Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.
In the second episode (part 2), Kristine Alarcon, MPH sits down with Chari Cohen, DrPH, MPH, Vice President of Public Health Programs of the Hepatitis B Foundation, to talk about public health research at the Hepatitis B Foundation.
Disclaimer: The information provided in this audio post is not intended to serve as medical advice of endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.
Kristine Alarcon, MPH and Samantha Young
Modern – iMovie Library Collection
Welcome to Journey to the Cure! Every month, we’ll sit down with scientists from the Hepatitis B Foundation and the Baruch S. Blumberg Institute to talk to you about hepatitis B and efforts to find a cure for hepatitis B. There’s still a long way to go, but we’re here to walk you through our journey.
Kristine Alarcon, MPH:
In our last episode, Dr. Block was talking about how the Hep B Foundation is dedicated to public health research. Can you tell us more about that?
Chari Cohen, DrPH, MPH: One of our major goals is to get everyone in the United States – or in the world really – but primarily in the US, everyone who has hepatitis B should be aware of their diagnosis and should be able to access to care. In order to do that, we have to do research. We have to figure out what are the best ways to get people tested and into care. In order to do that, we have to first figure out why people aren’t getting tested now, what barriers are people facing, what challenges are people facing to get tested, and how can we help them overcome those challenges. Every time we do a public health program, we are also doing research, so we are collecting a lot of data. And then, we use the data to develop new programs, and we share it with others as well. We also collect information and data on prevalence, so looking at where some of the high risk and highly impacted communities are in the U.S. We will do testing ourselves. We’ll go into communities in Philadelphia, and we’ll do hepatitis B testing. Through that, we know which communities need more care.
Kristine Alarcon, MPH: What types of public health programs are you carrying out right now?
Chari Cohen, DrPH, MPH: We have a number of different programs right now. One is our Hep B United Philadelphia program, where we like to train the trainers. In Philadelphia, we’re training people who do health education; we’re training community leaders; and we’re helping them to learn about hep B, so that that they can go into high risk communities and teach other people about hep B. We’re also screening a lot of people. This year, we screened a little over 200 people for hepatitis B. When we find people to be infected, we link them into care. We’re also working on a new project, looking at the challenges that African immigrants face in the US in terms of hepatitis B testing. We’re trying to figure out what are the best ways to overcome those challenges and what are the best ways to get people tested and into care. And then, we have our #justB program, which is our national patient storytelling program, where people who have hep B or with family members who have hep B tell their stories and make videos, and they share how hep B has impacted their lives.
Kristine Alarcon, MPH: Thank you so much for joining us in this episode!
Hepatitis delta, or hepatitis D, is an aggressive form of hepatitis that can only infect someone who is also infected with hepatitis B.
People can become infected with hepatitis B and hepatitis D from the same exposure, or people who are already infected with hepatitis B can later be infected with hepatitis D. Coinfection can promote more rapid progression to cirrhosis and liver cancer than being infected with hepatitis B alone and will require an altered treatment and management plan. Being aware could save your life!
Hepatitis D can be spread similarly to hepatitis B, through exposure to blood or bodily fluids of an infected person. People with hepatitis B are likely to develop a chronic hepatitis delta coinfection if they are exposed to the virus, making it important for you and your doctor to be aware of the signs of a coinfection.
Cues to suspect a coinfection:
You have chronic hepatitis B but are not responding to antiviral treatment, or you have signs of liver damage even though your viral load is low (HBV DNA below 2,000 IU/mL)
Note: Fatty liver disease (caused by obesity) and liver damage from alcohol or environmental toxins should be ruled out as causes of liver damage before testing for hepatitis D.
It is also important for hepatitis B patients who originate from Sub-Saharan Africa, China, Russia, the Middle East, Mongolia, Romania, Georgia, Turkey, Pakistan and the Amazonian River Basin to be tested for hepatitis D, where it is more common. Most of the time, patients do not have any signs or symptoms to let them know they are coinfected, so a simple blood test is the only way to know for sure! Talk to your liver specialist about testing at your next appointment.
