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  • May 19 is National Hepatitis Testing Day

    May is Hepatitis Awareness Month and Saturday, May 19this National Hepatitis Testing Day in the United States. This day is an opportunity to increase awareness and testing for both hepatitis B and C. It is also a reminder for health care providers and the public of the importance of testing for viral hepatitis. Why is hepatitis B testing necessary? Hepatitis B is largely asymptomatic, which means that symptoms don’t always occur or are not obvious. Some people will not know that they have hepatitis B until it is too late, or they may learn of their infection from a blood donation screening or lab work.  There are groups of people who have a greater risk of hepatitis B compared to others, so it doesn’t hurt to be sure. here are some places around the world that have an extremely high hepatitis B prevalence (where many people are infected). It is important that people who are at high risk for a hepatitis B infection see a doctor to get tested, to find out if they have a hepatitis B infection. People living with chronic hepatitis B should be monitored regularly and appropriately screened for liver cancer. So, if you find you do have hepatitis B, talk to your doctor about what to do next. Remember, hepatitis B does not discriminate. Don’t wait for symptoms. B sure. B tested. If you do not have hepatitis B, then give yourself lifelong protection with the hepatitis B vaccine. The hepatitis B vaccine is safe and effective. Children or adults can get the 3-shot vaccine series, and there isa newly approved two-dose adult vaccine to protect us against hepatitis B! However, the vaccine doesn’t work if you are already infected. Don’t forget to check out these free, confidential hepatitis screenings this weekend! Check out Hep B United’s resource to find local events in your area. You can also visit the CDC’s website for more ideas on how to increase awareness on National Hepatitis Testing Day, and every day!

    http://www.hepb.org/blog/may-19-national-hepatitis-testing-day/
  • #StigmaStops: Can We End Hepatitis B Discrimination

    Around the world, millions of people with chronic hepatitis B face wrenching discrimination that limits their dreams, education, careers, income and personal relationships. Discrimination is unethical, unnecessary and a violation of human rights. Hepatitis B is simply not transmitted through casual contact. The stigma that persists is based on ignorance and it impacts millions around the world daily. The United Nations created Zero Discrimination Day to highlight the negative impact of discrimination and promote tolerance, compassion and peace. Many hepatitis activist organizations, including the Hepatitis B Foundation, used this commemorative day to draw attention to global hepatitis B discrimination. Even though Zero Discrimination Day was on March 1, we still need to recognize the importance of stopping hepatitis B discrimination. Every day is zero discrimination day, and ending discrimination starts with each of us working in any way we can in our communities to end this stigma. No one is to blame for hepatitis B, and people who have hepatitis B deserve the same opportunities to live fulfilling lives – at work, at home and in the community.  . There is a safe and effective vaccine that prevents hepatitis B infection. When people are protected, there is no reason to fear that healthcare workers or hotel maids will spread this infection. Even without vaccination hepatitis B transmission can be avoided with simple prevention measures. Hepatitis B is not transmitted casually. People who have hepatitis B are part of our global community. They are our mothers, brothers, doctors, teachers, spouses and friends. To learn about how the fear of discrimination affects people who have hepatitis B, check out some of our #justB patient stories. Jin’s story tells us how a vibrant young woman handles her fear, and Carolyn’s story shows us the devastating consequences of hiding a hepatitis B diagnosis. It is morally reprehensible that given the tools and knowledge we have

    http://www.hepb.org/blog/stigmastops-can-end-hepatitis-b-discrimination/
  • How to Navigate Disclosure, Denial and Drinking with Hepatitis B During the Holidays

    Image courtesy of stockimages at FreeDigitalPhotos.net By Christine Kukka With the holidays come  family reunions and parties that can set the stage for some big emotional challenges for people living with hepatitis B. Do we disclose our hepatitis B to our families or keep quiet? Do we remind relatives to get tested and/or treated, or quietly endure their denial? And, can we resist the host who insists everyone should be drinking alcohol with him? Is this the holiday when we finally tell our parents or siblings about our hepatitis B? First, take your family’s cultural temperature towards hepatitis B. Historically, in many cultures people with hepatitis B were shunned and could not marry, attend college or advance professionally. If your family still holds some of these baseless beliefs, be prepared to do some educating as you try to dispel their fears and prejudices. Come armed with printed information, website addresses and other material to bolster your family-focused public health campaign. If you were infected at birth, you may have family members who are also infected. The most valuable gift you may give them is your disclosure and your education, especially if it leads them to get tested, vaccinated and treated. If you suspect you are the only one in your family who is infected because of a past medical procedures that transmitted the infection, or sexual encounters or injecting drug use, think carefully about disclosing. Are your family members open and accepting? Will they suspend judgement and be supportive? Perhaps you should tell only one or two relatives whom you can trust, or stick to your community of friends. If you have doubts, erring on the side of caution for the time being may be best. Should you encourage family members to get tested, vaccinated or treated? If you know hepatitis B runs in your family, then your parents, uncles, aunts and siblings could also be infected. Should you bring up hepatitis B during dinner and encourage them to be

    http://www.hepb.org/blog/navigate-disclosure-denial-drinking-hepatitis-b-holidays/
  • Do You Forget Your Daily Hepatitis B Antiviral? Why We "Forget" Our Meds, and How to Improve Compliance

