Hep B Blog

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Hepatitis Delta (HDV), Liver Cancer, Uncategorized

Where is Hepatitis D? High Prevalence of Hepatitis B/D Coinfection in Central Africa

By Sierra Pellechio, Hepatitis Delta Connect Coordinator

While hepatitis B is known to be highly endemic to sub-Saharan Africa and is estimated to affect 5-20% of the general population, the burden of hepatitis D, a dangerous coinfection of hepatitis B, has largely been left undescribed. Since the virus’s discovery 40 years ago, Africa has faced structural barriers that have contributed to the ongoing prevalence of the virus in this region. Widespread instability, under-resourced health systems, and poor surveillance have contributed to inadequate research and a lack of understanding about the health burden of hepatitis D on hepatitis B patients, particularly in Central Africa.

New data, however, reveals pockets of hepatitis B/D coinfection in this region, particularly in countries such as Cameroon, Central African Republic and Gabon. In a recently published study of nearly 2,000 hepatitis B infected blood samples from 2010-2016 in Cameroon, 46.7% tested positive for hepatitis D antibodies, a marker of past or current hepatitis D coinfection. Another study of 233 chronic hepatitis B carriers from 2008-2009 found a 17.6% positivity for hepatitis D antibodies. Other small studies from the Central African Republic have revealed 68.2% prevalence in hepatitis B patients, 50% coinfection in liver cancer patients and an 18.8% coinfection in hepatitis B infected pregnant women. Not only are new studies revealing evidence that there are groups at higher risk for hepatitis D, but a 2008 study on 124 community members in Gabon found 66% of them had markers for hepatitis D, proving this virus can also be circulating in the general population. Globally, hepatitis D is thought to affect about 5-10% of hepatitis B patients, making Central Africa an area of extremely high prevalence.

A diagnosis with hepatitis B and D can increase the risk for cirrhosis and liver cancer by nearly three times, and with only one available treatment, the future for coinfected patients if often uncertain. Although hepatitis B and D can be safely prevented by completing the hepatitis B vaccine series, which is available in many countries throughout Africa, the birth dose of the hepatitis B vaccine is often not given within the recommended 24 hours of birth. Lack of awareness, availability, and high cost mean many infants will not begin the vaccine series until 6 weeks of age, creating a window for exposure to hepatitis B. Greater than 95% of babies infected with hepatitis B will go on to develop chronic hepatitis B infections, leaving them susceptible to a future hepatitis D infection. Spread the same way as hepatitis B, through direct contact with infected blood and sexual fluids, hepatitis D can be contracted through unsterile medical and dental equipment and procedures, blood transfusions, shared razors and unprotected sex. Although the severity of disease varies greatly by hepatitis D genotype, coinfection always requires expert management by a knowledgeable liver specialist, which are often difficult to find.

As an increasing number of studies continue to describe the widespread endemicity of hepatitis B/D coinfection and its public health burden, researchers and the Hepatitis Delta International Network are calling on the World Health Organization (WHO) to declare hepatitis D a “threat” in this region in order to promote increased priority and awareness. Addressing hepatitis B/D coinfection prevention and management will be complex and require a multi-pronged approach through methods such as government prioritization, increased funding for health systems, hepatitis B vaccination awareness programs, birth dose prioritization, better sterilization techniques in hospitals, clinics, and barbers, and public awareness of the disease.

For more information about hepatitis B/D coinfection and the Hepatitis Delta Connect program, please visit www.hepdconnect.org or email us at connect@hepdconnect.org. Hepatitis Delta Connect seeks to provide information, resources and support for hepatitis B/D patients and their families through its website, social media, fact sheets, webinars and hepatitis D liver specialist directory.

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National African Immigrant and Refugee HIV & Hepatitis Awareness Day 2018

The Hepatitis B Foundation (HBF) is joining the Africans for Improved Access (AFIA) program at the Multicultural Aids Coalition (MAC), the Coalition Against Hepatitis for People of African Origin (CHIPO), the New England AIDS Education and Training Center (NEAETC), and the Harvard University Center for AIDS Research (CFAR) in continuing the national fight for federal recognition of National African Immigrant and Refugee HIV and Hepatitis Awareness Day (NAIRAHHA).

