Hep B Blog

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World Refugee Day!

June 20th is World Refugee Day! This day “celebrates the strength and courage of people who have been forced to flee their home country to escape conflict or persecution. World Refugee Day is an occasion to build empathy and understanding for their plight and to recognize their resilience in rebuilding their lives.”1

In 2020, the United Nations Refugee Agency estimates that 80 million people were forcibly displaced. A majority of refugees originate from Syria, Venezuela, Afghanistan, South Sudan, and Myanmar and are mostly resettling in countries like Turkey, Colombia, Pakistan, Uganda, and Germany.1

As individuals who are experiencing forcible displacement begin to resettle, it is important to encourage hepatitis B testing and vaccination, even though hepatitis B might be the last thing on their minds. It is important to keep health, and especially hepatitis B in mind because hepatitis B disproportionately affects people from the World Health Organization’s (WHO) African, Western Pacific, and Asian regions.

In South Sudan, hepatitis B accounts for 80% of the viral hepatitis cases. Moreover, Myanmar has a moderate to high burden, with 6.5% of the general population being infected with hepatitis B. It is imperative that testing and vaccination is encouraged in countries like South Sudan and Myanmar and in countries where people are resettling to not only prevent the spread of hepatitis B but also allow people living with hepatitis B who might not know it to live a long and healthy life. Additionally, it is important to note that the continuation of care for people experiencing forcible displacement is halted when resettling in different countries. This interruption can be damaging to individuals’ health, especially those living with hepatitis B as medication must be taken daily, and seeing a liver specialist should happen every 6 months.

However, some people who are in the process of resettling might be hesitant to get tested for hepatitis B. This can be due to a myriad of reasons like the cost of healthcare if they do test positive, access to quality healthcare, fear of stigma, and other cultural/language barriers.

So how can organizations encourage people experiencing displacement to get tested for hepatitis B? This answer is frankly too complicated and complex for a simple blog post, but here are a few suggestions for organizations.

  1. Utilize community health workers. Community health workers who are fluent in refugee languages and cultures can educate community members about preventative health measures. People might be more receptive to the information if someone familiar with the community is the educator.
  2. Reduce barriers to healthcare. Transportation sometimes is a barrier for individuals experiencing resettlement. Offering transportation to and from healthcare clinics can greatly increase access to quality healthcare. Furthermore, when the individual arrives at their healthcare facility, they must have an interpreter if they do not speak the local language or go to a provider who speaks their native language.
  3. Use culturally sensitive educational materials. Using materials in languages other than English is so important to effectively communicate health information about hepatitis B! The Centers for Disease Control and Prevention (CDC), has their Know Hepatitis B Campaign where you can access FREE multi-lingual hepatitis B educational materials.

Reference:

  1. https://www.unhcr.org/en-us/world-refugee-day.html

Happy Pride Month – HIV/HBV Co-Infection

 

June is Pride Month in the United States! This month we celebrate the LGBTQ+ community in honor of the 1969 Stonewall Uprising in Manhattan. This blog post will discuss HIV/HBV coinfection in LGBTQ+ individuals and how to prevent both viruses.

HIV/HBV Co-Infection

Human Immunodeficiency Virus or HIV disproportionately affects LGBTQ+ individuals, mostly gay and bisexual men. In the United States, approximately 69% of the 37,968 new HIV cases were among gay and bisexual men in 2018. HIV can also impact lesbian women, although the infection rate among this community is lower. There is also very limited current data out about lesbian and bisexual women and the burden of HIV. However, HIV can be transmitted between women who have sex with women through sex toys and injection drug use. The CDC reports 1 million people have identified as transgender in the United States, and 2% of those individuals are affected by HIV.

Approximately 5-20% of the HIV-infected population worldwide is also living with hepatitis B. These rates vary among different regions and at-risk populations based on modes of transmission. This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe. In the U.S., Western Europe, and Australia, the prevalence of chronic hepatitis B was reported to be 5%-14% among HIV-positive individuals.

