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.
15. How do the hepatitis B therapies work?
17. What is needed to manage hepatitis B worldwide?