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World Hepatitis Day: Preventing Hepatitis B in New York City

Screen Shot 2015-07-19 at 10.22.51 AMBy Vivian Huang, MD MPH,
Hepatitis B Program Director
at the Charles B Wang Community Health Center, NYC

World Hepatitis Day is commemorated on July 28 every year.  The date was selected to honor the birthday of the Nobel Laureate Professor Baruch Blumberg, who discovered the hepatitis B virus. Continue reading "World Hepatitis Day: Preventing Hepatitis B in New York City"

Join Hep B United and Watch the Hep B Summit Online!

hepb-united-btnThe Hep B United Summit in Washington D.C., starting Sunday afternoon and running through Monday, July 26 and 27, can be viewed LIVE and in real time on Periscope. Plus, you can follow the conversation on Twitter with #HepBSummit! Continue reading "Join Hep B United and Watch the Hep B Summit Online!"

Inexpensive Test Could Reveal Liver Cancer Risk

Could an inexpensive test, used in conjunction with current, traditional HCC testing help reveal one’s liver cancer risk? Research for the V-chip is described in an article published in this week’s  Health Canal

Scientists from the Houston Methodist Research Institute and the University of Texas M.D. Anderson Cancer Center will receive about $2.1 million from the National Cancer Institute to learn whether a small, low-cost device can help assess a person’s risk of developing a common form of liver cancer.

The four-year project is based on technology previously developed by Houston Methodist nanomedicine faculty member Lidong Qin, Ph.D., who is the new project’s principal investigator. Qin’s “V-Chip,” or volumetric bar-chart chip, will be used to detect biomarkers for hepatocellular carcinoma (HCC), the most common cause of liver cancer. The device only requires a drop of blood from a finger prick.


The V-Chip allows the testing of up to 50 different molecules in a blood or urine sample.

“Most of the burden of HCC is borne by people who have low income, with the highest incidence rates reported in regions of the world where infection with hepatitis B virus is endemic,” Qin said. “Developing an accurate and low-cost technology that assesses the risk of cancer could make a big difference to people who ordinarily can’t afford expensive tests.”

M.D. Anderson Department of Epidemiology Chair Xifeng Wu is the project’s co-principal investigator.

Qin and Wu will see whether the V-Chip accurately detects HCC biomarkers. The researchers will also determine which combination of these biomarkers proves most predictive of disease.

Among the biomarkers the researchers will look at are antigens of hepatitis viruses B and C, aflatoxin (a fungal toxin that at high doses is associated with cancer risk), and metabolic indicators of alcohol consumption, obesity, diabetes, and iron overdose.

Tests of the V-chip will not replace traditional testing methods, but rather be carried out in tandem so that patients’ care cannot be adversely affected.

Hepatocellular carcinoma is believed to be the third-highest cause of cancer death worldwide and the ninth leading cause of cancer death in the U.S. It is most commonly caused by a past infection of hepatitis viruses B or C (HBV or HCV) and cirrhosis of the liver caused by alcohol abuse or other toxic damage.

Please visit Health News, Health Canal for more information 

A Personal Reflection on China for World Hepatitis Day – Part II

(If you missed it, see part I) The second trip entailed the training of rural doctors.  During the training course, we used a number of simple visuals to better get some basic ideas across.  We wanted to drive home how common HBV was in China, and the number of Chinese people infected. We asked 10 people to stand up.  They smiled with pride, having been selected, until they realized they were being identified as one of those possibly infected with HBV.  The numbers dwindled as we went through the process of asking some to sit down representing those that had been infected, but resolved the virus, until finally, the last one standing represented someone with chronic HBV. This person was clearly horrified. This visual certainly drove the point home, but perhaps we were the ones educated by this process.