Since both HIV and the hepatitis B virus share similar transmission routes, it is not surprising that there is a high frequency of coinfection. Sexual activity and/or injection drug use are the most common routes of transmission of the hepatitis B virus among those also infected with HIV.

Prevention

You can easily prevent hepatitis B with a safe and effective vaccine. The vaccine comes in either 2 or 3 doses, given over a span of 6 months. Learn more about the vaccine dose schedule here!

If you are not vaccinated for hepatitis B, ask your doctor or primary care provider for the vaccination! Check out this list of LGBTQ+ friendly providers.

If you are unsure of your hepatitis B status, ask your doctor or primary care provider to become tested! The hepatitis B test is super simple – it only requires one blood sample. Your doctor should order the “hepatitis B panel” which includes different tests. Read more hepatitis B testing here!

You can lower your risk of acquiring HIV by using PrEP (pre-exposure prophylaxis). PrEP is a daily medication you can take to prevent HIV. Just make sure you are tested for hepatitis B before starting PrEP. Read more about PrEP here!

 

Author: Evangeline Wang

Contact Information: info@hepb.org

Happy Hepatitis Testing Day

May 19th is national Hepatitis Testing Day! Today we raise awareness about viral hepatitis and encourage people to know their status. More than half of the people living with viral hepatitis in the U.S. do not know their status, so if you do not know your status, get tested!

Since 2013, the United States has officially observed May 19th as Hepatitis Testing Day. With over 2.4 million people living with chronic hepatitis B in the United States and 300 million people living with it globally, it is so important to know your status! Additionally, hepatitis B is known as a “silent infection” which means that you do not know you have the disease until it has done major damage to your liver. Luckily, with hepatitis B testing, you can find out your status and take control of your health!

Hepatitis B Testing

The hepatitis B test is a simple blood test that can be done at your doctor’s office or local care clinic. The hepatitis B blood test requires only one sample of blood and your health care provider should order the “Hepatitis B Panel,” which includes three parts. You and your health care provider will need to know all three test results in order to fully understand whether you are infected, protected or still at risk for a hepatitis B infection. Remember to ask for a copy of your hepatitis B blood test results so that you fully understand which tests are positive or negative.

Interpreting Results

Your results should include HBsAg (hepatitis B surface antigen), HBsAb (hepatitis B surface antibody), and HBcAb (hepatitis B core antibody). Below is a chart to help you interpret your results!

Newly Diagnosed

Here are some next steps if you have received your test results and tested positive for hepatitis B. The first thing you should know is that you can live a long and healthy life.

Next Steps:

  1. Understand your diagnosis. Do you have an acute or chronic infection? When someone is first infected with hepatitis B, it is considered an acute infection. Most healthy adults who are acutely infected are able to get rid of the virus on their own. If you continue to test positive for hepatitis B after 6 months, it is considered a chronic infection. Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. If you are unsure of what your blood test results mean, you may find Understanding Your Blood Tests helpful.
  2. Prevent the Spread to Others. Hepatitis B can be transmitted to others through blood and bodily fluids, but there is a safe and effective vaccine that can protect your loved ones from hepatitis B. You should also be aware of how to protect your loved ones to avoid passing the infection to family and household members and sexual partners.
  3. Find a Physician. If you have been diagnosed with chronic hepatitis B, it is important to find a doctor that has expertise in treating liver disease. We maintain a searchable physician directory database to help you find a liver specialist near you.
  4. Educate Yourself. Get the facts about hepatitis B, including what it is, who gets it, and possible symptoms, starting with What is Hepatitis B.
  5. Seek Support. It might be helpful to you if you seek community support. You can join Hep B Community, an online global forum dedicated to supporting people affected by hepatitis B. The Hepatitis B Foundation also lists more support groups you can check out here .

 

Author: Evangeline Wang

Contact Information: info@hepb.org

Hepatitis B Discrimination Registry

 

Despite almost 300 million people living globally with the world’s most common liver infection, hepatitis B remains stigmatized and those living with it can still face discrimination from various sources. Each year, the Hepatitis B Foundation answers numerous calls from around the world from people who have faced school, workplace, and travel challenges due to their hepatitis B status. These challenges are typically rooted in misinformation, outdated laws or guidelines, stigma, and an overall lack of awareness.

