Hep B Blog

Raising awareness and Enabling Protective Action in an Affected Community in Australia: A work in progress…

Welcome Guest Blogger Yvonne Drazic. She is a PhD candidate at James Cook University in Cairns, Far North Queensland, Australia. Her research focus is on reducing the rate of undiagnosed and untreated chronic hepatitis B, in migrant communities from endemic areas, particularly the local Hmong community. Yvonne lives with chronic hepatitis B, and feels privileged to be one of the less than 3% of hepatitis B cases treated in Australia. She gives back in so many ways, and is also a list parent on the HB-List, an online patient forum

As a research student from tropical Far North Queensland in Australia, I am grateful that today’s technology allows me to be part of the global hepatitis B community. My goal is to help our local Hmong community of about 700 people to prevent future repercussions of undetected and untreated chronic hepatitis B (CHB). Having CHB myself, I was amazed to learn how many people miss out on vital medical care because they are unaware of their infection, or of its potential consequences. At present, the incidence of hepatitis B-related liver cancer is rising in Australia because undiagnosed CHB is doing much more harm than newly acquired infections in adults. The majority of affected people in Australia are migrants from endemic areas and Aboriginal and Torres Straits Islander people who were mostly infected at birth or in early childhood. Yet, less than 3% of cases are currently receiving antiviral therapy (Carville & Cowie, 2012).

I chose to focus on the Hmong community because studies in the U.S. show a particularly high CHB prevalence (~15%) in this population (Kowdley, Wang, Welch, Roberts, & Brosgart, 2011). And sure enough, when talking to members of the community, I heard sad stories of family members getting sick or dying from liver disease. Hepatitis B as a threat to public health has long been neglected in Australia, compared to the attention given to HIV and hepatitis C. However, based on a National Hepatitis B Needs assessment (Wallace, McNally, & Richmond, 2008) and other reports that showed an urgent need for a co-ordinated public health response, the first National Hepatitis B Strategy was finally released in 2010. The strategy highlights priority action areas such as raising awareness in patients and doctors, improving screening and diagnosis practices, and removing barriers in culturally and linguistically diverse (CALD) populations.

In Australia, pregnant women are routinely screened for hepatitis B. However, research suggests that many who test positive during pregnancy do not receive adequate follow-up care (Guirgis, Zekry, Yan, Bu, & Lee, 2009). In addition, recent studies indicate that CHB awareness is still low in Australian general practitioners (GPs), and that many patients are not managed according to guidelines (Dev, Nguyen, Munafo, Hardie, & Iacono, 2011; Guirgis, Yan, Bu, & Zekry, 2011). Therefore, in order to achieve improvements in early detection and timely referral for treatment, increasing GP involvement is a priority.

My project comprises (1) an assessment of knowledge, current practice, awareness of resources and educational preferences of local GPs; (2) assessments (pre- and post) and an appropriate intervention in the Hmong community (all based on behavioural theory); and (3) an assessment of pregnant women and new mothers. At the time of writing, data collection from GPs is under way.

Community engagement is, of course, an ongoing process. The project has the support of a community leader who is providing invaluable information about what may and may not work in his community. Initial information about the project was recently distributed. Building trust and showing that my motives are genuine takes time and it is important to let things develop instead of pushing ahead too fast. The fact that I have CHB myself may help to convey the message that it is okay and even necessary to talk about hepatitis B. Normalization assists in the removal of stigma.

More of my work to be shared in another blog. A big thank you to the special people who have been inspiring and encouraging me to do this work and keep offering tremendous, ongoing support.

Yvonne

References:

Carville, K. S., & Cowie, B. C. (2012). Recognising the role of infection: preventing liver cancer in special populations. Cancer Forum, 36(1), 21-24.

Dev, A., Nguyen, J., Munafo, L., Hardie, E., & Iacono, L. (2011). Chronic hepatitis B: A clinical audit of GP management. Australian Family Physician, 40(7), 533-537.

