Hep B Blog

Gearing up for World Hepatitis Day!

World Hepatitis Day is July 28th!  What are you doing to raise awareness and educate others about hepatitis B?  I asked this on HBF’s facebook page, and a friend from Ghana wondered what he could do to help raise awareness.  Another friend replied about his concern with HBV in Malawi.

When you consider the scope of hepatitis B, globally, it is indeed sobering.  Statistically, two billion people have been infected with hepatitis B worldwide, and 400 million are chronically infected.  Don’t let these numbers discourage you from your efforts.

When I returned from China in 2003, my heart was heavy with the burden the Chinese people experience on a day-to-day basis, living with HBV.  At the time I was providing infectious disease training for specific groups of Chinese people, but of course in the scheme of things, the outreach effort seemed minimal when compared to the burden.  I had to focus my efforts one-person-at-a-time.  I couldn’t let the sheer numbers discourage me from my mission to educate and raise HBV awareness at any level.

If you have the money or the connections to do something in a big way, that is wonderful.  Then many will benefit from your contribution.  However, I think it is important to note that hepatitis B education and awareness is fundamentally carried out at a grassroots level, where small numbers of individuals band together to make a difference.   Organizations like the Hepatitis B Foundation are crucial due to their ability to reach out and impact larger numbers of people through research, outreach, education and increased HBV awareness.  Utilize their website, social media channels and outreach to gain and share educational information, and help raise awareness.

So what can you do as an individual?  First thing you need to do is get educated on viral hepatitis.  There is much confusion among people about how HBV is transmitted.  If you mention hepatitis B, someone will invariably say, “oh yes.  My uncle got that from eating contaminated food!”  Well, he did get NOT hepatitis B from food!  Know the ABC’s of viral hepatitis, and eliminate these myths.  Hepatitis B is not spread casually, or by sharing a meal, hugging or kissing someone with hep B.  However, HBV is non-discriminating, and we are all vulnerable if we are not vaccinated.

Learn the facts about HBV.  Know some of the statistics, and how it is transmitted.  Know the difference between an acute infection vs. a chronic infection.  Know that 90% of adults will clear an acute infection, while 90% of infants infected will surely live with hepB for life.  Be sure safe injection and medical practices are followed in health care settings.

To raise awareness and eliminate confusion, you don’t have to know the details of surface antigens, antibodies or how to interpret blood test results.  You can look that up on HBF’s website!   This detailed info comes with time.  Start with the hep B basics.  If you are educated, you can educate others.

Learn about the HBV vaccination.  Know that if you are in a high risk group, you should be screened before you are vaccinated.  The vaccine doesn’t work if you already have hepB!  If you are not infected, then get vaccinated.  Let everyone know why vaccination is necessary.  Encourage pregnant women to be screened for HBV.  Ninety percent of  mother-to-child transmission of HBV can be eliminated by ensuring an infant receives a birth dose of the hepatitis B vaccine, followed by the other two shots in the series.  If HBIG is available to newborns of infected mothers, that is even better.

Many believe that hepatitis B will not affect them because they may not have symptoms. They do not realize HBV is a silent epidemic.  They may not realize the importance of their non-complaining liver, and how HBV can destroy it over time.

If you or loved ones have HBV, be sure you are vaccinated for Hepatitis A.  Take care of your liver and abstain from alcohol and tobacco use.  Eat a healthy diet, and practice safe sex.  Practice standard precautions.  Use common sense!

Now for the outreach part… Depending on your hep B status, you might be reluctant to share your new found information with everyone.  Start with your family, friends and household contacts.  They may not understand the global significance of HBV.  It’s okay to start small.

If you’re ready to increase your effort, then reach out to your church, and your community.  Join with others and participate in local city or village health center and community awareness events.  Join an HBV support group, and if you’re interested, create a language specific group for your country.  Volunteer, speak out, and help educate the masses of people who are unaware that HBV is truly a silent epidemic.

Together we can make a difference!

Mosquito Repellent and Hepatitis B

Summer has arrived and so have your annoying neighborhood mosquitoes, who show up uninvited to every party.  Everyone’s first impulse is to spray on the DEET, an effective, insect repellent, to keep them away.