The Hepatitis B Foundation has been a longtime advocate of people living with hepatitis B. In fact, our advocacy successfully made hepatitis B a protected condition under the Americans with Disabilities Act (ADA) in the United States. We also support programs to fight discrimination faced by people living with hepatitis B when applying to schools, jobs, or accessing affordable medicine.

We also compiled a report called “Health Insurance Costs Impacting Shoppers Living with Hepatitis B (2020) to help people living with hepatitis B in the U.S. make informed decisions when choosing a health insurance plan. It can also be shared with policymakers to inform them of potentially discriminatory benefit plan designs in various states.

Most recently, Hepatitis B Foundation is excited to announce the launch of our discrimination registry! The purpose of this registry is to document and track discrimination related to hepatitis B.  Hepatitis B discrimination is described as unjust, unfair, or prejudicial treatment of persons on the basis of their hepatitis B status. In other words, being treated differently because of one’s hepatitis B infection. For someone with hepatitis B, this can mean exclusion, denying benefits, denied employment, education, training, goods or services, or having significant burdens imposed on an individual due to their infection status.

How to Share Your Experience

Use the registry link here and fill out the questions accordingly.

  1.  In the first section, we ask about your demographics which you can always select prefer not to answer for any of the questions.
  2. In the second section, we ask about your hepatitis B discrimination experience. In the third section, we offer additional support.
  3.  If you are located in the United States and are experiencing discrimination due to your hepatitis B status we can assist you to file a claim with the Department of Justice.

Other Discrimination Resources

Check out our Know Your Rights page. This page will help guide you through steps if you are experiencing discrimination in various institutional settings.

We have sections for:

  1. U.S. Schools and Education
  2. U.S. Employment
  3. U.S. Military
  4. U.S. Access to Medication
  5. Immigrant and International Issues

If you have any questions or concerns please email discrimination@hepb.org

Author: Evangeline Wang

Contact Information: info@hepb.org

May is Hepatitis Awareness Month!

May is Hepatitis Awareness Month! This month, we bring awareness to the public health impact of viral hepatitis in the U.S., and the health consequences of hepatitis B and C infections if left untreated.

Globally, hepatitis B virus (HBV) affects 2 billion people and in the U.S. an estimated 2.4 million people are living with a chronic hepatitis B infection. Hepatitis B is often called the “silent killer”, as people often do not realize they are infected with hepatitis B until their liver is severely damaged, which makes it vital that the month of May is dedicated to raising awareness of hepatitis B. Because chronic hepatitis B infection is the most common risk factor for liver cancer, it is critical that we improve awareness on how to prevent, diagnose and treat hepatitis B. Individuals chronically infected with hepatitis B have a 25% to 40% lifetime risk of developing liver cancer. However, it is important to note that with proper testing and treatment, people living with hepatitis B can reduce that risk and live a long and happy life.

This month we look forward to encouraging all adults in the U.S. to get tested for hepatitis B with a simple blood test, and get vaccinated with a safe and effective vaccine if they are not yet protected or infected.  Thank you for helping us bring awareness to hepatitis B this May!

Resources For Patients

The Hepatitis B Foundation has multiple resources for patients you might not be aware of. Below is a small list you should check out!

  • Hep B Community
    • A new global online support group.
  • Physician Directory
    • Find knowledgeable doctors! The Hepatitis B Foundation has created a directory of liver specialists to help those seeking qualified medical care. The specialists have agreed to be included in this directory and treat chronic hepatitis B and/or liver cancer and are willing to be contacted for further information.
  • B Heppy
    • A podcast discussing all things hepatitis B-related. Our first episode discusses the COVID-19 vaccine and people living with hepatitis B.
  • Liver Q’s Video Series on Hepatitis B
    • These short video clips answer some frequently asked questions about hepatitis B.
  • Clinical Trial Locator
    • Volunteering for a clinical trial program can be very valuable. Expensive blood work, treatment medications, and doctor’s visits are usually provided free of charge for those accepted into a study. Clinical trials also provide the opportunity to potentially benefit from the latest advances in medical science.