Hepatitis Delta Connect is a dedicated program of the Hepatitis B Foundation aimed to provide information and support for those affected by hepatitis D. Please visit our website, www.hepdconnect.org for more information and follow us on Facebook, Twitter and Instagram to stay up to date on the latest hepatitis D news! If you are a patient or provider and have questions or concerns, please email us at firstname.lastname@example.org.
Check out our previous posts about hepatitis D here, here, and here.
Join the Hepatitis B Foundation (HBF) for a hepatitis B awareness campaign to commemorate Hepatitis Awareness Month! Start with a photo and create an awareness message about hepatitis B and
what makes you a Hep beLIeVER. Your photo entries will be a part of our national awareness campaign during the month of May!
Anyone and everyone may participate! (International followers can enter as well!)
What to Do
Upload a photo of yourself with your hand over your liver and tells us whatmakes you a hep beLIeVER! You can take the picture of yourself or with a group of friends! Be creative with your photo! You can take a look at CDC‘s and Hep B United‘s Know Hepatitis B campaign for inspiration.
Images should not include any material that would require third-party consent or violate copyright, privacy, or other right of any third party. If used, Know Hepatitis B campaign materials should be used in their entirety and retain the CDC and Hep B United logos.
Submissions including offensive language, imagery, or themes will be excluded and disqualified from the competition.
Approximately 5-10% of people do not develop protective antibodies following the completion of the hepatitis B vaccine series. This is confirmed with a blood test called an anti-HBs titer test which is given 4 weeks following the completion of the series. If the test shows the titer is less then 10 mIU/mL the general recommendation is to complete the series again using a different brand of vaccine (e.g. if you received Engerix B, the first time, switch to Recombivax the 2nd time or vice-versa). A person is considered to be a “non-responder” if they have completed 2 full vaccination series’ without producing adequate protective antibodies.
Another vaccine option is the new two-dose hepatitis B vaccine, HEPLISAV-BTM. The new vaccine is expected to increase immunization rates for adults in the United States and is administered over a one-month period. The vaccine provides greater seroprotection, which can mean a greater antibody response especially in adults who may be older, obese or live with type 2 diabetes making it an effective vaccine option.
It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a “vaccine non-responder.”
Persons who do not respond to the primary hepatitis B vaccine series (i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive. Persons who do not respond to an initial 3-dose vaccine series have a 30%–50% chance of responding to a second 3-dose series.
Revaccinated persons should be retested at the completion of the second vaccine series, 1-2 months following the last shot of the series.
Persons exposed to HBsAg-positive blood or body fluids who are known not to have responded to a primary vaccine series should receive a single dose of hepatitis B immunoglobulin (HBIG) and restart the hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after exposure. Alternatively, they should receive two doses of HBIG, one dose as soon as possible after exposure, and the second dose 1 month later.
The option of administering one dose of HBIG and restarting the vaccine series is preferred for non-responders who did not complete a second 3-dose vaccine series.
For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred.
Hepatitis B vaccine “non-responders” who test negative for hepatitis B infection are at risk for being infected and should be counseled regarding how to prevent a hepatitis B infection and to seek immediate medical care to receive a dose of hepatitis B immunoglobulin (HBIG) if they have been exposed to potentially infected blood.
“Non-responders” who test negative for hepatitis B infection as well as friends and family members should practice ways to prevent the spread of hepatitis B, including washing hands, using condoms during sex, avoid direct contact with blood and bodily fluids, and more.
Hepatitis B vaccine “non-responders” to vaccination who test positive for hepatitis B infection should be counseled regarding how to prevent transmitting the hepatitis B virus to others and the need for regular medical care and monitoring for their chronic infection.
In the case of possible exposures to HBV infected blood or body fluids, it is recommended that non-responders receive 2 doses of hepatitis B immunoglobulin (HBIG) – the first dose should be given within 24 hours of the exposure, and the second dose should be given 1 month later. The CDC has recommendations online for what to do in case a susceptible person is possibly exposed to the hepatitis B virus.