Hep B Blog

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Diagnosing Hepatitis Delta in the U.S.

Robert Gish, MD

David Hillyard, MD

Hepatitis D, or hepatitis delta, is the most severe form of viral hepatitis known to humans. The hepatitis D virus infects the liver and is dependent on the hepatitis B virus to reproduce. This means that people who are already infected with hepatitis B are at risk of contracting hepatitis D as well.

Worldwide, more than 257 million people live with hepatitis B and of this number, an estimated 15-20 million are also infected with the hepatitis delta virus (HDV). While uncommon in the United States, HDV co-infection is more common in parts of the world such as China, Russia, Middle East, Mongolia, Romania, Georgia, Turkey, Pakistan, Africa, and the Amazonian river basin. For this reason, it is important to test hepatitis B patients who originate from these higher endemic areas for hepatitis D. Anyone with chronic hepatitis B who is not responding to antiviral treatment, or who has signs of liver damage even though they have a low viral load (HBV DNA below 2,000 IU/mL) should also be tested. 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 HDV.  Hepatitis D infections lead to more serious liver disease than hepatitis B infection alone. It is associated with faster progression to liver fibrosis, increased risk of liver cancer, and early decompensated cirrhosis and liver failure. This is why it is so important that people with hepatitis B and D coinfection are diagnosed before it can lead to severe complications.

Robert Gish, MD, Hepatitis B Foundation Medical Director, and David Hillyard, MD, Medical Director, Molecular Infectious Diseases, ARUP Laboratories, tackled the topic of diagnosing hepatitis D in a webinar in October. Dr. Gish also answered additional questions, which are featured below:

  • What is the first step in diagnosing an HDV patient?

The HDV antibody test (anti-HDV) is the first test that is run to see if a patient has been infected with hepatitis delta. Because this test will be positive even if a patient has cleared a hepatitis delta infection, it is followed up with an HDV RNA test, which determines an active infection. There is also an antibody test (anti-HDV igM) that can test for an acute active infection.

  • Are there tests available in the US that can detect the HDV genotypes or just genotype I?

Although there have been 8 genotypes of HDV identified, each with their own distinct progression outcomes, genotype testing in the US remains rare and often difficult to acquire.

  • What is the role of measuring HDV RNA in monitoring chronic HDV progression or response to treatment?

The most effective way to understand the progression of a hepatitis D infection is to use liver ultrasounds, elastrography and fibroscans. These tests can evaluate the health of the liver. Declining HDV RNA level usually indicates a positive response to treatment.

  • Is there value to testing patients for a disease for which there are not many treatments?

Because patients who are coinfected with B and D have twice the risk of cirrhosis and liver cancer compared to monoinfected patients, it is an important diagnosis to make. Although there is currently only 1 treatment, lives are still being saved.

  • Should primary care providers be testing high-risk patients for HBV and HDV at the same time?

No, providers should only test patients who already have hepatitis B. One in twenty people with hepatitis B are thought to also be infected with hepatitis D. Bottom line: testing for hepatitis D is a simple blood test that could change the course of treatment and save your patient’s life!

If you do find out that you have hepatitis D, it can be overwhelming and scary. However, knowing the basics can help you manage your diagnosis. Through the Hepatitis B Foundation’s Hep Delta Connect program, you can get information on how to protect your loved ones, find a physician, and seek out support.

For more information, please click here or visit our Hepatitis Delta Connect program website. Please also contact Sierra Pellechio, the Program Manager for Hepatitis Delta Connect program at sierra.pellechio@hepb.org for any questions.

World Immunization Day! Hepatitis B Vaccine

While World Immunization Week takes place during April, World Immunization Day is TODAY, November 10th! The World Health Organization (WHO) established the day to raise awareness for vaccines as a cost effective and low-tech method of preventing illness and disease.

Worldwide 84% of countries have hepatitis B immunization programs; yet only 39% provide the necessary birth dose to prevent hepatitis B. This is a huge gap that must be addressed if we are to meet hepatitis elimination goals by 2030.

To celebrate World Immunization Day, here are some facts about the hepatitis B vaccine!

The safe and effective vaccine provides lifetime protection against hepatitis B, the most serious common liver infection in the world.  The vaccine is a series of 3 shots given over a 6-month period, typically at 0, 1 and 6 months.

There are minimum time periods that are needed between each dose. The second dose is given at least 4 weeks after the first dose; the third dose is given at least 8 weeks after the second dose, and there must be at least 16 weeks between doses 1 and 3.

