Hepatitis B in the Asian & Pacific Islander Community : What You Need to Know

1. Hepatitis B in the Asian & Pacific Islander Community : What You Need to Know

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

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

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 2nd 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 Hepatitis B-Associated Liver Cancer Destroying Normal Liver Image from netterimages.com Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.

10. High Risk Population • 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 Mother to Child

12. Most Asians with Chronic Hepatitis B Were Infected at Birth or Early Childhood1 Other Routes of Transmission Include2 Vertical Transmission (Mother to Child) Razors/Needles Unprotected Sexual Contact with HBV+ Contact with Infected Fluids Transfusion/Organ Transplant 12 Lin SY, et al. Hepatology. 2007;46:1034-1040. 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.

13. Clarifying Myths About Transmission of Hepatitis B Hepatitis B is Not Transmitted by Sharing Food, Water, Utensils, Glasses Mosquitoes Tears, 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. 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! 14 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. Clarifying Myths About Transmission of Hepatitis B 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! 15 Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.

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 1 2 3 • Hepatitis B vaccine Complete 3 shots in six months for life-long protection

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 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. 1 CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm 2.WHO. Available at: www.who.int/csr/disease/hepatitis/en/

23. San Mateo Hep B Free • 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 1 CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm 2.WHO. Available at: www.who.int/csr/disease/hepatitis/en/

24. Thank you! Questions/Comments/Concerns? christine@smhepbfree