and Mt. Zion • Brochures in different languages • Mention options for treatment for chronic hepatitis B • Signup sheet (please state whether you have been screened/vaccinated before)

17. Quiz Time! • Questions to test staff knowledge of methods of transmission, etc.

18. Question Time! • Any questions? • write on paper or raise hands

19. Discussion Time! • Engage audience to figure out best way to reach out to clients

20. What if I am pregnant and have hepatitis B? (extra slide for APA) • Your child is at risk of getting hepatitis B during birth • Tell your Ob/Gyn doctor that you have hepatitis B • Immediately after birth AND before leaving hospital, your baby can get treatment that will reduce the chances that your child will be infected

21. Extra questions that may need to be addressed at end of presentation • Do I really want to know? • What if I don’t have health insurance? • What if I’m worried about my legal status? • Where can I go if I have chronic hepatitis B and no insurance? • If I’ve been screened before, should I get screened again? • If I’ve been vaccinated before but never tested, should I get tested? • What if I only got one or two of the vaccination series? • If I have chronic hepatitis B, will I definitely get Liver failure/cancer?