The Chinese people love children. I had a photo album of my children, which many enjoyed during the break.  There was one photo with a picture of both my two children and my colleague’s two children. My colleague and I were traveling with two of the children and had not identified if either were infected.  (As a result, we sat at every meal where most assuredly there was a large serving spoon in every dish…)  There was only one child that could be “safely” identified. When I pointed the child out to them, I could hear them, speaking in English, saying “Yes, I knew it.  Look at her.  She’s sick… doesn’t look well.”  I can’t even imagine what was said in Chinese.  HBV is nearly always asymptomatic in children.  All four children in the photo appeared equally healthy.  At that moment, I was grateful these children were spared the taunts.

During the course of the visit, we made an impromptu stop at a hospital on the outskirts of one of the cities.  We were shocked when we were permitted to enter the compound without pre-approval.  It was not a sanitized visit like all of the other stops we made.  We were traveling with a U.S. doctor, and I think the Chinese doctor we met was interested in speaking with her.  The facility was well below the standards we had encountered elsewhere. The largest building on the compound was the “women’s facility”.  We were not allowed in the building, nor were any pictures permitted of that particular building.

In another city we met with a conventionally trained doctor who had grown up in a very rural province, and was sometimes requested due to her rural background and familiarity.  She told us of a recent rural visit, where hundreds of women had been infected with an STD.  As a result of migration of workers into the cities, these women villagers are more often victims of diseases previously not seen in these areas.  Sadly, many of the women were being infected due to the lack of precautions taken during the annual examination of women.  The major culprit was the reuse of speculums that were not disinfected.

Finally, we met so many interesting, young Chinese, and heard so many wonderful stories like the one about a young university graduate who started the first online community of hbvers (that’s what they like to call themselves.)  It would turn out to be the biggest in the world, and would provide much needed support for many isolated Chinese, living with HBV.  There were also other stories, too, of how Chinese hbvers fought against discrimination by using a stand-in – either a paid “professional”, or other, loyal friends for their compulsory medical blood tests.  Imagine living with the fear of losing everything just because of the results of a simple blood test.

I went to China, naively thinking I would make a difference.  I was overwhelmed with the dire situation of those living with HBV.  The experiences and stories were sobering and haunted me for months after returning.  It was so personal. I certainly cannot  fix this global problem on my own, but I will do everything possible, so that others may understand, just a little, the impact of living with hepatitis B in China.

Raw Shellfish Warning for those with Hepatitis B

Summer is here, and it’s time for a smorgasbord of your favorite, fresh seafood.  All good, but if you have hepatitis B, you’re going to want to take precautions to ensure you don’t get sick, or even die, from the seafood that you eat.

There are a couple of variations on what is considered shellfish, but basically it includes oysters, clams, mussels, shrimp, crab, and lobster.  Oysters and clams are the only shellfish eaten raw, so they present the greatest danger.  Raw oysters are the main culprit, although all raw or undercooked shellfish from warm coastal waters, especially during the summer months, are a risk.  It’s difficult to ensure the origin of your seafood, despite labeling requirements, and whether or not it was frozen, or partially unfrozen at some time.  As a result, it’s best to treat all seafood equally.  And of course it’s not the shellfish itself, but rather a microbe called Vibrio vulnificus.  In fact this hearty microbe may exist in warm, salt-water directly, and care should be taken to avoid exposure of open wounds to potentially contaminated water.

V. vulnificus is very virulent with a 50% mortality rate.  The microbe may enter the blood stream via an open wound, or the GI tract where it may cause sepsis.  This is especially perilous for people that are immunocompromised, or have liver damage due to chronic infections such as viral hepatitis – specifically hepatitis B.  Symptoms may include fever, chills, vomiting, diarrhea, and abdominal pain.  It is very serious, and may lead to septic shock and death.  Septic infections are carry a high mortality rate of 50% in individuals without liver disease.  Those that are immunocompromised or suffer from liver disease are 80 to 200 times more likely to develop septicemia from V. vulnificus than those without liver disease.  Those are pretty serious odds.

Please keep in mind that this is not to be confused with basic food poisoning from “bad seafood”.  There are no visible signs of the bacterium.  Contaminated shellfish smell and taste fine.  If you believe you may have been infected, you need to seek immediate medical attention.