If you have hepatitis B, and are working hard to “love your liver”, you might be wondering what affect DEET will have on your liver.   Your liver is an amazing organ responsible for filtering just about everything we inhale, ingest or absorb through the skin.  DEET is an effective, but strong chemical, that when applied to the skin, or accidentally inhaled while spraying, or ingested due to poor hand washing, may be found in the blood stream up to 12 hours later.  It’s your liver’s job to ensure this toxin is filtered from your system.   An over-taxed liver can be problematic for anyone, but placing additional burdens on your liver when you have HBV can contribute to liver damage over time.

Here are a couple of things to consider.  Mosquitoes and other flying, or biting insects are vectors for numerous diseases that can make us very sick.   (Please keep in mind that mosquitoes are NOT vectors for hepatitis B.)  As a result we have to consider other options, or weigh the risks vs. the benefits of spraying on a dose of DEET.  If you do decide that DEET is the best protection against mosquitoes, consider limiting your exposure by applying it to your clothing, rather than directly to the skin.  When you’re back inside and out of mosquito territory, wash it off.  Don’t wear it to bed.

A natural alternative to chemically produced repellents is citronella, which has been registered for use in the U.S. since 1948.  It is made by steam distillation of certain grasses, and is considered a biopesticide, a naturally occurring substance that controls by non-toxic means.

Citronella can be purchased in various outdoor candles and natural, registered products such as Burt’s Bee’s Herbal Insect Repellent, or Avon Skin So Soft.  Citronella and other remedies can be purchased as essential oils and applied to the skin.  Please remember that natural does not equate to safe.  Make sure directions-for-use are legitimate and followed explicitly.  These oils are dangerous when ingested, and they are not packaged in child-resistant containers to avoid accidental swallowing.  Be sure to research all natural remedies or chemical products, and ensure the directions-for-use are legitimate, and that they are stored out of reach of children.  In researching this blog, I ran across various factoids and instructions-for-use with natural remedies that were contradicted in other articles.

Here are some additional tips that may require a little more forethought, and may not be as effective as a chemical repellent.  However, they can provide some relief and perhaps a balance.  Recommendations include:

  • Wear light colored clothing.  Mosquitoes are attracted to dark clothing.
  • Cover as much skin as possible with clothing… long sleeves, pants, socks, hats, etc.
  • Consider the fragrances you wear.  Floral or fruity fragrances, scented soaps, perfumes, hair products, scented sunscreen and even fragrance from fabric softeners and dryer sheets attract mosquitoes.  In my house, nothing smells clean and fresh.  Everything is unscented.
  • Avoid being out when mosquitoes are most active – dawn and dusk.
  • Use external fans.  Mosquitoes don’t fly well in a stiff breeze!
  • Avoid areas with standing water.
  • Eat garlic…lots of it.  My pharmacist is Indian, and also prescribes natural remedies.  She told me garlic is often consumed in massive quantities to discourage mosquitoes.
  • Bats are your friends…   I grew up with two medium-sized, but stagnant ponds on our property.  We had lots of bats and no mosquitoes.

As always, it’s all about common sense and balance.  If you’re having a picnic at the Dismal Swamp, or traveling to countries where the risk of disease carrying mosquitoes is very high, then you might want to think about bringing along the can of DEET, and using it responsibly.  Perhaps an outing here or there may also warrant the use.  Otherwise, make an attempt to combat mosquitoes naturally, or make a concerted effort to avoid them at their worst.  Yet another way to incorporate “loving your liver” into your daily life!

 

 

 

 

 

 

Choosing a Liver Specialist to Treat Your HBV

Got HepB?  Which doctor is right for you?  Do you need a hepatologist, gastroenterologist (GI doctor), or an infectious disease doctor?  Is the patient an adult or child?  If you’re new to HBV, these specialty doctors are likely foreign to your doctor line-up, and weeding through the specialty titles and training can be confusing.   However, if you have HBV, it’s essential that you find a knowledgeable liver specialist to monitor and potentially treat your hepatitis B.

A hepatologist is a doctor that specializes in diseases associated with the liver.  Hepatology is a sub-specialty of gastroenterology.  This is an obvious choice for patients with HBV, but it may be difficult to find a hepatologist in your vicinity.