Founded during one of the African National HIV Alliance’s (ANHA) strategic planning summits, NAIRAHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. This year,  NAIRHHA Day commemoration began on September 1st. Quotes collected from #justB storytellers, healthcare providers, and health educators are currently being circulated across social media accounts to start a virtual conversation. The hashtags #StigmaCantWin and #NAIRHHADay2018 are being used to organize the discussion and raise awareness on Twitter. The quotes are centered upon addressing stigma and myths surrounding HIV and hepatitis in African immigrant communities. Some quotes remind viewers that despite how it may feel, many reliable HIV and hepatitis B resources are present around the country. Other quotes – like this one from #justB storyteller Bright – offer words of encouragement and support to those who may feel alone.

A comprehensive webinar, titled Stigma Can’t Win: HIV and Hep B Among African Immigrants, will take place on Wednesday, Sept. 20 from 3 p.m. – 4:30 p.m.  and will complete the commemoration of NAIRHHA Day 2018. You can register for the webinar here. In addition to stigma’s impact on access to care and screening for HIV and hepatitis, viewers will learn about the root causes of these particular stigmas and how prevention-related stigma differs from the stigma of living with a certain disease. These topics are essential to the process of global eliminating viral hepatitis by 2030 – a goal set by the World Health Organization (WHO). Healthcare providers and community members will share their experiences with the audience during this interactive webinar.

In America, it is estimated that 5% – 15% of the African immigrant population is living with chronic hepatitis B. Less than 20% are aware of their infection. Unfortunately, these numbers are thought to be a low estimate due to lack of awareness, surveillance, and knowledge about modes of transmission. NAIRHHA Day was founded to help address the numerous barriers to prevention and treatment that African immigrants face. It was also founded to acknowledge the cultural and ethnic differences that influence how African-born individuals interact with their medical community and the concept of illness. The specific goals of the day of recognition include:  

  • Raising awareness about HIV/AIDS and viral hepatitis to eliminate stigma;
  • Learning about ways to protect against HIV, viral hepatitis and other related diseases;
  • Taking control by encouraging screenings and treatment, including viral hepatitis vaccination;
  • Advocating for policies and practices that promote healthy African immigrant communities, families, and individuals.

Last year, the Hepatitis B Foundation launched a project in partnership with CHIPO and the Centers for Disease Control and Prevention (CDC) to raise hepatitis B awareness among African immigrant communities. The project seeks to improve hepatitis B awareness, linkage to care, screening rates, and vaccination rates. The first phase of the project, which was completed in 2017, assessed the needs of African immigrant communities – including cultural beliefs, religious beliefs and common barriers to accessing healthcare. The second phase is currently underway and focuses on the development of educational materials to be disseminated amongst community leaders and healthcare professionals to further their understanding of both hepatitis B and the needs of the specific communities they are working with. Materials are anticipated to be released in early 2019.

Ending stigma and bringing attention to these issues doesn’t only start with coalitions and organizations; it also starts with YOU! Everyday actions can help to increase the visibility of HIV and hepatitis B, and encourage others to speak up. Below are some tips for individuals on NAIRHHA Day – or any day!

How to help:

    • Start a conversation in real life: Take the information that you see and talk about it with your friends, families, and co-workers!
    • Know your facts: Don’t have a lot of time to read? Fact sheets like this  one for NAIRHHA Day provide brief, but informational summaries of why a cause is important! HIV and hepatitis infographics are also available on the CDC website and the Know Hepatitis B campaign even has short videos and free posters so you can pass the knowledge along!
    • Share what you see: Social media may seem trivial at times, but it can help spread the message. Retweet, like, and repost the quotes you see or any information that can help combat stigma!
    • Help get NAIRHHA Day federally recognized: Contact your local health departments, local and national HIV and hepatitis organizations, and the HIV.gov Team at @HIVGov and express the need for NAIRHHA Day!