After the 1st dose of HBV vaccine, there can be up to 50% protection. After the 2nd dose of HBV vaccine, there can be up to 80% protection.  It is very important to receive the third shot to ensure maximum, long-term protection.

If your vaccine schedule has been delayed, you do not need to start the series over, you can continue from where you have left off – even if there have been years between doses.

CDC, AAP and WHO recommend the birth dose for ALL newborns within 24 hours of birth because newborns and babies are at the greatest risk of developing lifelong, chronic infection if they are exposed to the hepatitis B virus. Giving the “birth dose” of the hepatitis B vaccine after a baby is born helps to reduce the risk of transmission to this very vulnerable population.

Perinatal prevention is especially critical for babies born to women who are infected with hepatitis B. All pregnant women should be screened for HBV. If positive, mom should be referred to care, and her baby should receive the birth dose of the vaccine and shot of hepatitis B immune globulin (HBIG), if available, within 12 hours of birth.

In order to meet this requirement, the first dose of the hepatitis B vaccine must be the “monovalent vaccine,” which means it is only the hepatitis B vaccine.

Many countries provide the “pentavalent vaccine”, which protects against 5 diseases, including hepatitis B. Unfortunately, the first dose of the “pentavalent vaccine” is given at 6 weeks, which means babies are not protected at birth and during the first 6 weeks of life against the hepatitis B virus.

It is very important that babies receive the “monovalent” hepatitis B vaccine at birth (not the “pentavalent vaccine”) in order to protect against a lifelong chronic hepatitis B infection. Babies must complete the vaccine series according to schedule. This can be done singly with the HBV monovalent vaccination or in combination with other vaccines (pentavalent, hexavalent etc.) Babies born to mothers that are hepatitis B positive should follow up with post-serologic testing at 9 months or a year to ensure the baby is protected against the hepatitis B virus.

There is no second chance to protect a newborn or baby from hepatitis B!

If a child, adolescent or adult missed the hepatitis B vaccine, they can be vaccinated at any time. For adults, it is never too late to start the hepatitis B vaccine (unless you are already infected with the hepatitis B virus, or have recovered from a past infection).

For more information on hepatitis B vaccine in babies or children, consult the “Summary of Recommendations for Child/Teen Immunization.” For more information on hepatitis B vaccine in adults, consult CDC’s Recommended Adult Immunization Schedule.

Be sure to talk to your doctor about getting the hepatitis B vaccine (if you have not already). Not only does it protect against hepatitis B, but also hepatitis D and help prevent liver cancer!

References:

https://medgenomelabs.wordpress.com/2015/11/10/world-immunization-day/

Navigating Our Emotions When We’re First Diagnosed with Hepatitis B

Image courtesy of Pixabay

When we’re first diagnosed with hepatitis B, our physical health isn’t the only thing we need to focus on. Many of us experience powerful surges of fear, anger, sadness, powerlessness, depression, and anxiety.

No matter what you’re feeling, you have a right to feel whatever emotions are welling up – sometimes unexpectedly – inside you. There are no right or wrong feelings, they just are, and it’s up to you to decide what choices you make and how to respond to them.

When my daughter was first diagnosed, she was a toddler and happened to be coming down with a cold. I knew nothing about hepatitis B and was convinced she would soon die from it given her crankiness, lethargy, and nonstop sleeping.

Within a day or two, she was her smiling, energetic self again, and I happily slipped into denial. Surely the test was wrong or there was a mix-up in the result. My husband dragged his feet for weeks before he agreed to be screened for hepatitis B so great was his denial and fear.

Denial is a normal first reaction, it can give us some  breathing room to get used to the idea that we’re infected. But denial can also be dangerous, especially if we’re in a sexual relationship with someone and don’t take precautions. Denial can be dangerous when we hide our infection and don’t tell our family members or partners, even though they may have been exposed. Denial is dangerous when we don’t tell our parents, who may not know they’re infected and unknowingly passed the virus to us at birth.

It’s important to talk out our feelings with a doctor, a therapist, or a friend you trust. We need to move through denial so we can begin to receive the care and support we need, and talk to others who may also be at risk.

Anger is another common and natural feeling after a diagnosis. It’s OK to get upset about how we or our family members were infected, or get angry that our parents or lovers didn’t know they had the virus and infected us. Try to talk about your anger with counselors or friends, get some exercise to work off your tension and avoid situations—including drugs or alcohol—that can ignite festering emotions.

It’s normal to feel sad, and sometimes the sadness doesn’t go away quickly. If you feel prolonged sadness, anxiety, or fear, or find you’re gaining or losing weight or sleeping more or less than usual, it’s time to talk to someone who can help.

