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The HBV Asian Epidemic You Don't Know About
A press conference in New York City last month addressed an issue that often goes ignored but is already affecting many Asian Americans in the 21st century - Chronic Hepatitis B.
A study released by pharmaceutical giants Idenix and Novartis revealed some alarming figures. A survey of 301 CHB (chronic hepatitis B) patients (55% of whom were Asian American) indicated that not enough CHB patients or the general population are properly informed about CHB and its causes, although the similarities to the HIV epidemic are obvious.
In the U.S. and estimated 1.25 million people are critically infected with HBV -- Asian Americans make up more than half of this number.
* One in 10 Asian-Americans has CHB, compared with one in 1,000 for the general U.S. population:
* 1 in 10 Chinese Americans
* 1 in 12 Korean Americans
* 1 in 8 Vietnamese Americans
"The transmission of Hepatitis B usually is silent, that's why we call it a ticking time bomb. Patients don't usually have any symptoms when they're very infected until a very late stage when the symptoms surface and the disease appears - in fact they (patients) may have normal results in a laboratory test," said Dr. Calvin Pan, Director of Clinical Research / Hepatology for Amherst Hospital and Assistant Professor of Clinical Medicine for Mt. Sinai School of Medicine in New York.
Along with Dr. Albert Min, Associate Professor of Clinical Medicine and Director of Hepatitis Research at Albert Einstein College of Medicine, the two medical professionals shared some vital information on Hepatitis B with a group of mostly Asian media in New York and outlined its impact on the community. Here's just a thought on how it was widely covered on TV across the globe, but I didn't see anything about it in the good old American press. After all this is Hyphen and we're one of a kind.
Like HIV, Hepatitis B can be transmitted in several ways. First is vertical transmission; the passage of a disease-causing agent vertically from mother directly to baby during the perinatal period (the period immediately before and after birth). The perinatal period starts between the 20th to 28th week of pregnancy and ends 1 to 4 weeks after birth.
The second is horizontal transmission, which would come through contact with contaminated blood through unprotected sex or re-use/ sharing of needles
For vertical transmission, Pan recommended that all children from an infected mother should be screened for Hep B because 90% of the babies infected with Hepatitis B in the newborn or infant stage will become chronic. Pan stated that only about 50% of children infected between ages 1 and 5 will become chronic, so the disease should be caught in newborns.
Pan then identified a major at-risk group in the Asian community: Southeast Asians. He recommended that all immigrants from Southeast Asia should be screened for Hepatitis B because they averaged a15-20% rate of Hep B infection.
"We need to encourage those immigrants or anyone from Southeast Asia to go for screening," Pan said.
Asked to outline the common environmental factors that contribute to the Hepatitis B epidemic across regions of Asia, Dr. Pan said:
"One of the major factors in Southeast Asia causing a lot of cultures of Hepatitis B is the social setting. Many years ago in Southeast Asia a lot of countries were not using disposable needles or medical equipment in the hospital or they were in a remote area that was not well disinfected. The other cultural factor was the unconventional medical methods of treating disease / holistic medicine. Some disease can be transmitted by traditional ways to treat people. For example clubbing (the body) can cause some continuous bleeding, brutish as it being, and that's been proposed as a mode to transmit disease. Many of you are aware of the acupuncture part, and in Southeast Asia many countries are still practicing that. If you don't have very clean, disinfected needle that can lead to transmitting Hep B."
Pan also pointed to environmental factors such as proper pre-natal and post-natal care as variables that can play a role. "The vaccination for the newborn baby and the infected mother is important and precautions may not be taken in those countries," Pan said.
"They just came out with guidelines recommending vaccination of children under age 18 from high-risk groups that Dr. Pan pointed out," added Min, recalling new guidelines from the Center for Disease Control and Authorized Committee on Immunization Practice, "In terms of transmitting a virus to newborn children, if they all get vaccinated and the mother has chronic Hepatitis B, they also get opportunities of passage through prophylactics. New cases in newborn and young children would be 90-95% preventable."
But why is Hep B more prevalent in some parts of Asia and not others?
"Theoretically, you have to look at the geographic distribution of Hep B, because we know that close contact is a mode of transmission," Pan explained, " You have to be aware of where those patients are coming from, whether they're immigrants or you find any higher prevalence area. In general, Southeast Asia. Then China, especially, [is] the major country, out of Korea, China and Japan. And Taiwan. People from Taiwan have a high chance of contracting of Hep B. It's not so much of an ethnic factor - I don't believe that the data shows that Chinese are more easily infected with Hep B than Japanese or Koreans. It's about the geographic distribution of the disease."
In the U.S., social issues are the leading factors contributing to the transmission of Hepatitis B among members of the Asian community. "More likely we have to focus on behavioral modifications such as sexual contact, unprotected sex, needle use, men having sex with men, or any factors associated with HIV should be associated with Hepatitis B," elaborated Pan.
Are those with Hep B aware of how it is transmitted?
The survey data shows that the majority of respondents correctly identify blood transfusion (78%) and sexual contact (68%) as the main sources of transmitting the virus. But, 36% of respondents believed that sharing utensils with an infected person would spread Hep B. And 23% said that living in the same household as an infected person could spread Hep B. Meanwhile, 9% believed that social contact such as a handshake could also lead to transmitting the virus. The parallels to misconceptions about HIV were obvious, and added to that Dr. Pan mentioned some of the same behavioral risks.
Singling-out lifestyles more at risk for contracting Hep B, Pan said, "I think certain communities, a) the Gay and Lesbian community--- probably they should screen everybody, b) those people known to use IV drugs should be screened, c) those people having unprotected sex with multiple partners they should be screened," he said.
Then, Pan talked about something of a fad in our generation: tattooing. This hit home, for me, because I have several tats myself, though my artist used new needles. "A lot of people with different backgrounds, even in Southeast Asia like to get tattoos. In the United States some tattoo services might have a clean facility, but others are still practicing without disinfecting tattooing equipment. Sharing sharp objects is another factor. For example ladies who share earrings might have some risk for passing disease and infections," Pan said.
With so little knowledge about Hep B, the message needs to be spread and precautions need to be taken. While the real reason Idenix and Novartis called this press conference was to promote their new drug, the recently FDA-approved TYZEKA (tebivudine 600mg), and compare its effect over two others: lamivudine and adefovir. The Asian American community should be able to find out more about this rarely mentioned affliction.
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