A gastroenterologist, or GI doctor, specializes in the function and disorders of the GI tract, which includes the esophagus, stomach, pancreas, intestines and the liver.  This covers a very broad spectrum of functions and diseases.  The key is to find a GI doctor that has experience treating patients with liver disease – specifically, viral hepatitis, and hepatitis B.  If your GI candidate spends much of his week performing endoscopies, he is likely not a good choice for a liver specialist.

Because hepatitis B is an infectious disease, it would seem logical that an infectious disease specialist would be the best choice.  However, this is not usually the case with hepatitis B, or viral hepatitis, but rather HIV and other infectious diseases.  Your best bet will most likely be a hepatologist or a GI doctor.

If the patient is a child, it is imperative that the child see a pediatric liver specialist.  Some of the best and brightest, cutting edge doctors are both pediatric hepatologists and GI docs.  Children with HBV are monitored and treated much differently than adults.  The labs look different, and the treatment protocols also differ.  You need a pediatric specialist.

Ultimately, the key is finding a liver specialist that has experience monitoring and treating patients with hepatitis B.  You need to ask the important questions.   How many patients are they currently monitoring and treating with hep B?  How is your doctor keeping abreast of the latest and greatest advances in the management of hepatitis B?  Does she attend conferences on viral hepatitis?

HBV is a chronic disease, so you are potentially entering into a long term relationship.  Be sure to ask questions that are important to YOU.  How are test results disseminated?  Are frequent visits required?  Is your doctor open minded – perhaps willing to consult with other experts treating patients with HBV?  It would be great if this specialist is affiliated with a large hospital or university center.  This may provide additional options such as clinical trials, should they become available.  Plus they tend to have a larger patient population, hence more case specific experience.

Typically, the need to visit your liver specialist is not that frequent, unless you are undergoing treatment.  Even then, much of the monitoring and follow-up are in the blood work, and much of that can be drawn locally, with the results sent to your liver specialist.  Some treatment protocols require more monitoring and blood work than others, but even so, it is typically for a short period of time.  This fact is significant, as it expands the size of your geographic circle of potential experts.

The Hepatitis B Foundation maintains a wonderful database of liver specialists for both adults and children.  From there you can check out your potential expert with members of HBV support groups that may have personal experience with your candidate.

Good luck choosing your liver specialist!

Sending Your Child to Camp with HBV

Got a camper in your house with HBV?  Are you concerned about filling out the mountain of paperwork associated with sending your child off to a day camp, or over-night camp this summer?  The paper work is not consistent from camp to camp, and quite often probing health questions may be asked.  If you’re a parent with a child with HBV, seeing it in print will likely be unnerving.

Camp forms will have a health history section which may start with the following:

Does the camper have a history of any of the following?  Check all that apply.

A long list of conditions including things like asthma, diabetes, migraines, surgery, and physical disabilities may be on the list, along with the possibility of “other” accompanied by a blank-line.  It is also possible there will be a box specifically for hepatitis B.

Personally, I would NOT check the “other” box, nor would I list hepatitis B on the line following “other”.   I would also NOT check the box if the medical history specifically refers to hepatitis B, or viral hepatitis.  I would also not consider my child’s liver biopsy as a “surgery”. There is NO need to offer up unnecessary information that does not pertain to the safety of your child’s camp experience.

Here is my thinking.  A condition like diabetes, asthma, or even allergies may well require acute care while the camper is at camp.  A nurse or staff person may be responsible for administering medication for this acute condition.  Children with hepatitis B are rarely symptomatic and have compensated livers. They can take prescribed or OTC drugs you and your doctor have noted on the paperwork.  The likelihood of an emergency occurring due to the child’s HBV is nil, and in the event of an unrelated emergency, your child’s liver would tolerate emergency services necessary to stabilize him.  Life saving decisions would be left in the hands of an emergency care facility and ER trained staff.

There is always the concern that camp staff should be notified in order to protect them in case of accidental exposure, but I believe this is unnecessary.  We live in a small world and disclosing a child’s HBV status to camp staff may come back to haunt you.  HBV is vaccine preventable, and staff should be up-to-date on their immunizations.  Standard precautions training is a must for camp staff.  This will protect staff and all children from potential exposure to body fluids, such as blood, if protocols are properly followed. 