Guirgis, M., Yan, K., Bu, Y. M., & Zekry, A. (2011). A study into general practitioners’ knowledge and management of viral hepatitis in the migrant population. Internal Medicine Journal, Accepted article. doi: 10.1111/j.1445-5994.2011.02440.x

Guirgis, M., Zekry, A., Yan, K., Bu, Y. M., & Lee, A. (2009). Chronic hepatitis B infection in an Australian antenatal population: Seroprevalence and opportunities for better outcomes. Journal of Gastroenterology and Hepatology, 24(6), 998-1001. doi: 10.1111/j.1440-1746.2009.05841.x

Kowdley, K., Wang, C., Welch, S., Roberts, H., & Brosgart, C. (2011). Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology, Accepted preprint.

Wallace, J., McNally, S., & Richmond, J. (2008). National hepatitis B needs assessment. Melbourne: Australian Research Centre in Sex, Health, and Society, La Trobe University.

 

 

Join CDC and HBF for a World Hepatitis Day Twitter Chat

Are you planning to join us for the World Hepatitis Day Twitter Chat on Friday, July 27th? The CDC and HBF will be hosting a Twitter Chat at 2 pm EDT.  Are you thinking, “What… me??  I don’t know how to use twitter!!” Well, get-on- board with twitter before July 27th and join us!

What is twitter?  Twitter allows you to stay connected or exchange short messages called tweets with friends, family, co-workers, organizations and partners, and the world at large. You can tweet from your computer, your laptop, i-pad or smartphone. You can use it to update your status on the go, or in HBF’s case, use it to educate and raise hepatitis B awareness.  We also use it to send out current or new information on hepatitis B and to make our resources available to others.  If you are a hepatitis B advocate, twitter is a great outlet to get your message out there.

What is a handle? Your twitter username is your handle. For example HBF’s twitter handle is @HepBFoundation. Handles are preceded with a @symbol. You can find us at www.twitter.com/HepBFoundation.

What is a tweet? A tweet is basically a short message or status that you post to twitter. You can compose a tweet by clicking on the blue compose button in the top right corner, or from the “Compose New Tweet” box (top left after you login) Tweets are kept at 140 characters or less. If you make your tweets about 10 characters shorter, you’ll leave room for others to easily retweet your messages.  Don’t worry. Twitter does the counting for you.

Your message can be just that – a message: “2 billion people in the world have been infected with #hepatitis B”, or you can add a reference to the source such as HBF’s website where you can find this quote  A URL shortener will be invoked to take that long URLs like  http://www.hepb.org/hepb/statistics.htm  and turn it into: http://ow.ly/ciWvu

What is a retweet? A retweet or RT is when you repost someone else’s tweet so it will be shared with your followers. It lets everyone know you like that message and lets you spread the word.  Retweeting is a great way to get started if you’re a little nervous about composing your own tweets.  To retweet, all you need to do is put your cursor over a tweet that you like, and you’ll see retweet highlighted. Click and you’ve just done your first retweet!

What’s a hashtag? A hashtag allows you to categorize messages in twitter.  You precede a keyword with a hashtag, or the “#” symbol, to note a topic of interest. I typically use simple twitter hashtags such as #hepatitis B, or #HBV in my messages so that others interested in HBV topics will see my tweets. Rather than put them at the end of a tweet, I typically work them into my message. For example: “There are 400 million people chronically infected with #hepatitis B in the world.” Lots of viral hepatitis followers are using the #hepatitis hashtag, so they are sure to see my posted tweet. The hashtag will allow them to easily search twitter from the search box (top right) in twitter and retweet my message.  It might also encourage them to follow me since hepatitis B is an interest that we share. When I see tweeps tweeting with the #hepatitis hashtag, I tend to follow them, and if they continue to post good content, I might even add them to one of my twitter lists.

What is a Tweep? A tweep is a twitter user.

Getting Started.  All you need to get started is an email account, a picture or logo (though twitter will assign you their default image if you don’t upload one, so don’t let that stop you.), and a statement about you or your organization.