    Image courtesy of foto76 at FreeDigitalPhotos.net By Christine Kukka Your daily antiviral pill can save your life when you have liver damage from chronic hepatitis B. Entecavir or tenofovir (Viread) quickly reduce the amount of virus in your liver and the damage it causes. All you have to do is take it. Every day. But 20 to 30 percent of prescriptions are never filled, and about 50 to 70 percent of us don’t take our medications as prescribed. When we stop taking our daily antiviral, hepatitis B can reactivate and threaten our health. In one study, researchers provided 100 hepatitis B patients with an entecavir pill dispenser that monitored whether or not they took their daily pill over a 16-week period. They found about 70 percent of patients took their antiviral pill as prescribed more than 80 percent of the time -- which means these patients were “medication compliant.” Those who missed taking their antivirals more than 20 percent of the time--and were "noncompliant"--tended to be younger and had indifferent attitudes about whether or not the antiviral was really needed or would work. Image courtesy of Carlos Porto at FreeDigitalPhotos.net According to experts, whether we are "medication compliant" or not depends on how much trust we have in our doctors. If we like our healthcare provider and feel comfortable asking questions, we’re much more likely to take our medication on time. And, if our friends and family support and encourage us, we’re even more inclined to take our medication as prescribed. "The trust I have in my doctor is a big factor," said a member of the Hepatitis B Support List. "It is important to find a doctor who understands hepatitis B and is willing to work with me in terms of explaining what the options are and what the best approach is in managing my condition." "I know antivirals won't cure me," another email list member wrote, "but I'm committed to staying healthy and productive as long as God permits."However, people need more

    http://www.hepb.org/blog/forget-daily-hepatitis-b-antiviral-forget-meds-improve-compliance/
  • Help Stop Insurers from Over-Charging Patients for Hepatitis B Drugs on the Healthcare Marketplace

    Image courtesy of Taoty at FreeDigitalPhotos.net By Christine Kukka Blog reviewed and deemed accurate Jan. 2023. For years, people with pre-existing conditions like chronic hepatitis B struggled to get health insurance. News stories and Michael Moore’s documentary Sicko highlighted insurance companies’ refusal to cover pre-existing conditions and their practice of inflating premium prices if consumers had chronic health problems. Outraged by industry efforts to cover only low-cost, “healthy” consumers, lawmakers banned discrimination  against pre-existing conditions in the Affordable Care Act (ACA - Obamacare). The ACA’s Healthcare Marketplace website promises, “Your insurance company can’t turn you down or charge you more because of your pre-existing health or medical condition like asthma, back pain, diabetes, or cancer.” While health plans sold on the marketplace can’t openly refuse to insure people with pre-existing conditions, some have devised an insidious way to discourage people with hepatitis B from buying their policies. They have dramatically increased the copays consumers pay out-of-pocket for the two leading hepatitis B antiviral drugs (Viread and generic entecavir) to deliberately make their health plans unaffordable for people with chronic hepatitis B. When health insurers design plans, they assign each prescription drug a price “tier.” A low-cost generic antibiotic may be a Tier 1 while a new, brand-name drug is assigned a pricier Tier 4 or 5 ranking. A review of several Silver Plans sold on the marketplace shows entecavir and Viread (tenofovir) prices can reach up to $500 a month after the plan’s deductible is met. This deliberate over-pricing of certain drugs to deter people with chronic conditions from buying a health plan is called “adverse tiering” and it violates the ban against discriminating against pre-existing conditions. For example, a survey of Silver Plans sold on the marketplace in one region found one

    http://www.hepb.org/blog/help-stop-insurers-from-over-charging-patients-for-hepatitis-b-drugs-on-the-healthcare-marketplace/
  • Will herbals, natural “remedies”, Ayurveda or Traditional Chinese Medicine, supplements, or vitamins and minerals control hepatitis B?