Because HBV and HCV are typically asymptomatic, and children are not screened prior to attending camp, you have to assume that someone else at camp will have HBV, HCV or even HIV. 

If you can’t get past concerns regarding your child and her HBV, then perhaps you need to re-consider camp for this summer.  We all have our own comfort level, and we get there in our own time.  However, my advice is to relax, fill out the forms, and send your happy camper off to camp!

Hepatitis B and Your Neighborhood Pool

Photo by Sheila http://ht.ly/6eRlt

Memorial Day marks the unofficial beginning of the summer, and with it, the opening of the community pool.  Every summer, questions regarding hepatitis B and the public pool are asked.  Typically it is those that are infected, or have children that are infected with HBV, that have concerns.  Hepatitis B is 100 times more infectious than HIV.  Does that mean you should be worried about contracting or spreading a blood borne pathogen like hepatitis B at the community pool?  Personally I don’t believe so, but there are a couple of things to consider.

If you’re concerned about a blood spill in the pool water than do not worry.  As long as you are frequenting a well-maintained pool that follows guidelines for consistently monitoring chlorine and pH levels in the pool, you’ll be fine.

Use common sense when at the pool.  Check that the water is clear, and the sides aren’t slimy. If the odor of your pool is too strong, something may be off.  Speak with management if you have concerns.  Pool staff are responsible for keeping water safe.  There are strict guidelines that must be followed.  Still have doubts?  Purchase your own pool test strips to confirm disinfecting quality of the pool.

Blood spills on the deck are a plausible transmission route for blood borne pathogens like HBV, but this hazard can be readily averted with proper cleanup.  Chlorine is a very effective agent against hepatitis B and other pathogens.  When made fresh and used in the correct concentrations, (nine parts water to one part chlorine) it kills pathogens like HBV.  As a team manager of a neighborhood swim team, I found the lifeguard slow to clean up a blood spill on deck.  The protocols are in place, but everyone needs to be vigilant to ensure they are followed.  If you have HBV and are bleeding on deck, don’t be afraid to insist that the blood spill be properly disinfected.  There’s no need to disclose your status.  These are standard precautions that should be followed for all blood and other body fluid spills.

The big culprit at the pool is swimmers with diarrhea.  Diarrhea causing germs may survive even in a well-maintained pool.    Chlorine resistant Cryptosporidium, also known as “Crypto”, is one such microbe.  One inadvertent gulp of contaminated pool water and it’s possible you, too, will contract diarrhea.  The good news is HBV is not spread via contaminated water, or the oral-fecal route.  Know the ABC’s of viral hepatitis!  Keep little ones out of the pool if they have diarrhea, make frequent swim-diaper changes, and don’t count on the plastic swim pants to keep everything in.  Oh, and don’t let the kids drink the pool water.  Parents, good luck with that one!

There are legitimate dangers lurking at the pool – a recent recall on pool drain covers jeopardize the safety of children, the risk of drowning and injury always exists, and of course there’s the risk of diarrhea causing illnesses.  Fortunately the odds of transmitting or contracting HBV are infinitesimal in a well maintained pool.  As always, remember that HBV has a safe and effective vaccine. Be sure those you know and love are vaccinated.

Beat the heat at your neighborhood pool this summer.  And finally, if your public pool looks like this… well, common sense would tell you there’s a lot more to worry about than hepatitis B!

 

B A Hero Flash Mob Event!

Participants Perform a B A Hero Chant
What a pleasure and inspiration is was to participate in Hep B Free Philadelphia’s “B A Hero Flash Mob” event at City Hall, this week, in Philadelphia. It was great to experience the energy of the event through the many students and participants.

The group gathered at 11:30 to listen to brief messages from former Philadelphia Health commissioner Dr. Walter Tsou; current Philadelphia Health Commissioner Dr. Donald Schwarz; along with Professor Raymond Lum, Drexel University School of Public Health; Chari Cohen, MPH, Associate Director of Public Health of the Hepatitis B Foundation, and Dr. Timothy Block, Volunteer President, Hepatitis B Foundation, and Professor, Drexel University College of Medicine, who addressed the group.  This was a great forum to raise awareness of Hepatitis B, and urge the public to be screened and vaccinated.

