hepatitis b what you need to know. what is the liver?what is hepatitis b?transmissionglobal/local...
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Hepatitis BWhat You Need To Know
What is the Liver?
• Where is the liver?
• What does it do?• Cleans your blood• Helps you digest food• Helps your body fight infections
•“Hepatitis” = liver inflammation
What is Hepatitis?
How is Hepatitis B Spread?
• From a mother passing the hepatitis B virus to their baby during birth
How is Hepatitis B Spread?
• By having unprotected sex with a person who has the hepatitis B virus
• By using unsterilized needles for tattoos, body piercings, injection drug use, or acupuncture
• By sharing shaving razors, toothbrushes, or other personal items that may come into contact with blood
How Hepatitis B is NOT Spread
• It is NOT spread from hugging, holding hands, sharing food, breastfeeding, kissing, or living with an infected person
Acute vs. Chronic Hepatitis B
• Acute: initial infection with the hepatitis B virus
• Chronic: the hepatitis B virus remains in the blood for more than 6 months
• The younger a person is first exposed to the hepatitis B virus, the more likely they’ll develop chronic hepatitis B1
1 Asian Liver Center. FAQ about Hepatitis B. Available at: http://liver.stanford.edu/Education/faq.html#question1. Accessed Jan 28 2010 .2 Hepatitis B Foundation. Acute vs. Chronic Hepatitis B. Available at: http://www.hepb.org/patients/acute_vs_chronic.htm. Accessed Jan 28 2010 .
Why Do We Care About Chronic Hepatitis B?
• 25% of those with chronic hepatitis B end up with liver cirrhosis and/or cancer without proper management• 60-80% of primary liver cancer worldwide is caused by chronic hepatitis B1
1Asian Liver Center. FAQ about Hepatitis B. Available at: http://liver.stanford.edu/Education/faq.html#question1. Accessed Jan 28 2010 .
Chronic Hepatitis B is a Silent Threat
• Half of all people with chronic hepatitis B show no symptoms1
• People who have the hepatitis B virus may infect others without knowing it
• People 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 infection
• There is no cure, but there are effective treatments available
1 Centers for Disease Control and Prevention. Hepatitis B. Available at: http://www.cdc.gov/communication/tips/hep-b.htm. Accessed May 21, 2004.
Hepatitis B is Serious – Global Impact
• It’s a common disease!• Over 350 million people in the world have
chronic hepatitis B1
1 Centers for Disease Control and Prevention. Hepatitis B FAQs for Health Professionals. Available at: http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#b12. Accessed January 28, 2010.2 World Health Organization. Hepatitis B. Available at: http://www.who.int/emc-documents/hepatitis/docs/whocdscsrlyo20022/disease/world_distribution.html. Accessed June 1, 2004.
• Chronic hepatitis B is one of the top 10 causes of death worldwide1
• The hepatitis B virus is 100 times more infectious than HIV2
1 Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures.J Viral Hepatitis. 2004;11:97-107.22 Hepatitis B Foundation. Hep B Statistics. Available at: http://www.hepb.org/hepb/statistics.htm. Accessed December 29, 2009.
Hepatitis B is Serious – Global Impact
Hepatitis B is Serious – U.S.
• Chronic hepatitis B causes 4,000 to 5,500 deaths a year in the U.S.1
1 Centers for Disease Control and Prevention. Hepatitis B and the vaccine. Available at: http://www.cdc.gov/nip/vacsafe/concerns/ hepb/q&a.htm. Accessed June 1, 2004.2 Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hepatitis/statistics.htm. Accessed February 20, 2010.
Hepatitis B in the United States2
Hepatitis B and AA & NHOPIs• AA & NHOPIs account for
– 78% of the 350 million people worldwide with chronic
hepatitis B1
– More than 50% of the chronic hepatitis B cases in the U.S. (estimated 750,000)2
• 1 in 10 AA & NHOPIs in the United States are positive for chronic hepatitis B1
• Asians have the highest liver cancer rates of any ethnic group3
1 Stanford School of Medicine. Hep B Education FAQ. Available at: http://liver.stanford.edu/Education/faq.html. 2 Asian Liver Center at Stanford University. Hepatitis B in Asian Americans. Available at: http://liver.stanford.edu/index2.asp?lang=eng&page=hepinasians. Accessed June 1, 2004.3 International Agency for Research on Cancer. GLOBOCAN 2000. Available at: http://www-dep.iarc.fr. Accessed June 1, 2004.