Check out our website for more!

Resources For Providers

  • CDC’s Hepatitis Awareness Month Social Media Toolkit
  • Hep B United’s and CDC’s Know Hepatitis B Social Media Templates
    • The Know Hepatitis B campaign provides translations in multiple languages like Arabic, Amharic, French, and Swahili, Chinese, and Vietnamese.
  • Hep B United Philadelphia’s Provider ECHO
    • The goal of the Hepatitis B ECHO is to expand provider capacity at the primary care level to diagnose, treat and manage hepatitis B. Each ECHO session will include one case discussion and a 15-minute didactic aimed to empower providers to manage hepatitis B.
  • Webinar: Educational Resources for African Communities
    • Panelists from the Centers for Disease Control and Prevention (CDC) and the African Services Committee will discuss Know Hepatitis B campaign resources for community health workers working within African communities and community-based hepatitis B prevention initiatives. Additionally, hepatitis B activist and storyteller Bright Ansah will share his personal experiences with hepatitis B and highlight the need for greater awareness, education, and resources about hepatitis B in African communities.

April 30 is National Adult Hepatitis B Vaccination Awareness Day

The Need for an Adult Hepatitis B Vaccination Awareness Day

 In 2019, the hepatitis B community successfully advocated for the introduction of U.S. House and Senate resolutions to designate April 30th as National Adult Hepatitis B Vaccination Awareness Day for the first time! Two years later, the Hepatitis B Foundation is proud to support this day and continue adult vaccination efforts as we gear up for May, Hepatitis Awareness Month.

On April 30th we bring awareness to adult hepatitis B vaccination efforts. Despite a safe and effective hepatitis B vaccine, only 25% of the U.S. adult population has been vaccinated, primarily due to people being born before the vaccine was universally recommended.1 New hepatitis B infections are highest among people aged 30-49 years because many people at risk in this group have not been vaccinated in spite of federal recommendations.

Acute hepatitis B cases are rising partially due to the opioid epidemic with the increase in injection drug use. Hepatitis B can be spread through needle sharing or unsterile drug injection equipment. Additionally, hepatitis B can be transmitted from mother-to-child, and about 1,000 newborns become infected   each year in the U.S..2 This statistic is concerning because mother to child transmission can be prevented in most cases with appropriate use of the vaccine. When exposed to the hepatitis B virus at birth, 90% of newborns will develop chronic life-long infection, putting them at much greater risk for cirrhosis and liver cancer.

Immunization rates also remain low among vulnerable populations including those living with other chronic conditions such as hepatitis C, HIV, kidney disease, or diabetes. In fact, just 12% of diabetic adults 60 years old or older are fully vaccinated, and 26% of diabetic adults ages 19-59 have received the complete vaccine series. Healthcare workers are an under-vaccinated vulnerable population as well. According to the Centers for Disease Control and Prevention, just 60% of healthcare personnel have completed their vaccine series. Get yourself vaccinated for yourself and your loved ones!

How to Become Vaccinated for Hepatitis B

In the era of COVID, we are reminded how important vaccines are. Make sure you and your loved ones are vaccinated for hepatitis B. If you are not vaccinated, ask your doctor or healthcare provider for the hepatitis B vaccine. This safe and effective vaccine is given in 2 or 3 doses depending on the vaccine:

The three-dose vaccine (scheduled at 0, 1 and 6 months):

  1. The first dose is administered at any time (newborns should receive their first dose in the delivery room).
  2. The second dose is administered one month after the first dose.
  3. The third dose is administered 6 months after the first dose.

Sometimes committing to a 3-dose shot is hard. Luckily, there is an approved 2-dose hepatitis vaccine, Heplisav-B, for adults in theU.S..

The two-dose vaccine:

  1. The first dose is administered at any time.
  2. The second and final dose is administered one month after the first dose.