As the clock-ticked down to the final minutes, the sun beamed and particpants waited in anticipation to reveal their “secret” to the world.

Richard Liu, MPH, rallied the crowd….

“Everyone has a secret.
Someone you know has Hepatitis B.
You can fight hepatitis B and liver cancer.
Reveal your secret.
B A Hero!”

The bull-horn blew at noon, and the crowd stripped off their jackets and cover-ups, revealing their blue T-shirts emblazoned with a superman-like emblem with a big, red “B” in the shield, all the while chanting:

 “B A Hero!  Get Screened!  Get Vaccinated!”

B A Hero!

The crowd was charged with energy.  The chanting continued.  Some ran about with their B A Hero T-shirts, and red capes. 

One group of elderly adults quietly displayed their support, wearing their T-shirts.  Guest speakers were interviewed.  One group of students performed an educational, “Hep B Rap”.   

The message was clear.  Hepatitis B is a serious problem, and the public needs to be screened for hepatitis B.  There are effective drugs for those identified, and may be in need of treatment.  There is a safe and effective vaccine.  We need to ensure vaccination against hepatitis B for young and old, and especially those in high risk groups.

It was great to have media coverage at the event.  We were thankful to have KYW News Radio, CBS, Fox and ABC in attendance to help spread the word to a broader, listening group.  This was a wonderful event for Hep B Free Philly, the Hepatitis B FoundationHepatitis Awareness Month and the community.

Now it’s time to do your part.  Be an educator, and help raise hepatitis B awareness.  Be sure everyone you know has been screened and vaccinated for HBV. 

B A Hero today!

Impressions of the Congressional Briefing and HHS Viral Hepatitis Action Plan Press Release

Last Thursday, May 12th, I attended the Congressional Briefing, and the Press Conference releasing the U.S. Department of Health and Human Services (HHS) Action Plan to Prevent, Care and Treat Viral Hepatitis, in Washington D.C..  The HHS Action Plan is in response to the 2010 Institute of Medicine (IOM) report on viral hepatitis.

I have been involved with viral hepatitis, specifically hepatitis B, from a patient perspective for over a decade, but my recent involvement in the political arena is new.   So, I’m still struggling with the numerous acronyms, political calendars and jargon…

It was encouraging to see members of Congress in attendance at the Congressional Briefing – hosted by U.S. Senator John Kerry (D-MA) and Rep. Mike Honda (D-CA), but it is clear that viral hepatitis needs more champions in Congress.  Congressional leaders who spoke included Rep. Honda (D-CA) , Rep. Cassidy (R-LA), Rep. Judy Chu (D-CA), Rep. Dr. Christensen (D-VI), Rep. Barbara Lee (D-CA), and Rep. Dent (R-PA).  Federal public health leaders Dr. Howard Koh, Assistant Secretary of Health, and Dr. Kevin Fenton, Director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention of the CDC  spoke regarding the direction and implementation of the plan.

Congressman Honda’s message was loud and clear to the audience:  “You need to be the megaphone.”  As advocates we need to educate and get our representatives on-board. The other, clear message is that the plan is a strategy with the tactics not yet clearly defined.  More importantly, there is no clear funding dedicated to the roll-out.  Rep. Bill Cassidy, a hepatologist, tells us we must be “fiscally responsible”, and yet he also said “Sometimes you have to increase the budget to reduce the deficit”.  Rep. Donna Christensen, also a doctor, states:  “We can save money and reduce the debt” with the viral hepatitis plan.  As a hepatologist and physician, these representatives understand that money spent on patient education, screening, prevention and treatment will be cost effective over time.  I wonder how many Representatives truly understand the ticking time bomb of this silent epidemic.

The representation at the press conference in D.C. was encouraging –everyone in the room with the same goals.   Dr. Susan Wang, a doctor in NYC spoke of her patient base where one in eight patients are infected with HBV.  Michael Ninburg told his personal story with his fight with hepatitis C, and the successful prevention of HBV from his chronically infected wife to their newborn son.  Michael was cured with the new HCV drugs, and his son was protected by a safe vaccine.  All good.