Fear and anxiety are common because we don’t know what’s going to happen next. If you’ve just been diagnosed, you may have to wait six months for another test to show whether you were recently infected and have acute (short-term) or were infected as a child and have chronic (long-term) hepatitis B. That wait can be insufferable.

Our stress can cause a host of physical symptoms, ranging from headaches to fatigue, that may have nothing to do with hepatitis B. It’s important to talk to your doctor about these symptoms so you know what is hepatitis B-related, and what’s caused by worry and fears.

At this early stage, many of us want to get rid of the virus as soon as possible and we’re willing to try any supplement or treatment available, even if our doctors tell us we’re healthy and don’t need any treatment. At this early diagnosis point, we just need to take care of ourselves, eat healthy foods, avoid alcohol and cigarettes, and get monitored regularly, even though what we really want is a magic pill that will make this infection go away.

In normal grief cycles, there is a point of acceptance. But I’m not sure we totally ever accept this loss of our “perfect” health, and our ability to have sexual relations, give birth, or drink a glass of wine without thinking of the shadow hepatitis B casts over these activities.

As a wise friend has pointed out, we need to accept that hepatitis B is part of us, but it doesn’t have to define us. Perhaps getting to that realization is the journey we begin when we read that first lab report and hear the diagnosis.

For support and information from other people living with hepatitis B, join the Hepatitis B Information and Support Email List at  http://hblist.net

The 3-Shot Hepatitis B Vaccine – Do I Need to Restart the Series if I Am Off the Recommended Schedule?

The Hepatitis B vaccine is a safe and effective 3-shot series that protects against the hepatitis B virus.  If you do not have a current hepatitis B infection, or have not recovered from a past infection, then hepatitis B vaccination is an important way to protect yourself. The recommended schedule for the hepatitis B vaccine is to receive the first shot, followed in one month by the second shot.  Six months following the first shot, you should receive your third and final shot of the series.

If you wish to ensure you have generated adequate immunity, and are protected, you can have your anti-HBs (HBsAb) titres checked 4-8 weeks following the last shot of the hepatitis B vaccine series.  If your titer is greater than 10 mIU/mL, then you have adequate immunity which is thought to confer lifetime immunity, but studies so far show 30 years.  This is because these studies are on-going!

Please note that checking anti-HBs titres is not generally recommended for all vaccine recipients, with the exception of those that are at greater risk of infection.   This includes but is not limited to health care workers, those with sexual partners with hepatitis B, and those living in a household where someone is infected. Talk to your doctor if you think you might be at higher risk and need to have your titres checked.

So what happens if you go for shot one, followed by shot two in a month, but you never get to shot three?  The minimum length of time between the three shots in the series is 0, 1 month, and 6 months.  There is an accelerated schedule, but this is the schedule recommended for the shortest amount of time, with the best immune response for the general population.  However, if you don’t get to shot three of the series for another two years, or if you never got to shot two, you can resume right from where you left off, and continue without the need for repeating the series.

Here is a rule to remember the minimum time in between shots in the series:

Dose 2 should be separated by dose 1 by at least one month (4 weeks or 28 days)

Dose 3 should be separated by dose 2 by at least 2 months (8 weeks) AND from dose 1 by at least 4 months (16 weeks).

Keep in mind that the goal is to get people protected in the shortest amount of time, with the fewest number of doses. If you do not complete the series, you will not have adequate, longterm protection from hepatitis B.

What happens if you don’t have your vaccine records, and you have no idea if you ever got shot 1 or 2, and you just want to repeat the series? There is no concern with repeating the HBV vaccine series, so if you are unsure, please start the series from shot 1.

Be sure you and your loved ones vaccinated are against hepatitis B so you can be hepatitis B free for life!

Hepatitis B Foundation Mini-Grantees 2016

At the Hepatitis B Foundation, we have many research and programs throughout the year. With the Association of Asian Pacific Community Health Organizations (AAPCHO), we co-founded and co-chair Hep B United, a national coalition dedicated to reducing the health disparities associated with hepatitis B by increasing awareness, screening, vaccination, and linkage to care for high-risk communities across the United States. The coalition works to reduce the impact of hepatitis B through prevention and education efforts, addressing perinatal transmission, improving screening and linkage to care, contributing to national surveillance data, and advocating on a national level.

Last year, the Hepatitis B Foundation offered mini-grants for one year to Hep B United coalition partners working on hepatitis B education, screening and linkage to care activities. These grants ranged between $5,000 to $10,000 each. The mini-grants were offered to enhance the capacity of Hep B United coalition partners to conduct HBV education, testing and linkage to care in their local Asian American, Native Hawaiian and Pacific Islander (AA & NHPI) communities to advance the hepatitis B priority areas of the U.S. Department of Health and Human Services’ National Viral Hepatitis Action Plan (VHAP).