More information on the dosing schedule can be found here.

You can show your support for National Adult Hepatitis B Vaccine Day by using the social media toolkit and hashtag #AdultHepBVaxDay on April 30th and when discussing the hepatitis B vaccine on social media! Graphics are also available to share throughout your networks.

Join the Hepatitis B Foundation and other leading hepatitis organizations for a Congressional Briefing on Thursday, April 29th at 3pm ET where a group of panelists will discuss how we can work towards achieving health equity by increasing adult hepatitis B vaccination rates.

References

  1. https://www.cdc.gov/hepatitis/populations/idu.htm
  2. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html

Author: Evangeline Wang

Contact Information: info@hepb.org

Hep B Community – A New Global Online Support Group

The Hepatitis B Foundation is excited to announce our support of a new global online community support group called Hep B Community. Thomas Tu, PhD, a researcher at Westmead Institute for Medical Research founded this online community to reach a global audience who might need support if they are affected by hepatitis B. 

Dr Tu stated that “While hepatitis B remains incurable, it can be managed and treated. But, people with hepatitis B face social stigma and discrimination, discouraging them from seeking medical help that could prevent progression of their illness to serious disease like liver cancer,”. He further explained that this online forum is important for people affected by hepatitis B to feel supported and empowered to take control of their diagnosis. 

Westmead Hospital’s Storr Liver Centre and the Hepatitis B Foundation have provided start-up funding and help coordinate the forum with support from the World Hepatitis Alliance. The site is peer-led, volunteer-run and is free to join. Already, more than 200 members from all over the world have joined.

Chari Cohen, DrPH, MPH, senior vice president, Hepatitis B Foundation, believes, “The new forum is critically important because people can anonymously seek advice about how to live with hepatitis B, and what they can do to protect their liver and long-term health.” If you are considering joining Hep B Community – do not hesitate! In fact, research has shown that people participating in hepatitis support groups can increase their knowledge, coping, and compliance.1 

How Does it Work?

The online forum has multiple sections like learning resources, media about hepatitis B, and general discussion. 

You can post completely anonymously and a hepatitis B expert or a person living with hepatitis B will respond to your questions. You can also choose your own username and the platform will never show your email, ensuring privacy and confidentiality. 

The hepatitis B experts responding to your questions go through a verification process to identify that they are trustworthy sources of information. These providers are clinicians, nurses, scientists or patient experts,  there to provide reliable answers and give information about health guidelines and treatment options. The forum also has researchers and scientists giving explanations and updates about technical information related to hepatitis B virus and treatment. 

The site is completely free! You can access the site even without making an account if you want to browse. However, in order to ask questions or post content, you will need to create an account. Empower yourself and join the other 200 users and immerse yourself in the supportive hepatitis B community!

Reference

  1. Jessop, Amy B. PhD, MPH; Cohen, Chari MPH; Burke, Monika M. RN; Conti, Molli BS; Black, Martin MD Hepatitis Support Groups, Gastroenterology Nursing: July 2004 – Volume 27 – Issue 4 – p 163-169 

Author: Evangeline Wang

Contact Information: info@hepb.org

How to Find a Hepatitis B Provider

How to Find a Hepatitis B Provider

If you have chronic hepatitis B or are newly diagnosed, it’s important to see a medical provider who has experience managing and treating hepatitis B.

Having a medical provider with hepatitis B expertise on your team not only safeguards your health but also lessens the stress of having a chronic liver disease. “My specialist gave me all the possible scenarios, but most importantly, he gave me my life back,” one hepatitis B patient recalled.

When first diagnosed, it’s often a primary health provider (PCP) or for children a pediatrician who orders diagnostic tests for hepatitis B. Doctors may run additional blood tests and/or immediately refer you to a liver specialist. If your PCP has experience managing and treating hepatitis B, you may decide to continue your hepatitis B care with that provider. Or, they may recommend a specialist who accepts your insurance or practices in the same healthcare system. But,  you may have to do some research to find the best specialist to treat your hepatitis B.