Go to www.twitter.com and sign up for a new account. It’s really pretty simple. If you have your email and image ready to upload, you can be in and out in a few minutes. Twitter will walk you through the whole thing – nothing tricky!

So what should you do to become familiar with twitter? Assuming you plan to follow what’s new in the world of hepatitis B, our twitter chat on the 27th and viral hepatitis events beyond World Hepatitis Day, then consider a few things:

Who do you want to follow? Consider following viral hepatitis organizations like the Hepatitis B Foundation (@HepBfoundation), CDCs Division of Viral Hepatitis (@cdchep), World Hepatitis Alliance (@Hep_Alliance) or other favorite viral hepatitis orgs you may know. You may also consider following medical doctors, journalists, or viral hepatitis advocates you find out there in the big-virtual world. Don’t forget about the community at large. You’ll find others interested in hepatitis B by using the #hepatitis, #HBV or #worldhepday hashtags in the search box. Part of the goal is to educate and raise HBV awareness. At HBF, The world is our target audience. We are happy to follow, or be followed by anyone that is interested in hepatitis B.

Who will follow you? In the beginning, you’re not going to have a lot of followers. Don’t worry about it! Building a following takes time. Slowly but surely as you start participating, you will gain new followers. Start by “retweeting” someone you are following, and most likely they will follow you back if you are helping them get their message out.

The World Hepatitis Day Twitter Chat sounds great! How do I join the conversation? It’s simple. The Twitter Chat starts at 2 pm EDT on Friday, July 27th. Login to your twitter account and be ready to contribute. We will be using the #WHDchat hashtag for this chat. All you need to do is search twitter for the #WHDchat and it will generate a list with all of the tweets from the conversation. If you see a tweet that you like, retweet it.  If you’d like to contribute to the conversation with your own message, compose your tweet and be sure to add the #WHDchat at the end of your tweet or no one will see it.

That’s it! Join the conversation on July 27th at 2 pm EDT!

Diagnosed with Hepatitis B? Preventing Transmission to Others. Learning the HBV Basics Transmission – Part III

How can you prevent future transmission? Now that you are aware of your infection, it’s easier than you think.  In a perfect world, everyone would be vaccinated against HBV and be protected, but of course this is not the case. Always encourage HBV vaccination when possible now that you understand the importance of this safe and effective 3-shot series. However, the vaccine does take time to complete, so in the interim, some general precautions will keep you and everyone you know safe.

Always maintain a barrier between blood and infected body fluids and any open cuts, mucous membranes (eyes, nose or mouth), or orifices of someone else. Keep cuts, bug bites – anything that bleeds or oozes – covered with a bandage. Also, remember to carry a spare bandage.  These are some simple prevention methods.

Do not consider unprotected sex unless you are sure your partner has had all 3 shots of the HBV vaccine series. And remember to consider the risks of other infectious diseases that are transmitted sexually if you are not in a monogamous relationship.  Multiple sex partners and non-monogamous relationships expose you to the potential of more health risks and even the possibility of a co-infection.  Co-infections are when someone has more than one serious chronic condition (like HBV and HCV , HBV and HIV or HBV and HDV).  Co-infections are complicated health conditions that you want to avoid. Therefore, practice safe sex by using a latex or polyurethane condom if you have multiple partners.

General precautions include carefully handling your own blood, tending to your own blood spills, and properly disposing of feminine hygiene products. Properly dispose of blood stained materials in tightly closed plastic bags. If someone else must tend to your bleeding wound or clean up your blood spill, be sure they wear gloves, or maintain a barrier, and wash their hands thoroughly with soap and water.  Many germs and virus (like HBV) can be effectively killed when cleaned using a diluted bleach solution of 1 part bleach to 9 parts water.  Ideally this solution should be made when needed as the shelf life is limited.  Everyone should use these basic precautions – with or without a known HBV infection.  Make this part of your daily life.