Courtesy of CPACS

The 2016-17 project year offered grants to 9 coalition partners, which included Center for Pan Asian Community Services, Inc (CPACS), Hepatitis B Initiative-Minnesota (HBI-MN), Midwest Asian Health Association (MAHA), Hepatitis B Initiative-DC (HBI-DC), Asian Services in Action (ASIA), Asian American Community Services (AACS), Asian Pacific Health Foundation (APHF), and HOPE Clinic. Together, Hep B United coalition partners screened 4,649 people, educated and reached out to 11,884 people, and distributed 13,112 handouts. Some coalition partners were featured in  newspapers, on TV with 496,189 views, and in a social media video. Mini-grantees also participated in activities such as developing key partnerships in local communities, providing linkage to care, and conducting provider training. One coalition partner also screened the “Be About It” documentary.

For 2017-2018 mini-grants, six Hep B United coalition partners (listed below) were recently awarded mini-grants. We are excited to kick off these projects and look forward to their future endeavors and results.

·     Asian American Community Services (Columbus, OH) -AACS’ Live Healthy – Hep Free project will use the H+EAL model to increase HBV education and awareness and encourage testing by targeting high school students and their parents.

·       Asian Pacific Community in Action (Phoenix, AZ) – APCA will be organizing community town hall events in collaboration with the #justB campaign across Maricopa County to collect and share stories that promote increased awareness and proactive approaches to treatment for hepatitis B.

·       Asian Pacific Health Foundation (San Diego, CA) – APHF will be working to increase community knowledge and awareness of hepatitis B, determine gaps in knowledge, develop in-language education materials, and provide hepatitis B screening within high-risk communities throughout San Diego.

·       Asian Services in Action (Cleveland, OH) – ASIA will be using community health outreach workers to increase HBV education and screening, including outreach to AAPI businesses in Akron and Cleveland, OH.

·       Center for Pan Asian Community Services (Atlanta, GA) – CPACS’ project focuses on expanding their Atlanta-based hepatitis B coalition, increasing the number of Georgia AAPI community members who know their HBV status through community and provider education, and improving testing and linkage to care services throughout the city.

·       Philadelphia Department of Public Health (Philadelphia, PA) -The Perinatal Hepatitis B Prevention Program auxiliary project will create new education modules for prenatal and pediatric care and conduct on-site provider education sessions to improve knowledge and care for infected mothers.

The 2017-18 project period expanded its priorities to address perinatal transmission and education through storytelling efforts with the #JustB Storytelling Campaign in addition to screenings and linkage to care.   The overall success of the Hep B United mini-grants has been proven through the significant number of high-risk populations educated, screened and linked into appropriate care for hepatitis B.   We look forward to updating you further in the coming months as we continue to highlight the national work of the Hepatitis B Foundation and Hep B United partners around the U.S.

October is Liver Cancer Awareness Month! What’s the Hep B Connection?

Liver Cancer Ribbon

According to the World Health Organization (WHO), liver cancer is the second most common cancer in the world, leading to 788,000 annual deaths worldwide. Most liver cancer cases occur in developing countries. More than 80 percent of these cancers are found in sub-Saharan Africa and Eastern Asia where more than 20 of every 100,000 people will suffer and die from liver cancer. However, liver cancer is alarmingly on the rise in developed countries, as well. In a recent study, researchers from The American Cancer Society found that liver cancer is the fastest-growing cause of cancer deaths in the United States. Only 20 percent of people diagnosed with liver cancer survive beyond five years, and the number of deaths have doubled since the mid-1980s, and they are expected to continue to rise.

Why is liver cancer growing in most of the world? There are many risk factors for liver cancer, but chronic hepatitis B accounts for up to 60% of liver cancer and is the most common risk factor for this type of cancer. People who are chronically infected with hepatitis B are 100 times more likely to develop liver cancer compared to those who are not. The hepatitis B virus attacks the liver directly and repeatedly over time. This can lead to liver damage and scarring of the liver (or cirrhosis); which greatly increases the risk of liver cancer.

Sometimes, people with hepatitis B can develop liver cancer even when they do not have cirrhosis. There are a number of complicating factors which can  increase the risk of liver cancer including traits specific to the virus and the person and their health status, which should be discussed with a liver specialist to determine when you should initiate screening.

Forms

How many years have you had hepatitis B? The longer you’re infected, the higher your risk of liver cancer.