Hepatitis B in Washington State
• 15,296 cases of chronic hepatitis B were reported between Dec 2000-September 20081
– King County (64%)– Snohomish County (7%)– Pierce County (7%)
• 1272 new chronic hepatitis B cases are reported annually1
• More than 28,000 Washingtonians are currently living with chronic hepatitis B2
1 Washington State Department of Health. Washington State Chronic Hepatitis B and Chronic Hepatitis C Surveillance Report. Available: http://www.doh.wa.gov/cfh/IDRH_Assessment/default.htm. Accessed Jan 29 2010.2 Email communication from DOH Public Health staff
Hepatitis B and Refugees (Seattle-King County)
• The four largest refugee communities in 2009 were from Bhutan (29%), Burma/Myanmar (24%), former USSR (12%), and Iraq (12%)1
1 Public Health – Seattle & King County – 1996-2009 Refugee Health Screening Report
*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 – 1996-2009 Refugee Health Screening Report
Near East/South Asia
Caribbean/Latin America
AfricaSoviet Union/East Europe*
Other SE Asia
Caribbean/Latin America AfricaSoviet Union/
East Europe*
Other SE Asia
Near East/South Asia
Hepatitis B and Refugees (Seattle-King County)
*No. screened may be too small to draw accurate conclusionsPublic Health – Seattle and King County
Number of Hepatitis B Positive Cases by Country (2008)
Hepatitis B and Refugees (Seattle-King County)
Number of Hepatitis B Positive Cases by Country (2009)
*No. screened may be too small to draw accurate conclusionsPublic Health – Seattle and King County
Hepatitis B and Refugees (Seattle-King County)
Protect Yourself And Your Family!
• Hepatitis B can infect EVERYONE, regardless of age
• By getting tested and vaccinated, you can protect your family
• If you test positive, ask your doctor about your treatment/management options
• Prevention is the best approach to hepatitis B.
Importance of Testing
• The 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 B• People of all ages should be tested, especially
if you’re from areas of high prevalence• Early detection can help:
- Prevent spread of the hepatitis B virus- Identify appropriate treatment options- Reduce risk for developing liver cancer
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 vaccine
• You need all 3 shots to be protected• It is okay to finish the last shot at anytime
after 6 months from the 1st shot
1st shot – at any time
2nd shot – 1 month after the 1st
3rd shot –6 months after the 1st
• Other ways to prevent exposure to the hepatitis B virus include:– Receiving vaccination at
birth– Practicing protected sex– NOT sharing needles or
personal care items that may come into contact with blood (toothbrushes, razors, etc)
– Knowing your status!
Importance of Prevention
Living with Chronic Hepatitis B
• Chronic hepatitis B requires management, just like diabetes!
• Ask your doctor about…– Getting regular blood tests– Whether or not you need treatment or ultrasounds
• Be informed!– Understand your test results– Get the hepatitis B vaccine– Avoid drinking alcohol and smoking– Help prevent transmission to others
• Talk to your friends and family!– Make sure your loved ones have been tested
and vaccinated– Develop a support system for yourself
Asian Liver Center. For Hepatitis B and Liver Cancer Patients. Available at: http://liver.stanford.edu/Education/hepbpatients.html. Accessed Jan 28 2010.
There is Treatment for Chronic Hepatitis B!
• Pills, shots, or a combination of both
• Not everyone with chronic hepatitis B needs treatment immediately
• If you have hepatitis B, you should see your family doctor, who can refer you to a specialist if needed
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!
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.
Frequently Asked Questions (FAQ)
• What are the common signs/symptoms of hepatitis B?
If an infected person does have symptoms, they might include:
Resources
• Hepatitis B Coalition of Washington - http://www.hepbwa.org/
• WithinReach - http://withinreachwa.org/• Association of Asian Pacific Community Health
Organizations - http://www.aapcho.org• Hepatitis B Facts -
http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm
• Hepatitis B Foundation - http://www.hepb.org/• Asian and Pacific Islander American Health Forum
- http://www.apiahf.org
Acknowledgements
• This 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 state
• Additionally, staff and volunteers from the Hepatitis B Coalition of Washington State and International Community Health Services, including AmeriCorps team members contributed to this presentation.
Questions??Hepatitis B