Transcript Hepatitis B

Hepatitis B
What You Need To Know
What is the Liver?
Seattle-King County
Refugee Data
What is Hepatitis B?
Test, vaccinate, treat!
Transmission
Living with Chronic
Hepatitis B
Global/Local Impact
FAQ
Hepatitis B and
AA & NHOPIs
Resources
What is the Liver?
• Where is the liver?
• What does it do?
• Cleans your blood
• Helps you digest food
• Helps your body fight infections
What is Hepatitis?
Hepatitis A
Hepatitis B
Hepatitis C
Cause
Hepatitis A virus
(HAV)
Hepatitis B virus
(HBV)
Hepatitis C virus
(HCV)
Most Common
Modes of
Transmission
• Eating or drinking
food or water that
has been
contaminated by
an infected
person’s stool
• Mother to child
transmission
during childbirth
• Unprotected sex
with an infected
person
• Exposure to blood
on contaminated
needles or medical
equipment
• Exposure to blood
on other things like
toothbrushes and
razors
• Unprotected sex
with an infected
person
• Exposure to blood
on contaminated
needles or medical
equipment
• Exposure to blood
on other things like
toothbrushes and
razors
Yes
Yes
No
•“Hepatitis” = liver inflammation
Vaccine Available
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
1
Percent of
Hepatitis B Cases
chronic hepatitis
BAcute
2
Developing Chronic Hepatitis B
1 Asian
Infants
90%
Children
50%
Adults
5-10%
Liver Center. FAQ about Hepatitis B. Available at: http://liver.stanford.edu/Education/faq.html#question1. Accessed Jan 28 2010 .
Hepatitis B Foundation. Acute vs. Chronic Hepatitis B. Available at: http://www.hepb.org/patients/acute_vs_chronic.htm. Accessed Jan
28 2010 .
2
Why Do We Care About Chronic Hepatitis
B?
Chronic
Hepatitis
B
Liver
cirrhosis
Liver
failure
Liver
cancer
• 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
2010 .
Liver Center. FAQ about Hepatitis B. Available at: http://liver.stanford.edu/Education/faq.html#question1. Accessed Jan 28
Chronic Hepatitis B is a Silent
Threat
• Half of all people with chronic hepatitis B
show no symptoms 1
• 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 B 1
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/emcdocuments/hepatitis/docs/whocdscsrlyo20022/disease/world_distribution.html.
Accessed June 1, 2004.
Hepatitis B is Serious – Global Impact
• Chronic hepatitis B is one of the top 10
causes of death worldwide 1
• The hepatitis B virus is 100 times more
infectious than HIV 2
1
Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures.J Viral
Hepatitis. 2004;11:97-107.2
2 Hepatitis B Foundation. Hep B Statistics. Available at: http://www.hepb.org/hepb/statistics.htm. Accessed December 29, 2009.
Hepatitis B is Serious – U.S.
• Chronic hepatitis B causes 4,000 to 5,500
deaths a year in the U.S. 1
Hepatitis B in the United States2
1
Percent Ever Infected (acute &
chronic)
4.3% - 5.6%
Number of Persons Living with
Chronic Infection
800,000 – 1.4
million persons
Annual Number of Chronic Liver
Disease Deaths associated with Viral
Hepatitis
3,000
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 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 B 1
• Asians have the highest liver
cancer rates of any ethnic group 3
1
Stanford School of Medicine. Hep B Education FAQ. Available at: http://liver.stanford.edu/Education/faq.html.
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.
2
Hepatitis B in Washington State
• 15,296 cases of chronic hepatitis B were
reported between Dec 2000-September 2008 1
– King County (64%)
– Snohomish County (7%)
– Pierce County (7%)
• 1272 new chronic hepatitis B cases are
reported annually 1
• More than 28,000 Washingtonians are
currently living with chronic hepatitis B 2
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
Hepatitis B and Refugees
Other
(Seattle-King
County)
SE
Asia
Other
SE
Asia
Africa
Soviet Union/
East Europe*
Caribbean/
Latin America
Near East/South Asia
Caribbean/
Latin America Soviet Union/
East Europe*
Africa
Near East/South Asia
*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
Hepatitis B and Refugees
(Seattle-King
County)
Number of Hepatitis B Positive Cases by Country (2008)
Country
No. Positive
Cases (HBsAG+)
No. Screened
Cases
Percent Positive
(HBsAG+)
Burma/Myanmar
24
263
9.1%
Somalia
5
111
4.5%
Eritrea
2
19
10.5%*
Burundi
2
11
18.2%*
Iraq
2
117
1.7%
Total
35
521
(2.93% of total cases
screened)
*No. screened may be too small to draw accurate conclusions
Public Health – Seattle and King County
Hepatitis B and Refugees
(Seattle-King
County)
Number of Hepatitis B Positive Cases by Country (2009)
Country
No. Positive
Cases (HBsAG+)
No. Screened
Cases
Percent
Positive
(HBsAG+)
Burma/Myanmar
20
358
5.6%
Somalia
9
118
7.6%
Bhutan
3
446
0.7%
Iraq
2
175
1.1%
Vietnam
2
17
11.8%*
Eritrea
1
82
1.2%
Ethiopia
1
18
5.6%*
Total
38
1214
(2.49% of total cases
screened)
*No. screened may be too small to draw accurate conclusions
Public Health – Seattle and 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!
shot –
at any time
1st
2nd shot –
1 month
after the 1st
3rd shot –
6 months
after the 1st
• 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 1 st shot
Importance of Prevention
• 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!
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.ht
m
• Hepatitis B Foundation - http://www.hepb.org/
• Asian and Pacific Islander American Health Forum http://www.apiahf.org
Resources
• International Community Health Services (ICHS) www.ichs.com/
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