 

 

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Vlog: Advocacy Day on Capitol Hill

Join Michaela Jackson for A Day in the Life of a Public Health Coordinator as she takes you behind the scenes of Advocacy Day – a day of speaking to Congress members and their staffers about hepatitis B.

In this episode, participants visit Capitol Hill to ask Congress to support funding for Hepatitis B research and to raise awareness on the topic. Advocacy Day takes place the day before the Hep B United Summit.

Hepatitis B Prevention, Living with Hepatitis B, Uncategorized

What to do about hepatitis B when you’re pregnant?

Around the world, the most common mode of hepatitis B transmission is from mother to child. Unfortunately, pregnant mothers who have hepatitis B can transmit the virus to their newborn during the delivery process. 90% of these HBV infected babies will progress to chronic infection  putting them at increased risk of serious liver disease or liver cancer later in life.

It is important that ALL pregnant women get tested for hepatitis B to prevent the transmission of the virus to newborns at birth.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all newborns born to hepatitis B positive women be given two shots in the delivery room – the first dose of hepatitis B vaccine (5 mcg dose) and one dose of hepatitis B immune globulin (HBIG, 0.5 mL dose). If a woman knows that she is infected, it is important that she tell her doctor to have these two drugs available when she is ready to deliver. These two shots must be given at separate injection sites, i.e. different limbs. When administered correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection. The infant will need to complete the hepatitis B vaccine according to schedule as part of a 3 or 4 dose series. CDC recommends follow up testing to confirm immunity or protection against HBV at 9 months or at the baby’s 1 year checkup.

The World Health Organization (WHO) recommends the birth dose of the hepatitis B vaccine for ALL babies, though it is especially important for a baby born to a woman with hepatitis B to receive the first dose of the vaccine as soon as possible, within 24 hours. HBIG may not be available in all countries or may be cost prohibitive. The hepatitis B vaccine series may be completed with the remaining monovalent  (single) injections of the HBV vaccine, or may be completed as part of a combination vaccine series.

In developing countries combination vaccines such as the pentavalent vaccine are often given to babies. The first dose of the pentavalent vaccine (which includes hepatitis B vaccine) is given at 6 weeks of age, and the 2nd and 3rd doses are given at 10 and 14 weeks of age. Waiting for the first dose at 6 weeks is too late for babies born to mothers living with chronic hepatitis, though the pentavalent vaccine should never be used as the birth dose or before 6 weeks. Women who know they have hepatitis B should talk to their doctor about ensuring that a birth dose of the hepatitis B vaccine is available for their baby at birth.

There is no second chance!  It is vitally important that we protect all newborns from hepatitis B!

Also, all infected pregnant women need to learn more about their hepatitis B infection from a liver specialist or a doctor with experience treating patients with chronic hepatitis B. It is recommended that pregnant women have their hepatitis B monitored throughout their pregnancy, to check the health of their liver and to see if they need treatment. For HBeAg positive women with high hepatitis B viral loads, taking FDA-approved antivirals during the last trimester can reduce the amount of virus in the blood and help prevent the chance of transmission to the newborn. Once an infected woman gives birth, it is important that she routinely see her doctor to keep monitoring her hepatitis B infection. Keeping mothers healthy allows them to better take care of their families!

For more information, or if you live in the U.S. and need help with hepatitis B infection during pregnancy, please visit the Perinatal Hepatitis B Prevention Program to find a coordinator near you. If you are outside of the U.S., you may consider visiting the World Hepatitis Alliance to find if there are organizations in your country that can ensure your baby starts with a birth dose of the hepatitis B vaccine.

Visit our website for additional information!