There are two types of specialists who treat liver diseases:

  • A gastroenterologist is an internist who has trained in digestive disorders including the liver, but how much liver expertise a gastroenterologist (GI doctor) has varies based on their training. It’s important to find out if they specialize in liver diseases and if they have experience with hepatitis B.
  • A hepatologist is a physician who specializes in the liver. This doctor has the most expertise and should be up-to-date about new treatments and clinical trials. But not all hepatologists have treated hepatitis B. Many will have treated hepatitis C, but not hepatitis B, so you need to ask.

Tips for finding a specialist:

  • Are they in the Hepatitis B Foundation directory? The Foundation has a Physician Directory of medical providers who treat hepatitis B around the world. These doctors have voluntarily signed up to be included in the database. It is not an exhaustive list, there may be hepatitis B specialists in your area who have not yet joined the directory.
  • Call the practice ahead of time and ask questions. How many hepatitis B patients have they treated? Do they participate in any clinical trials?  Are they aware of current monitoring and treatment guidelines for hepatitis B?
  • What’s the doctor’s reputation? Does anyone in your community see a liver specialist for viral hepatitis? Whom do they recommend?
  • Will you actually see the specialist or an assistant? Do you see a specialist only if there is a need for treatment? If you go to a teaching hospital, do you see the doctor or an intern, fellow or resident?

You are entering into a long-term relationship with someone who may care for you for many years. You need their expertise, but you also need to feel comfortable working with them. Do they listen when you speak and make eye contact? Trust and rapport are very critical.

“It’s really important that they don’t judge me,” one hepatitis B patient explained.  Another patient said that finding a doctor who spoke his language, or had an assistant who was fluent in his language, helped immensely.

Once you identify a specialist, here are some questions to ask:

  • Is the specialist accepting new patients? How long do you have to wait to get an appointment?
  • What hospital or lab do they use, and are they convenient for you? It’s important for you to always use the same lab so you have consistent results that allow apples-to-apples comparisons.
  • Will the doctor call you with the results or will a nurse or other assistants communicate with you?
  • What would you like your care plan to be? Will you go for blood tests and then see the specialist? Typically, hepatitis B patients get blood tests once or twice a year to monitor their liver, unless they are undergoing treatment.

How to design a long-distance care plan if the specialist is far away:  Sometimes, the best hepatitis B specialist is a few hours drive from where you live, but distance doesn’t have to be a deal-breaker. Many people see a specialist for a first visit, and afterwards, simply have their PCPs or local labs email lab results to the specialist. For this remote healthcare relationship to work, your PCP needs to be willing to partner with the specialist. Also, your specialist needs to be open to telephone or video consultations with you as needed.

Technology matters. Sharing medical records and lab tests electronically make a remote relationship work smoothly. If there are firewalls between practices, find out how to ensure your PCP and specialist share your medical records. Be prepared, you may have to be the conduit if the two healthcare systems don’t talk to each other.

Insurance and cost: Ideally, the hepatitis B specialist closest to you accepts your insurance or is in your provider network. That doesn’t always happen so finding out the charges in advance is important.

  • Will the specialist bill your insurance or will you need to pay the fee upfront and manage the insurance reimbursement yourself?
  • How much do you have to pay out-of-pocket if the specialist is outside your network, or if you are not insured? Some specialists charge a lower fee to uninsured patients. You may be able to have an annual consultation with a specialist and bring your lab results.

One hepatitis B patient reported he was not entirely happy with the specialist his PCP referred him to. “At the time, I had great insurance so all the tests he ordered weren’t a lot of money out-of-pocket,” he said. “But then I changed jobs and I couldn’t afford all of his tests, and he wanted me to go on treatment though my lab reports didn’t justify it.

“I went looking for a new one and found one in the Hepatitis B Foundation’s website,” he said. “I had to drive farther to see him, but his knowledge and patience were very comforting and he spoke my primary language. He really helped me regain confidence in life.”

Prepare for your visit: Before you see your hepatitis B medical provider, put together a list of questions (see sample questions) and have your lab reports available — either bring hard copies or call ahead of time to make sure the doctor has access to your latest labs and medical records.