And what about your personal items?  Well it’s best if they are kept personal and out of common areas. This includes things like nail clippers, files, toothbrushes and other personal items where microscopic droplets of blood are possible.  This is good practice for everyone in the house. After all, you may not be the only one with an infection. Simple changes in daily habits keep everyone safe.

If those at risk in your life are not already vaccinated, then they need to start the series immediately. This includes sexual partners, house hold contacts and close family members and friends. The HBV vaccine is a safe and effective 3-shot series.  Timing may be of concern or a sense of urgency, so just get it started. The regular schedule is completed within six months. Tack on an extra month and ask their doctor to test their surface antibody titres during the seventh month to ensure that adequate immunity has been generated by the vaccine.  This is not standard routine but will help insure those at higher risk that they are protected. In the interim, remember to practice safe sex with your partners.

The timing of the antibody titre should be 4-6 weeks following the last shot of the series. If titres are above 10 then there is protection for life.  If someone has been previously vaccinated a titre test may show that their titres have waned and dipped below the desired reading. There is no reason to panic, as a booster shot can be administered and then a repeated titre test one month later will ensure adequate immunity.

When recovering from an acute infection, if your follow up blood test results read: HBsAg negative, HBcAb positive and HBsAb positive then you have resolved your HBV infection and are no longer infectious to others and you are no longer at risk for infection by the HBV virus again.

However if your follow up blood tests show that you are chronically infected or your infection status is not clear, you will want to take the precautionary steps to prevent transmitting your HBV infection to others. You will also need to talk to your doctor to be sure you have the appropriate blood work to determine your HBV status and whether or not you are chronically infected.

Please be sure to talk to your doctor if you are unsure, and don’t forget to get copies of those labs. Don’t forget to look at transmission part I and part II if you are looking for a little more transmission information.

What Are Your Plans for World Hepatitis Day?

World Hepatitis Day is July 28th. Organizations and advocates around the globe are organizing viral hepatitis events to educate, screen, and raise viral hepatitis awareness in their communities.

World hepatitis Day was launched by the World Hepatitis Alliance in 2008. Last year, July 28th, the birthday of Dr. Baruch Blumberg was designated as the official World Hepatitis Day. Dr. Blumberg won the Nobel Prize in 1976 for his discovery of the hepatitis B virus, and development of the first hepatitis B vaccine. He was also an inspirational friend to the Hepatitis B Foundation.

Please take a look at the proposed World Hepatitis Day events occurring around the globe.  The chart is a work in progress, so let me know your activates for the day or days preceding World Hepatitis Day, and a contact point, and I’ll be sure to update the chart ASAP. Leave a comment or send your info to contact@hepb.org.  If you’re not planning an event, but would like to get involved, check out any events that may be near you. Countries are listed alphabetically.

Don’t forget to take advantage of the promotional campaign materials provided by the World Hepatitis Alliance. World Hepatitis Day really is “closer than you think”.

 

 

Country Event Contact
Australia Queensland:

  • Free lecture presented by Dr. Joshua Davis, speaking about his work with HBV in indigenous communities in the Northern Territory. Cairns.
  • Yarnin up HepB for Aboriginal and Torres Straits Islander health workers to discuss all things HBV with Dr. Davis. Cairns.
  • “Hep Day Out” at CSHS features tours of the QuIHN van, an acoustic jam and more. Cairns
  • Hepatitis Indigenous Community Awareness Event, organized by Hepatitis Queensland. Brisbane.

Australian Capital Territory (ACT): WHD Community & Stakeholder Forum. Canberra.

New South Wales (NSW): Numerous community events, including Love your Liver or Healthy liver themed lunches and breakfast events; art themed events and workshops; general hepatitis health promotion events; and targeted events focussing on Indigenous communities, youths, prisoners, injecting drug users, culturally and linguistically diverse communities, and tattooing.