What is your gender? Men are considered at higher risk of liver cancer and may be screened starting at an earlier age because they may be more likely to smoke, drink alcohol, have more “active” hepatitis, and higher iron stores—all of which increase cancer risk. Estrogen is believed to protect pre-menopausal women against liver cancer.

Have you had a high viral load (HBV DNA) after age 30? Having a viral load exceeding 2,000 international units per milliliter (IU/mL) is associated with a higher risk of liver cancer even if you have no other signs of liver damage.

Do you have a family history of liver cancer? If an immediate family member has had liver cancer, this greatly increases your risk.

Are you overweight, or have you been diagnosed recently with type 2 diabetes? A fatty liver and/or diabetes increase your risk of liver damage and cancer dramatically when you’re also infected with hepatitis B.

Do you have hepatitis B virus genotype C or core/precore viral mutations? Originating in Asia, this hepatitis B strain is associated with loss of the hepatitis B e antigen (HBeAg) later in life. That means you may have had a high viral load and liver damage for a longer period than people with genotypes who clear HBeAg at a younger age. Having core or precore mutations in your HBV also increase liver cancer risk.

If you are living with chronic hepatitis B and are concerned about liver cancer, there are steps you can take. Working with a good health care provider to manage your hepatitis B is important, as is having a healthy lifestyle. Talk to you doctor about your risk, and about getting screened for liver cancer at least annually – early detection saves lives!

To commemorate Liver Cancer Awareness Month this October, help us spread the word about the link between hepatitis B and liver cancer! You can also join our Twitter Chat on Thursday, October 12th at 2:00pm – along with our partners CDC Division of Viral Hepatitis, and the National Alliance of State and Territorial Aids Directors (NASTAD). To join the chat, use the hashtag #liverchat. For more information, visit our blog post.

Remember to talk to your doctor about the risk factors for liver cancer, and if you have hepatitis B, ask to get screened for liver cancer. For more information about liver cancer visit the Liver Cancer Connect website.

Who is Ted Slavin? #virusappreciationday

“We will long remember Ted Slavin as a gallant man who loved life and who contributed greatly to our research efforts”

-Baruch S. Blumberg, Irving Millman, W. Thomas London, and other members of the Division of Clinical Research Fox Chase Cancer Center, 19851

Baruch S. Blumberg

“Who is Ted Slavin? Why haven’t I heard about him before?” crept into my mind as I was reading The Immortal Life of Henrietta Lacks. Rebecca Skloot wrote a short snippet about Ted Slavin, detailing the story of a hemophiliac who sold his antibodies and aided Dr. Baruch Blumberg in the discovery of the link between the hepatitis B virus and liver cancer, which eventually led to the first hepatitis B vaccine.2 I was surprised that I had never heard of him, and that his name was not enshrined on the walls of the Hepatitis B Foundation. I see the smiling and jovial face of Dr. Blumberg nearly every time I walk into the office, but never the image of a man who contributed so much to his efforts.

Blood Serum

Ted Slavin developed antibodies against hepatitis B after receiving infected blood transfusions to treat his hemophilia. The blood he received back in the 1950s was not screened for any diseases. His doctor helped him realize that his blood was valuable because of the copious amounts of antibodies for hepatitis B. At the time, those antibodies were a hot commodity as scientists were conducting research to learn more about hepatitis B prevention and treatment. Slavin decided to the sell his antibody-rich blood and even donated his blood to Dr. Blumberg’s research team at Fox Chase Cancer Center. He later formed Essential Biologicals, a company that collected blood from others like him. They were everyday patients who could turn their rare or unique blood into money making products, while at the same time advancing important research into diseases that were not well understood.2

As I read the brief overview of Slavin’s life, I initially perceived him as someone who was both lucky and smart: Slavin was lucky because his doctor gave him information on the value of his antibodies2; and smart because he knew how to make the best of something once considered a burden in his life.3 As I did a little more detective work, I realized Ted Slavin was not just a guy who made money off his cells, but someone who contributed to the fight against the hepatitis B virus, which I am passionate about!

My detective work led me to a deeper understanding of Mr. Slavin and his contribution to important milestones on the road to hepatitis B elimination.3,4,5,6,7 I found discussions and case studies on the ethics associated with his circumstance. Through my research journey, I learned more about him and my perception of Slavin started to change. He was, like many, struggling to make ends meet. He didn’t entirely profit off his antibodies because he donated a majority of the money he made to advance scientific research.4 At the same time, Slavin was “hopeful for a cure,” and he trusted Dr. Blumberg, his favorite researcher among the many studying hepatitis B, with his antibodies.1 To Dr. Blumberg and the researchers working with him, Ted Slavin was a brave, courageous man who helped save millions of lives.1

The story of Ted Slavin, like that of Henrietta Lacks, is not only a reminder of the importance of bioethics and the need for public health and scientific research; his story reminds us there is an invisible face behind every success. Because of Ted Slavin, there are tests to diagnose hepatitis B, ways to detect liver cancer linked to hepatitis B, and the first cancer preventative vaccine!

