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1. What is the impact of hepatitis B in the US?

I think there's more and more interest and concern and emphasis on hepatitis B evolving currently. To follow up on the question of why people have been hung up on hepatitis C one concept is that the incidence of hepatitis C in the United States has been judged to be over four million people and the incidence of hepatitis B has been estimated at 1.25 million. There’s been some increased interest [in C] because the incidence is three times that of hepatitis B. Hepatitis B is a much larger worldwide problem than hepatitis C and is an incredibly important problem because of the high incidence of mortality from liver cancer which is a major cause of death across the world and one of the leading lethal cancers across the world. Hepatitis B is of increasing concern in the United States and there’s going to be increased concentration on it. One of the reasons is the Asian population, which is a big reservoir of hepatitis B, has increased tremendously in the United States. The estimate of 1.25 million people is probably underestimated. We have some data from very preliminary surveys that were done in Chinatown where we found as many as twenty-five percent of the population is infected with hepatitis B which actually interestingly enough is higher than the estimate for the infection in China itself. So, this is an increasing public health concern in the metropolitan areas. Its going to be the classical problem in the United States. In the major population centers on both coasts where the Asian population has increased significantly in the last few years, this is turning out to be a major problem. And you know how it goes in the United States, as the Asian population increases, obviously their importance as voters increases and I think the interests in this world [hepatitis B] will increase. The other point that Dr. London made is really that hepatitis C, in terms of increased incidence, is really a disappearing disease. Hepatitis C is basically going to run itself out of existence in the next twenty years because the main source of it was blood transfusions which are now tested and excluded and the number of new cases of hepatitis C has dropped from like hundreds and hundreds of thousands a year is now down to less than twenty thousand new cases a year year which really takes away from it as a new public health problem as an infectious disease. Of course, the reason that hepatitis C has garnered so much interest is that hepatitis C is a disease which evolves over twenty-five or thirty years. So the incidence of new cases of the disease has dropped incredibly and this will not be a public health problem in the future. Right now were seeing all the sequela of the people who contracted this twenty-five years ago and they are the ones who are developing cirrhosis, liver cancer, etc. and that’s the leading cause of liver transplant in the United States. Its sort of split between alcohol and hepatitis C. But this will diminish, well at first it will peak because there is still the people that contracted this before 1992. So if you think about it, in twenty-five years the peak of the problems from hepatitis C will peak around 2012 - 2020, but then it will be over. And then is when hepatitis B will be coming into its own and the number of these cases will be increasing. This disease is much more easily transmitted sexually than hepatitis C which is essentially non-transmissible sexually. So we haven’t eradicated the reservoir of the people here [in US] and you'll see that in order to eradicate this reservoir, were going to have many more extensive means.