After you meet with your specialist, take some time to reflect. Are you happy with the doctor? Did he or she communicate well? Are you clear about what you need to do in the weeks and months ahead to take charge of your health? If the answer is yes, congratulations, you have assembled a good healthcare team.

Contact Information: info@hepb.org

World Health Day!

 

Every year, April 7 marks World Health Day. During the 1948 First Health Assembly, the World Health Organization (WHO) developed this day “to create awareness of a specific health theme to highlight a priority area of concern for the WHO.” Since 1950, World Health Day has been drawing attention to specific health concerns affecting people all over the world, such as mental health, maternal and child care, and climate change. It is celebrated through activities, which extended beyond the day itself, and aids in focusing worldwide attention to global health features.

This year, World Health Day will focus on “building a fairer, healthier world for everyone.” With the COVID-19 pandemic undermining recent health gains, people have been experiencing poverty, food insecurity as well as increased inequities in areas, such as gender, social and health. The WHO has developed a year-long campaign as a call to action to eliminate inequities.

All over the world, people are struggling to earn a living. Poor housing conditions, lack of education and employment opportunities render vulnerable populations to experience inequalities to clean and safe food, air, water and health services. Consequently, more than 1 billion people living in informal or poorly built settlements face increased challenges to preventing infection and transmission of contagious diseases. According to WHO, the burden of disease is greatest in low to middle-income countries, specifically in Africa, South East Asia, Eastern Mediterranean, and Western Pacific regions. With approximately 50% of people living with chronic hepatitis B coming from Asian, Pacific Islander, or African descent, the issue of inequitable access to care becomes a problem for managing hepatitis B. Hepatitis B and the resulting liver cancer are amongst the largest health disparities for these groups. The World Health Day campaign will not only bring a fairer and healthier world to everyone, but it will also work to improve access to care, so people affected by hepatitis B can receive quality treatment and care and reduce their risk for liver cancer.

 

Join the Campaign to Reduce Inequities

  1. Contact your local community leaders and policymakers who are at the forefront in making decisions that will affect your community’s future. Make it known that everyone has the right to safe living and working conditions that are conducive to good health.
  2. Encourage leaders to monitor health inequities and ensure that people have access to quality health services. Hepatitis B management is essential for preventing the formation and development of long-term complications, such as cirrhosis and liver cancer. In communities most affected by the pandemic, individuals affected by hepatitis B will be at greater risk for experiencing adverse consequences.

 

Reference to WHO page about World Health Day: https://www.who.int/westernpacific/news/events/detail/2021/04/07/western-pacific-events/world-health-day-2021

 

Author: Vivian Cheng

Contact Information: info@hepb.org

Hepatitis B and Hepatitis Delta

 

What is Hepatitis Delta

Hepatitis delta is a liver infection that results from the hepatitis delta virus (also known as HDV) that causes the most severe form of viral hepatitis known to human beings. It is also the smallest virus known to infect humans. Hepatitis delta is unique because it is dependent on the hepatitis B virus (HBV) to infect and reproduce in liver cells, so those already infected with hepatitis B are at a greatly increased risk of developing hepatitis delta.

Since testing for hepatitis delta is not as widespread as it should be (everyone who is diagnosed with hepatitis B should also be tested for hepatitis delta), the exact number of people living with hepatitis delta is unknown. Some reports point to 15-20 million people living with hepatitis delta worldwide, but other studies have estimated that as many as 60-70 million people could be living with hepatitis delta around the world.

Co-Infection with Hepatitis B

Co-infection with hepatitis B and hepatitis delta can cause more serious liver disease than hepatitis B infection alone. This includes faster progression to liver fibrosis (or scarring), higher risk of liver cancer, and earlier onset of cirrhosis or liver failure.

There are two ways in which someone living with hepatitis B can become infected with hepatitis delta. One is through co-infection, which occurs when an individual acquires hepatitis B and hepatitis delta infections at the same time, and the other is through super-infection, which occurs when someone who is already living with hepatitis B acquires hepatitis delta.