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Liver Cancer, Living with Hepatitis B, Uncategorized

Sharing Your Story – Your Family’s Story

Sharing Your Story – Your Family’s Story

Image courtesy of Good Free Photos

Thanksgiving is not only a day to eat turkey or remind us to remember what we are thankful for; it is also National Family History Day!!1 This holiday can be used an opportunity for families to discuss and record health problems that run through the family, as this helps us live longer and healthier. 1

There are many chronic diseases that may run through multiple generations of a family. 1 Doctors can predict whether or not you could have a chronic disease just by knowing if your parents, grandparents, and other relatives have had it. 1 That is why knowing your family health history is an important and powerful screening tool.1 You can change unhealthy behaviors, reduce your risk of diseases, and know when you should be screened when you learn about what diseases run through your family. 2

Image courtesy of Wikimedia Commons

Hepatitis B is not like other chronic diseases, where if your parents have it, your genes make you more prone to it. Hepatitis B is not genetic. The hepatitis B virus is transmitted through blood and infected body fluids. This can happen through direct blood-to-blood contact, unprotected sex, body piercings or tattooing, intravenous drug use, and as a result of unsafe medical or dental procedures. It can also be transmitted from an hepatitis B positive mother to her baby at birth.

Even though hepatitis B is not genetic, you should still include it in your family health history discussion! The most common method of hepatitis B transmission worldwide is from mother-to-child due to the blood exchange that happens during child birth. Pregnant women who are infected with hepatitis B can transmit the virus to their newborns during delivery. 90% of babies exposed to hepatitis B at birth will become chronically infected with hepatitis B, which increases their risk of serious liver disease later in life. Knowing your family’s hepatitis B history can help you figure out if you and other loved ones should get screened for or vaccinated to protect against hepatitis B.

Image courtesy of Wikimedia Commons

Knowing if you have a family history of liver cancer can also be important, since hepatitis B is one of the leading causes of liver cancer. If your family has a history of hepatitis B related liver cancer, then you may have a greater risk of developing liver damage or liver cancer if you have hepatitis B. Be sure to discuss a family history of liver cancer with your liver specialist.

If you need some advice on how to start the conversation about your family health history, read more here. You can also use the US Department of Health & Human Services’s My Family Health Portrait Web tool to help start this dialogue and learn how to share family history information at a future doctor visit.

You don’t need to wait until this Thanksgiving to talk about your family health history. You can talk to your family about your family health history and hepatitis B status RIGHT NOW!

References:

  1. https://www.hhs.gov/programs/prevention-and-wellness/family-health-history/about-family-health-history/index.html
  2. https://www.cdc.gov/genomics/famhistory/famhist_basics.htm

 

 

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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/

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WHO’s New HBV Guidelines to Help Combat Africa’s Growing Hepatitis B Crisis

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The World Health Organization (WHO) will release their first management guidelines for hepatitis B virus (HBV) by the end of 2014. For the first time, the guidelines will be geared towards resource-constrained countries, where the disease burden is high but resources are lacking. The new guidelines will be particularly welcome in African nations, where the incidence of viral hepatitis is increasing.

The overall scope of the World Health Organization’s new management guidelines for hepatitis B will include prevention, screening, and treatment of chronic hepatitis B and will be geared towards resource-constrained countries. Thus, WHO’s guidelines will be valuable for countries where the disease burden is high but resources are lacking.

The WHO Global Hepatitis Programme established a Guideline Development Group of external experts in 2013, which includes Hepatitis B Foundation (HBF) executive director Joan Block, and is co-chaired by Dr. Brian McMahon, who also serves on the HBF Scientific and Medical Advisory Board.

The new WHO guidelines will be particularly welcome news to African nations, where the incidence of viral hepatitis is increasing.

According to the WHO Global Hepatitis Survey 2013, the prevalence of chronic hepatitis B virus (HBV) infection on the African continent is up to 8% of the general population, and 75% of the population may have had prior exposure to the virus.

Yet, only two of the African member states that responded to the WHO Survey have a written national strategy to prevent and control viral hepatitis.

In Ghana, where the incidence of viral hepatitis is increasing, the sero-prevalence rate is high among blood donors (6.7%), pregnant women (6.5%) and school
aged children (15.6%), according to Mr. Theobald Owusu-Ansah, president of the Theobald Hepatitis B Foundation and the Hepatitis B Coalition in Ghana.

Compounding the lack of public health plans and national investment are factors common in many low-resource countries: limited awareness of hepatitis B among the public and providers, poor access to care, expensive therapies, and few liver specialists.