The HHS Action Plan for Viral Hepatitis will roll out through 2013.  Some of the goals are more attainable than others, such as delivering the first birth dose of the HBV vaccine to infants prior to discharge.  Dr. Koh describes this as the “first shot of life.” Administering prophylaxis and vaccination to infants born to HBV infected mothers is also feasible.  Other goals are loftier, less clearly defined, and will require significant funding.

Dr. Fenton, of the CDC, tells us the viral hepatitis plan will be implemented as a collaborative effort, leveraging resources between government agencies such as HHS, HRSA (Health Resources and Services Adminstration , CDC (Centers for Disease Control), and CMS (Centers for Medicare and Medicaid Services). 

Portions of the plan are dependent on the Affordable Care Act (ACA) and Health Care Reform, which are under attack.  It will be important for these programs remain intact for the plan to be successful.

We are all well aware of shrinking budgets and the need to be fiscally responsible, keeping in mind the human component.  This plan cannot be implemented without collaboration and cooperation between government and community organizations and efforts, and most importantly – funding.

That’s where we, as voting Americans, fit into the equation.  We need to get educate our Representatives and Senators by raising their awareness of viral hepatitis.  We need to tell them there is a plan to combat viral hepatitis.  We need to personalize this, tell our stories, and let them know that we do NOT want funding for viral hepatitis cut from the budget.  

Was your Representative present at the briefing?  Mine was not…

Visit your Representative during Constituent Work Week.  Write a letter, send an email, call and speak to a health staffer, or tweet your Representative, today.

Read the HHS Action Plan to Prevent and Treat Viral Hepatitis.

Happy 20th Anniversary to the Hepatitis B Foundation!

Hepatitis B Foundation 20th Anniversary Gala

 

Join the Hepatitis B Foundation with this short, fun, YouTube video with great snapshots and music as the Hepatitis B Foundation  celebrates its 20th Anniversary.  The Hepatitis B Foundation is the only national non-profit organization solely dedicated to the global problem of Hepatitis B. 

If you want to know more about HBF, check out our mission and story.  We’ve had some great accomplishments over the last year, so take a moment and review our  2010 annual report, and see what contributions HBF has made to hepatitis B research, outreach, and advocacy.

Call to Action! Urge Your Members of Congress to Attend Viral Hepatitis Congressional Briefing!

On Thursday, May 12th, Congressman Mike Honda and Senator John Kerry will hold a Congressional briefing entitled “Combating the Hidden Epidemic: U.S. Department of Health and Human Services Action Plan for the Prevention and Treatment of Viral Hepatitis.” This briefing will inform Members of Congress and their staff about the long-awaited report from HHS that will detail the federal government’s strategy for combating hepatitis B and C in the United States.

The release of this report and the briefing offer a tremendous opportunity to change the course of the viral hepatitis epidemic in the U.S. and demonstrate Congressional leadership in moving forward a comprehensive prevention and treatment strategy.

We need as many Members of Congress and their staff to attend this briefing to show their commitment to implement and fund the HHS plan. You can help make this happen by making three important phone calls right now!

How you can make a difference:

Call the Capitol Switchboard toll-free at 1-888-876-6242 and ask to be connected to your U.S. Representative. When you are connected, ask for the staff person who handles health care issues. Whether you speak directly to the staff person or leave a message, tell him/her:

“My name is _____________ and I live in (city/state). I am calling to urge Representative _____________ to attend a Congressional briefing on fighting the viral hepatitis epidemic in the United States. This important briefing will outline the new HHS “Action Plan for the Prevention and Treatment of Viral Hepatitis.” The briefing will be held on Thursday, May 12th, from 9:30 – 11:00 am in 210 Cannon House Office Building. Please contact Meina Banh in Congressman Mike Honda’s office for more information and to register. In the next 10 years, about 150,000 people in the United States are projected to die from liver cancer and liver disease associated with chronic hepatitis B and C. I strongly urge your office to participate in this briefing and show your commitment to fighting these preventable diseases.”

Next, call both of your two U.S. Senators (using the Capitol Switchboard number) and deliver the same message to their health care staff.

You can also ask the staff person for his/her email address and forward the attached “Dear Colleague” letter with more information about the briefing.

Thank you for taking the time to make a difference!

This Action Alert was created by the Hepatitis Appropriations Partnership, the National Task Force on Hepatitis B: Focus on AAPIs, and the National Viral Hepatitis Roundtable.