For more information about the hepatitis B vaccine, please visit our website here.

For helping looking for the hepatitis B vaccine, you can go  here or to the HealthMap Vaccine Finder.

 

References:

  1. Lavin, EFS. (2013). Exploring Life and Death at the Cellular Level: An Examination of How Our Cells Can Live Without Us. Quadrivium: A Journal of Multidisciplinary Scholarship, 5(1),
  2. Skloot, R. (2010). The Immortal Life of Henrietta Lacks. Crown Publishing Group.
  3. Ted Slavin’s Story and more. Retrieved from: http://tissuerights.weebly.com/ted-slavin.html
  4. Skloot, R. (2006, Apr 16). Taking the Least of You. The New York Times Magazine. Retrieved from: http://www.nytimes.com/2006/04/16/magazine/taking-the-least-of-you.html
  5. Angsana T. (2010, Nov 9). Second Story from Ted Slavin. Retrieved from: http://angsanat.blogspot.com/2010/11/second-story-from-ted-slavin.html
  6. C, Anna. (2012, Jul 26). World Hepatitis Day: The History of the Hepatitis B Vaccine. Retrieved from: http://advocatesaz.org/2012/07/26/world-hepatitis-day-the-history-of-the-hepatitis-b-vaccine/

 

Reduce Liver Cancer Risk and Join a Liver Cancer Awareness Twitter Chat Oct. 12

On Thursday, Oct. 12, representatives from Hepatitis B Foundation, CDC’s Division of Viral Hepatitis, and NASTAD (the National Alliance of State and Territorial Aids Directors) will co-host a twitter chat at 2 p.m. EST using the hashtag #liverchat.

Also participating is special guest Katherine McGlynn, PhD of the National Cancer Institute. Dr. McGlynn is a Senior Investigator at the National Cancer Institute, Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch. She is a researcher and expert in hepatocellular carcinoma.

Below are questions scheduled to be discussed during the chat. How can you contribute to the conversation?  Share any resources or strategies you have that raise awareness and improve liver cancer surveillance. Join the conversation with the hashtag #liverchat.

Q1: What is primary liver cancer and why is raising awareness so important?

Q2: What are the risk factors for liver cancer and why should people with viral hepatitis worry?

Q3: What are some strategies to help prevent viral hepatitis and liver cancer?

Q4: What are the barriers that keep people from getting screened for hepatitis and liver cancer and how can they be addressed?

Q5: What can people living with chronic hepatitis B and C do to protect their liver health and prevent liver cancer?

Q6: Why are some populations more vulnerable to viral hepatitis and liver cancer, and how do we address the disparities?

Q7: What can we do to raise awareness & educate vulnerable communities about viral hepatitis and its link to liver cancer?

Q8: What resources are available to learn more about viral hepatitis and liver cancer?

Co-hosts and special guests for the chat include:

  • Hepatitis B Foundation – @hepbfoundation
  • NASTAD – @NASTAD
  • CDC Division of Viral Hepatitis – @cdchep
  • CDC Cancer – @cdc_cancer
  • Dr. Katherine McGlynn – National Cancer Institute, Division of Cancer Epidemiology and Genetics – @NCIEpiTraining
  • CDC National Prevention Information Network (CDCNPIN) will be moderating the chat – @cdcnpin

Confirmed participants and their handles include:

  • National Viral Hepatitis Roundtable – @NVHR1
  • Hep B United  – @hepbunited
  • Coalition Against Hepatitis For People of African Origin – @CHIPO_HBV
  • Hep B United Philadelphia – @HepBUnitedPhila
  • Liver Cancer Connect – @livercancerconn
  • Hep Free Hawaii – @hepfreehawaii
  • Hep Free NYC – @hepfreenyc

Just getting started with Twitter? Want to know how to join the conversation?  Type #liverchat in the search box of the Twitter application to follow the chat, and click on “Latest”.

 

 

 

 

 

 

 

 

You can prepare your tweets in response to the topics listed above in advance, or you can also tweet on the fly, re-tweet, or Like a tweet from the chat.

The questions are labeled Q1, Q2, etc. so please respond/answer specific question by using A1, A2, etc. in front of your tweets. Remember to include the #liverchat hashtag, which is not case sensitive, in all of your tweets.