Victoria (VIC): Spotlight on hepatitis B aiming to increase the capacity of community and health workers to include hepatitis B in their work; Street Shot photo exhibition and Love your liver lunch, using photography to educate young people about viral hepatitis

Western Australia (WA): Street Art exhibition targeted at youths; Love your Liver educational workshop and lunch; WHD Redbacks Basketball Game; CALD Community hepatitis B Workshop

Cairns events:

Rhondda Lewis,

Ph. 0061742264761

Email:

 

rhondda.lewis@health.qld.gov.au

Bangladesh
  • Round Table discussion meeting held at National Press Club in Dhaka
  • Publication of awareness articles in national news dailies
  • Talk show on one of the local satellite TV channels
  • Printing and nationwide distribution of posters bearing logos of Viral Hepatitis Foundation Bangladesh, CEVHAP and WHA.
Dr. Mamun-Al-Mahtab

www.drmahtab.org

Ghana Public disease awareness campaigns on radio and TV using KE drawn from the Theobald hepatitis B foundation Lectures and presentations targeting high schools, Market places and churches

Events will occur in Tamale 23-July, Kumasi 25-July, Accra 28-July

  • Floats through the principal street
  • Public disease awareness campaigns on radio and/or TV,
  • Free HBV screening for school age children and the public
  • Hepatitis B education presentation and materials
  • Possible fundraising through entertainment

Media programs to include:

  • Articles on hepatitis
  • Distribution of stickers, flyers and posters to hospitals, clinics, lorry stations and other public places
  • Press releases to all media houses
  • Interviews on Radio stations
  • Use of social media to educate people on hepatitis  (twitter, facebook)
Theobald Owusu-Ansah

theobald2003@yahoo.com

+233-20-8269214 /  +233-247093893

Hong Kong Hepatitis B

  • Asiahep HK LTD will have a week-long promotion in public for HBV awareness with support from celebrities
  • A press conference is scheduled on 27 July with arrangement by FH. We will be launching our liver APPS and revamped website
  • Talks to doctors and public late June, and in Macau for a talk on 28 July

Hepatitis C:

  • Press Conference to introduce CEVHAP organization and announcement of World Hepatitis Day (July 22)
  • TV / Radio interview program to promote WHD (July to October)
  • Newspaper / Magazine health featuring articles on HCV (July – Nov)
  • Mini-Education video on chronic hepatitis C
Dr. Nancy Leung

dr_nancyleung@yahoo.com.hk

 

 

 

Prof CL Lai

hrmelcl@hku.hk

New Zealand
  • A national campaign, beginning early July will have screen printed advertisements displayed on the back of public buses in all major cities of both the North and South Island.
  • Week before July 28th there will be a national radio campaign as well as advertisements in national publications including GP magazine.
  • July 26th there will be a rally on the grounds of the parliament. 1000 helium balloons, each representing NZers infected with viral hepatitis
Hepatitis Foundation of New Zealand

www.hepfoundation.org.nz

 

Sweden
  • Manifestation: 580 Roses, Place Sweden, Jppsala University Hospital; Main entrance: Sjukhusgatan; Time: 28 July 10 a.m. to 5 p.m.
Kaj Johansson RN

http://www.facebook.com/hepatitisday.sweden.5

United States NYC – community orgs and hepatitis advocates celebrate WHD by hosting events across all 5 boroughs of NYC

 

Philadelphia- Viral Hepatitis Symposium for patients, families and members of the general public. http://www.liverfoundation.org/chapters/midatlantic/events/823/ Register today.

http://www.facebook.com/NYCWorldHepDay

 

Delval@liverfoundation.org or Erica Stein at 215-425-8080

World Hepatitis Alliance
  • Join World Hepatitis Alliance as they celebrate World Hepatitis Day 2012 with their Guinness World Record: WHD 2012 by having the most people performing the “See no evil, hear no evil, speak no evil” actions in 24 hours at multiple venues around the world.  Check out the details and get a group together for the
http://worldhepatitisalliance.org/WorldHepatitisDay/GuinnessWorldRecord.aspx