A co-infection is less common and will often clear up on its own within six months, but sometimes it can cause very dangerous or fatal liver failure. A superinfection is more common and is the culprit of severe liver disease. As many as 90% of people with a superinfection will develop chronic (life-long) hepatitis B and hepatitis delta infections, 70% of which will progress to cirrhosis. This compares to only 15-20% of chronic hepatitis B infections alone.

Transmission and Prevention

Hepatitis delta can be transmitted in the same ways as hepatitis B, through exposure to infected blood or bodily fluids. This occurs most often through the sharing of hygiene equipment; practices of bodily alterations, such as tattoos, piercings or scarification; unsterile healthcare practices; sharing needles, syringes, or other paraphernalia during injection drug use; or having unprotected sex. Although hepatitis B virus is most commonly transmitted from mothers to their babies during childbirth, it is believed that hepatitis delta transmission through this route is uncommon. Since hepatitis delta cannot be contracted on its own, only people who are already infected with hepatitis B or who are at high risk of contracting both viruses simultaneously can contract hepatitis delta.

A vaccine for hepatitis delta does not exist, but fortunately, the vaccine for hepatitis B protects against hepatitis delta as well! Just as with hepatitis B, family members and sexual partners of people living with hepatitis delta should also receive the hepatitis B vaccine to significantly lower their risk of contracting hepatitis B and hepatitis delta. For those who are already infected with chronic hepatitis B, the best way to protect yourself from hepatitis delta is to practice protected sex (with a condom) and avoid potential blood exposure.

All individuals who have been diagnosed with hepatitis B should also get tested for hepatitis delta. The test is a simple blood test. Hepatitis delta can be managed by a doctor – it is most dangerous when a person does not know they have it, making it that much more important to get tested!

 Who is at Risk

If you are living with chronic hepatitis B, you are at risk for hepatitis Delta. Groups at risk for hepatitis delta include:

  • People chronically infected with hepatitis B are at risk for infection with HDV.
  • People who are not vaccinated for hepatitis B
  • People who inject drugs
  • Indigenous people and people with hepatitis C virus or HIV infection
  • Recipients of hemodialysis
  • Men who have sex with men
  • Commercial sex workers
  • Individuals from countries or regions where hepatitis delta prevalence is high

Several geographical hotspots have a high prevalence of hepatitis delta infection, including Mongolia, the Republic of Moldova, and countries in Western and Middle Africa.

For Patients

If you are living with hepatitis B, it is recommended you get tested for hepatitis delta. Please ask your healthcare providers to be tested for hepatitis delta.

The Hepatitis B Foundation has resources for patients living with hepatitis delta.

Drug Watch – Drugs and Medications in Development for Hepatitis Delta

Clinical Trials – Clinical trials are research studies that test new potential treatments for a disease. Talk to your doctor about possible clinical trials that could be helpful to you.

Find a Doctor – Visit our Physician Directory to locate a doctor near you! It now includes a specific search tool to locate doctors that also manage hepatitis delta patients. For additional assistance locating a doctor, email connect@hepdconnect.org.

Other educational resources include webinar recordings, multilingual fact sheets, and frequently asked questions.

For Providers

Providers in the United States can request hepatitis Delta tests from Quest Diagnostics. It is recommended that you first call your local Quest representative to confirm that the location does this specialty testing.

Below is the coding list for hepatitis delta testing as well as quantitative HBsAg and hepatitis B genotyping.

  • Quest Test Code for HDV Antibody Total—4990 Set up 2 times/week
  • Quest Test Code for HDV Antibody IgM—35664 Set up 2 times/week
  • Quest Test Code for HDV RNA Quantitative PCR—37889 Set up 6 times/week

Quest does not currently offer a national test code for hepatitis delta antibody reflex to HDV RNA quantitative, but you can coordinate with the Quest commercial person that covers your account to possibly set up a custom reflex.

 

Authors: Beatrice Zovich and Evangeline Wang

Contact Information: info@hepb.org