If you plan to participate, please contact us at info@hepb.org and we’ll add you to the list of confirmed participants. Let us know if you have any other questions about joining the chat.

2017 Commemoration of National African Immigrant and Refugee HIV & Hepatitis Awareness (NAIRHHA) Day

On Wednesday, September 13th, the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, Hepatitis B Foundation, and Coalition Against Hepatitis for People of African Origin (CHIPO) commemorated NAIRHHA Day by hosting a webinar discussing “Barriers and Strategies to Addressing HIV and Hepatitis B among African Immigrants: A NAIRHHA Day Webinar.” More than 100 people participated in the webinar. The majority represented government agencies and community-based organizations. This year is particularly exciting because lead organizers also submitted a request to HIV.gov (formerly AIDS.gov) to officially recognize NAIRHHA Day on Sept. 9th as a federal HIV awareness day for African immigrants and refugees in the U.S.

As discussed during the commemorating webinar, there is growing data related to the disproportionate impact of hepatitis B, as well as HIV on African immigrants in the US. African immigrants are underdiagnosed due to lower screening rates and present at a later stage of the disease compared to the general US population. Stigma is seen as the major barrier. In addition, the lack of knowledge about transmission, disease prognosis and treatment are widespread, reducing the likelihood that individuals will seek out testing and treatment services.

NAIRHHA Day was launched in 2014 in an effort to address these issues. It is a joint venture organized by the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, Hepatitis B Foundation, and Coalition Against Hepatitis for People of African Origin (CHIPO). As explained by Chioma Nnaji, Director at the Multicultural AIDS Coalition – Africans For Improved Access (AFIA) program, “Several of the current awareness days are inclusive of African immigrant communities, but do not comprehensively address their unique social factors, cultural diversity as well as divergent histories and experiences in the US.”

In addition to providing an overview on HIV and HBV epidemiological data, the webinar highlighted findings from two national initiatives. A recent project lead by The Hepatitis B Foundation and Coalition Against Hepatitis for People of African Origin (CHIPO) was funded by the Centers for Disease Control and Prevention (CDC) to better understand the individual, interpersonal, community, and society‐level barriers and facilitators associated with HBV screening, vaccination and linkage to care among African immigrant communities in the US. This project established a 14-member African Immigrant Advisory Board representing non‐profit leaders, community health educators, academics/researchers, government partners, clinicians across 8 states. Through focus groups, interviews and in-person meetings, the Advisory Board documented cultural and religious beliefs, and the complexity of the US healthcare system as major barriers to hepatitis B testing and linkage to care. The Advisory Board also identified approaches to help overcome these barriers, such as working with trusted community leaders, using storytelling, and finding ways to incorporate Western medicine into traditional medicine practices. Next steps will include working with coalition members around the U.S. to develop specific hepatitis education and screening projects that incorporate these strategies.

The webinar also highlighted the Tulumbe! Project. Tulumbe is a Luganda word (language spoken in Uganda) that means, “Let us engage.” The Tulumbe! Project is funded by the Pipeline to Proposals Award under Patient Centered Outcome Research Institute (PCORI) to engage diverse stakeholders in defining areas of need and priorities in HIV services for African immigrants, and identify research topics important to the African immigrant community, African immigrants living with HIV, providers and other stakeholders. Pipeline to Proposals Award funds three tiers of awards that help individuals or groups build community partnerships, develop research capacity, and hone a comparative effectiveness research question that could become the basis of a research funding proposal to submit to PCORI or other health research funders. For more info: https://www.pcori.org/research-results/2017/tulumbe-project-tier-ii

Overall, NAIRHHA Day provides a means for organizations, providers, communities, families, and individuals to:

  • Raise awareness about HIV/AIDS and viral Hepatitis to eliminate stigma
  • Learn about ways to protect against HIV, viral Hepatitis and other related diseases
  • Take control by encouraging screenings and treatment, including viral Hepatitis vaccination
  • Advocate for policies and practices that promote healthy African immigrant communities, families, and individuals

Recognizing September 9th as National African Immigrant & Refugee HIV/AIDS and Hepatitis Awareness Day (NAIRHHA Day) is an important step to addressing issues of HIV and viral hepatitis in the African immigrant community in a culturally and linguistically appropriate way. We are asking you to speak out and support federally recognizing NAIRHHA Day on Sept. 9th by contacting:

  • your local health departments
  • local and national HIV and hepatitis organizations
  • the HIV.gov Team at @HIVGov

Facebook: https://www.facebook.com/NAIRHHA

Twitter: @NAIRHHADay

Who’s at Risk for Hepatitis B? Learning the Hep B Basics

 

Are you or someone you know at risk for hepatitis B? You might be more at risk than you think, and since hepatitis B is vaccine preventable, it makes sense to get tested and vaccinated for HBV.  Hepatitis B is the number one cause of liver cancer worldwide. The survival statistics for liver cancer are particularly grim, with a relative 16,6% 5-year survival rate.  The hepatitis B vaccine also protects against hepatitis delta, the most severe form of viral hepatitis.