If you must eat shellfish, please follow precautions.  Be sure shellfish are thoroughly cooked.  Cook all oysters, clams and mussels until the shells open and continue boiling for five additional minutes.  If steaming, cook for an additional nine minutes.  Boil shucked oysters for at least three minutes, or fry them in oil for at least ten minutes at 375 degrees F.  Wear protective gloves when handling and cleaning raw shellfish, and avoid exposure to open wounds.  (This warning actually includes exposure of open wounds to infected waters, so be careful when vacationing.)  Take care to keep raw seafood and all other foods separate.  Eat when cooked, and immediately store leftovers in the fridge.

I’ve never been a fan of raw shellfish, and with my HBV awareness, I instilled a sense of fear in my children regarding raw shellfish, or any raw seafood.  If it’s got a shell – especially oysters, clams and mussels, they don’t touch it, and they gag at the sight of raw seafood.  Okay, so maybe I carried that a bit too far, but at least I can check that one off my danger list. V. Vulnificus is dangerous! If you have HBV, it would be best to avoid shellfish.

Got Hepatitis B? Share Your Favorite Liver Specialist with the HBV Community

Do you have a favorite liver specialist that you’d like to share with the Hepatitis B Foundation and friends living with HBV?  Friends with HBV live all over the globe, and we are interested in liver specialists with Hepatitis B treating experience from all over.  Pediatric patients are a special sub-population with special treating needs, too.  We’d love to hear from all of you!  Here’s what we’re looking for…

The Hepatitis B Foundation maintains a database of liver specialists that have experience treating patients with HBV.  Based on your recommendations, we would love to extend an invitation to your liver specialist to participate in our directory of liver specialists.  If your liver specialist replies, we will add his/her name to the list.

We’ve had some wonderful, new HBV friends on facebook from Africa and other continents, and we would encourage all of you to send us your liver specialist’s contact information.  Our international database is a little sparse, so we really need your input!  This would also include parents of children with HBV that are living abroad.  So, if you’ve got experience with a treating specialist that you’d like to share, you can be sure others will benefit from your advice.

Here is what the Hepatitis B Foundation needs to know:

  • Residing country
  • Adult or pediatric specialist
  • Liver specialist’s name and contact information  – including name, address, telephone number and email address (if available)
  • Anything else you’d like to share!

Email this important information to directory@hepb.org .  Please keep in mind that the information you provide is offered as a courtesy to others in the HBV community.  Your name will not be associated, and the addition of your physician does not make you responsible in any way.  This is not a physician referral service, but rather an opportunity for those living with HBV to share resources.  (Please note the disclaimer.)

Thanks to all who participate.  The entire HBV community benefits from your input!

 

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!

Why Vaccinate Infants Against Hepatitis B?

Sadly, out of all age groups, it is infants and very young children that are at the greatest risk for acquiring a chronic, life-long infection with hepatitis B.  In fact 90% of babies exposed to HBV will become chronically infected, and will live with the virus for the rest of their lives.  This includes mother-to-child transmission, and horizontal transmission from close contacts.  This is why the first dose of the hepatitis B vaccine is recommended before leaving the hospital.  The vaccine is safe and effective.  Choosing to vaccinate is an option those of us with HBV infected children would have LOVED to have.

Hepatitis B is a silent disease.  Forty percent of people living with HBV have no idea how they became infected.  Others have not yet been diagnosed.   Many likely acquired it at birth, or early exposure, and have had the virus smoldering for decades.  They may find out about it in routine blood tests, or from the Red Cross following a blood donation.  Hepatitis B is non-discriminating, although it is more prevalent in certain high risk groups.   Sometimes being part of a high risk group is as simple as having a parent born in a country where HBV is endemic.  Hepatitis B is 100 times more infectious than HIV, and yet many people say they would get vaccinated against HIV if a vaccine existed.  Why not hepatitis B?