Global agencies are beginning to recognize the urgency of the situation. In addition to the WHO, the World Health Assembly is taking steps to combat the growing crisis. The Assembly adopted a second resolution on viral hepatitis in May 2014 that advises governments on how to prioritize and coordinate public health efforts.

But governments cannot tackle these problems alone, Mr. Owusu-Ansah believes. He urges governments to partner with commercial and nonprofit organizations to mobilize much-needed expertise and resources.

Continue reading "WHO’s New HBV Guidelines to Help Combat Africa’s Growing Hepatitis B Crisis" →

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HBV Journal Review – November 2014

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Experts Say Breastfeeding While Taking Antivirals Is Safe
  • Doctors Fail to Adequately Treat HBV-Infected Women After Childbirth
  • Doctors Continue to Fail to Screen Asian-Americans for Hepatitis B
  • Statins Protect Hepatitis B Patients Against Heart Disease and Liver Cancer
  • New Study Finds Antivirals Lower Liver Cancer Risk
  • Studies Find Tenofovir Lowers Viral Load Faster Than Entecavir
  • Liver Transplants Safe in Older Hepatitis B Patients
  • Scientists Develop Micro Weapon to Disable HBV’s Cancer-Causing X Protein
  • Foreign-Born U.S. Residents Less Likely to Be Immunized
  • Antivirals Can Safely Replace HBIG Following Liver Transplantation
  • All Hepatitis B Patients Appear at Risk from Chemotherapy

Continue reading "HBV Journal Review – November 2014" →

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HBV Journal Review – October 2014

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ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Chronic Hepatitis B Remains Public Health Challenge in U.S.
  • Epidemiologists Become Molecular Detectives to Investigate HBV Outbreaks
  • Telbivudine Effectively Prevents Infection of Newborns Born to Infected Mothers
  • GGT Blood Test Reveals Fibrosis and Cirrhosis in Hepatitis B Patients
  • Early Research Combining Antivirals with a Protein “De-activator” Shows Promise
  • Diabetes Dramatically Increases Liver Cancer Risk in Cirrhotic Patients
  • Tenofovir Linked to Higher Rates of Bone Loss than Entecavir
  • Tenofovir Equally Effective against Hepatitis B in Asians and Non-Asians
  • Liver Cancer Risk Factors Do Vary Between Racial Groups
  • Even Liver Specialists Fail to Screen Chemotherapy Patients for Hepatitis B
  • European Study Confirms Coffee Dramatically Lowers Liver Cancer Risk

HBV Journal Review

October 1, 2014
Volume 11, Issue 10
by Christine M. Kukka

Chronic Hepatitis B Remains Public Health Challenge in U.S.

A new U.S. Centers for Disease Control and Prevention report on hepatitis B prevalence finds that while new infections have declined markedly, treating chronic hepatitis B infection remains a public health challenge.

New hepatitis B virus (HBV) infections have plummeted since 1990 due to comprehensive immunizations. The CDC report estimates only 18,760 people were infected with HBV in 2012.

In 2012, the highest rates of new infections were among those aged 30–39 years (2.17 cases per 100,000 population), and the lowest were among children under age 19 who had been immunized at birth.

Many of the new infections were transmitted sexually or through injecting drug use.

However, an estimated 700,000 to 1.4 million U.S. residents are chronically infected. According to the report, Viral Hepatitis Surveillance United States, 2012, about half of those chronically infected were either born in Asia or were born to HBV-infected mothers in the United States.

In 2011, the death rate from chronic hepatitis B was 0.5 deaths per 100,000 population. The highest mortality rates were among people aged 55–64 years, Asian and Pacific Islander, and male.

“Identifying these chronically infected persons and linking them to care remains a challenge,” the authors reported.

Source: www.cdc.gov/hepatitis/Statistics/
2012Surveillance/

Epidemiologists Become Molecular Detectives to Investigate HBV Outbreaks

While new HBV infections have declined dramatically since the early 1990s due to effective immunizations, public health officials continue to examine where new infections are coming from and who is getting infected.

Read the HBV Journal Review in its entirety here. 

 

Baruch S. Blumberg Institute