It is important to note that everyone is susceptible to hepatitis B. It does not discriminate.  It infects, babies, children, teens, adults and seniors. It has no racial or religious bias, though it is certainly more prevalent among certain ethnic groups –mainly because it is endemic to the homelands of these communities. For example, if you look at the prevalence map for hepatitis B, you will see that in most of the world, hepatitis B is at an intermediate, (2-7%) or high HBsAg prevalence (>8%) level.  Looking at the numbers, 2 billion people in the world, that’s 1 out of 3 people, have been infected with HBV and 257 million are chronically infected. That represents three-quarters of our world. Even if you aren’t living in these parts of the world, you may be traveling to some of these areas for work or pleasure, or perhaps your parents and other family members were born in HBV endemic areas.  Since there are often no symptoms for HBV, and screening and vaccination may be lacking in some populations, HBV is transmitted from one generation to the next, with many completely unaware of their HBV status – until it’s too late.

People at risk for hepatitis B include the following: (not noted in a particular order)

  • Health care providers and emergency responders due to the nature of their work and potential for exposure.
  • Sexually active heterosexuals (more than 1 partner in the past six months)
  • Men who have sex with men (MSM)
  • Individuals diagnosed with a sexually transmitted disease (STD)
  • Illicit drug users (injecting, inhaling, snorting, pill popping)
  • Sex contacts or close household members of an infected person (remember, you may not know who is or is not infected)
  • Children adopted from countries where hepatitis B is common (Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East) and their adopted families
  • Individuals emigrating from countries where hepatitis B is common (see above)
  • Individuals born to parents who have emigrated from countries where hepatitis B is common (see above)
  • ALL pregnant women – because infants are so vulnerable to HBV (90% of infected infants will remain chronically infected, and HBV is very effectively transmitted from infected mother to baby.)
  • Recipients of a blood transfusion before 1992
  • Recipients of unscreened blood and blood products – sadly an issue in many parts of the world.
  • Recipients of medical or dental services where strict infection control practices are not followed – sadly another issue in parts of the world.
  • Kidney dialysis patients and those in early renal failure
  • Inmates of a correctional facility
  • Staff and clients of institutions for the developmentally disabled
  • Individuals with tattoos and body piercings performed in a parlor that does not strictly adhere to infection control practices – it may be up to you to ensure proper infection control practices are followed.
  • People living with diabetes are at risk if diabetes-care equipment such as syringes or insulin pens are inadvertently shared.

The good news is that hepatitis B is a vaccine preventable disease. There is a safe and effective, 3-shot HBV vaccine series that can protect you and your loved ones from possible infection with HBV.  The earlier you are vaccinated, the better. In the US, a birth dose of the vaccine is recommended for all infants, since these little ones are most vulnerable to hepatitis. (90% of infected infants will live with HBV for life). HBV vaccination doesn’t give you a free-pass from other infectious diseases such as HCV or HIV, both without vaccines, so strict infection control practices should still be followed. However, HBV is a tenacious virus that survives outside the body for a week and is 50-100 times more infectious than HIV  3-5 times more infectious than HCV.  Plus the HBV vaccine is actually an anti-cancer vaccine, so why not get vaccinated?

Hepatitis B isn’t casually transmitted, but in the right scenario, it is effectively transmitted. You may think that situation may never come about for you, or for your loved ones –especially your little ones who are so vulnerable to HBV. Some people travel to exotic lands with unsafe blood supplies and poor infection control practices, and sometimes they get sick, or require emergency dental or medical services, so they may be put at risk. Most people have had a lapse in judgment – sometimes it’s a one-time thing, sometimes it lasts for years, but the net-net is that it’s unusual to find someone who has not engaged in some sort of high-risk activity, whether intentionally or unintentionally. If you are properly vaccinated to protect against hepatitis B, you can cross that concern off your list.

B sure. Get screened. if you do not have HBV, get vaccinated and be hepatitis B free. If you discover you have HBV, talk to your doctor and have him refer you to a liver specialist who can better evaluate your hepatitis B status and your liver health.