So why have your infant vaccinated at birth?  It just makes sense.  How can you be assured all house-hold contacts are not infected?  War heroes get infected, as do health care workers, and other loving family members – mommies, daddies, grandparents, aunts, uncles, and cousins.  Parents go to work, and little ones go to day care.  They play at the neighbor’s house or with friends at pre-school.  Blood spills occur and sometimes they’re not properly managed, or even noticed.   Boo-boo’s come uncovered and little friends touch.  Sometimes “love-bites” are exchanged much to the dismay of parents.  Even the most vigilant parent is going to miss something.   HBV is not transmitted casually, but the possibility of exposure cannot be denied – especially at such a young age.

Hepatitis B is a poster-child for infant vaccination.  It is a tenacious virus, and there is no true cure.  If you are a pregnant woman, be sure you are tested for hepatitis B during your pregnancy.  If you are HBV positive, break the cycle One in five at-risk babies in the U.S. may NOT be receiving the necessary treatment, so SPEAK UP and ensure your baby receives prophylaxis treatment at birth.  Complete the vaccine series and have your baby tested for HBV at his one-year checkup to ensure he is protected.

If you are not HBV positive give yourself piece-of-mind.  When your baby is born, be sure to have her vaccinated before you leave the hospital, and give her a lifetime of protection against hepatitis B.

Hepatitis B and Chocolate

Planning on digging into your favorite dark-chocolate stash, or biting the ears off of a dark-chocolate bunny this weekend?  Dark chocolate is popping up everywhere.  Even some old favorites have a new, dark chocolate wrapper, replacing the now-passé milk chocolate.  Recently, studies have extolled the benefits of dark chocolate, and how it potentially prevents heart disease, reduces the risk of brain damage after a stroke, lowers the risk of heart failure, lowers blood pressure, reduces heart disease, has anti-cancer benefits, slows dementia, raises libido, and last but not least, is mood enhancing.  What about those suffering hepatitis B associated liver disease?

Last year there was a study out of Spain that investigated the benefits of dark chocolate to patients with liver disease – specifically patients with cirrhosis.  Cirrhosis causes portal pressure to rise, potentially resulting in damage to blood vessels in the liver.  Eating causes an additional rise in pressure, which becomes more dangerous as liver disease progresses.  Half of the study participants were given white chocolate, and the other dark chocolate.  The dark chocolate group saw a larger decrease in the blood pressure of the liver, and increased blood flow.  Keep in mind that this was a small study with only 21 participants.

The good news is that dark chocolate, specifically the cocoa component, is rich in antioxidants called flavonoids, and other beneficial components such as  phenylethylamine, theobromine,  anandamide, magnesium, copper, and vitamins E and B.  That’s certainly a mouth-full, but it is these key components that provide all the benefits of chocolate.

Here’s the bad news.  Many of us enjoy milk chocolate, or even the dreaded white chocolate, which has little or no benefit due to the processing of the cocoa, and the resulting loss of flavonoids.   In fact, the lighter the chocolate, the fewer the benefits.  In a perfect world we would be eating unsweetened, cocoa powder right out of the tin, or a chocolate bar with upwards of 85% cocoa.  That can be a pretty biting chocolate.  The chocolate many of us enjoy has a larger quantity of white sugar , which is not beneficial to the liver, or any other organ, nor is the additional butterfat, which is added to lighter chocolate.  However, if you can adjust your tastes a little and learn to adapt to less sugar and butterfat, dark chocolate is great addition to your diet.

Aren’t most of us looking for an excuse to add chocolate to our diets?  Ultimately, all things in moderation is the key.  A small amount (roughly 6.7 grams) of dark chocolate added to your daily diet is certainly not going to hurt you, and may in fact reduce abdominal pressure and portal pressure in the liver.  Perhaps the greatest redeeming quality of chocolate is it’s mood enhancing qualities.  If it feels good, and eaten in moderation, then why not reap the benefits of dark chocolate and enjoy your improved mood.