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16. What should a community hepatitis B program look like?

In the last few slides we talk about how we can manage this disease in the world and in the community. In the vertical transmission that occurs in the Asian population, the mother has hepatitis B and when the child is born he/she catches the disease in the birth canal from the exposure to the blood and the child is then born with hepatitis B. A significant number of these people are born with hepatitis B that they’ve contracted in their immune incompetent state so it goes on to chronicity. This is really the core or the source of hepatitis B in the world for the most part even though it’s not in the Western countries where campaigns have been undertaken to inoculate the infant at birth to stop this vertical transmission. Taiwan is a classic example where programs were started because if you can inoculate the infant at birth, you can prevent eighty-five percent of this vertical transmission. So, ideally you want to go out and inoculate everyone born to a hepatitis B mother in the entire world. But if you stop to think about 350 million people, 175 million are women, this is a big project especially in underdeveloped countries. That’s what we sort of have to aim for. The other thing is that every child in the world should really be immunized against hepatitis B if they haven’t already contracted it from their mother. And you’d be surprised the number of people in the United States that aren’t immunized against hepatitis B. I'm always surprised with the number of dentists for example that aren’t immunized against hepatitis B because you think they’d be at high risk, but that’s the way it goes. We need a massive immunization program. That’s the way you’re really going to attack this disease. But you first have to find out who is immune and who is not immune because some people are naturally immune because they had an asymptomatic case of hepatitis B early in their life. And some people are already infected, so there’s no point in immunizing them. That was the basis of our program that we're going to undertake in Chinatown and the Asian population of New York. Try and test the population and see how many people need to be immunized and how were going to effectively immunize those who are either not infected or not immune. I put in the last bullet on this, adult populations especially in high risk groups such as Asian communities should be mass screened for hepatitis B infection, chronic hepatitis, cirrhosis, and liver cancer to find people who are sick and also to find people who need to be immunized.