    We get many people living with chronic hepatitis B asking about various herbals and supplements. The Hepatitis B Foundation does not recommend using these, as they are not FDA approved. Health authorities in different countries also don’t vet the content of such herbs or supplements. This is because they are not tested or regulated for effectiveness, safety, and purity. This lack of regulation means that you do not know what you are getting from dose to dose. The lack of testing means that taking some of these could do more harm to your liver than good. At best, these “might” be supportive of the liver, but they will not change the course of the virus and the damage to the liver that the virus may be doing. Keep in mind that not everyone needs treatment, but if you do, please talk to a knowledgeable doctor about getting first line antivirals (tenofovir (TDF), tenofovir (TAF) or entecavir) to control and suppress the hepatitis B virus. We know many are often “prescribed” a potentially supportive vitamin complex. Unless you have a vitamin deficiency, you may benefit equally as well by focusing on eating a healthy, well-balanced diet. Here is more information on how to maintain a healthy liver. There are many people out there trying to sell you a “cure”, but we can assure you that at this time, chronic hepatitis B is not a curable disease. If it sounds too good to be true, it is not true. if this is your first time being diagnosed with hepatitis B, discuss with your doctor whether this is an acute or chronic infection. If this is an acute infection, it is likely that you will resolve the infection without the need for medication or supplements.  Find more Frequently Asked Questions here.  Page updated 02/09/2022

    https://www.hepb.org/what-is-hepatitis-b/faqs/will-herbals-natural-remedies-ayurveda-or-traditional-chinese-medicine-supplements-or-vitamins-and-minerals-control-hepatitis-b/
  • CDC awards a $1.375 million, five-year grant to the Hepatitis B Foundation for expansion of Hep B United, a nationwide coalition

    Hep B United operates in 23 states, 30 cities and Washington, D.C. Aug. 13, 2021 – The U.S. Centers for Disease Control and Prevention has awarded a $1.375 million, five-year grant to the Hepatitis B Foundation to continue leading and expanding Hep B United, a nationwide coalition that operates in collaboration with the Association of Asian Pacific Community Health Organizations (AAPCHO). Hep B United is dedicated to reducing the health disparities associated with hepatitis B. With the new funding, the Foundation and AAPCHO will build the capacity of community coalitions to increase hepatitis B education and testing and improve linkage to care in a culturally and linguistically responsive manner for communities disparately impacted, including Asian Americans, Native Hawaiians and Pacific Islanders, African Immigrants and persons who inject drugs. Hep B United is composed of 50 national organizations and local community coalitions in 22 states, 30 cities and Washington, D.C. It promotes cross-sector partnerships between community organizations, health departments and Federally Qualified Health Centers, and has been building the capacity of multi-sectoral community coalitions to address hepatitis B in a nationally coordinated manner. Chari Cohen, DrPH, MPH, senior vice president of the Hepatitis B Foundation and co-chair of Hep B United, said the CDC’s new grant validates the work that’s being done by the Foundation’s staff, the AAPCHO team and others who are part of Hep B United across the country. “We appreciate the CDC’s continued support and commitment to eliminating hepatitis B and improving testing and linkage to care in highly impacted communities in the U.S.,” Dr. Cohen said. “The hundreds of partners who help to deliver hepatitis B-focused programs and initiatives clearly have benefited communities across the country and it’s gratifying that the CDC has recognized the successes of Hep B United over the past eight years.” Through a health equity lens, the Hepatitis B Foundation will build and strengthen the HBU network and offer capacity building, training, technical assistance and networking. The project also includes continued partnership in the development and dissemination of the Know Hepatitis B campaign, a national multi-lingual campaign led by CDC and co-branded with Hep B United. Jeffrey Caballero, MPH, co-chair and co-founder of Hep B United and executive director of the Association of Asian Pacific Community Health Organizations (AAPCHO), noted that the new grant will permit Hep B United to expand its work with African immigrant and Pacific Islander communities, along with minority-serving Federally Qualified Health Centers (FQHCs). “We are excited about the opportunity to increase our capacity to reach underserved populations nationwide while continuing to work alongside the community and our partners since we started in 2012,” Caballero said. “One of our key new initiatives will be growing a Hepatitis B Community Health Center Learning Collaborative to foster partnerships with a new cohort of FQHCs to implement hepatitis B education, screening and linkage to care programs.” The Foundation’s program strategies will include monthly coalition calls and webinars; mini-grants to support hepatitis awareness, education, testing and linkage to care; peer mentoring to foster the development of local and/or state hepatitis community coalitions and address specific capacity building needs; and the Hepatitis B Public Health Education Program, which utilizes the ECHO tele-education platform to train health educators and community leaders in an effort to improve hepatitis prevention and control strategies. Since 2012, Hep B United has awarded 28 mini-grants totaling $411,000 to partners in 17 states. The CDC grant also will support maintaining the Hep B United Community Coalition Leadership Development Program to focus on improving the capacity of individual local community leaders to lead and grow community-based hepatitis coalitions; and expanding the Hep B United Pacific Islander Community and Harm Reduction Strategy Workgroups to address the high rates of chronic hepatitis B among Pacific Islander communities and people who inject drugs, respectively. Hep B United’s National Advisory Committee members are:  Oakland, Calif., Jeffrey Caballero, MPH, co-chair and co-founder, executive director, Association of Asian Pacific Community Health Organizations (AAPCHO). Doylestown, Pa., Chari Cohen, DrPH, MPH, co-chair, senior V.P., Hepatitis B Foundation. Honolulu, Hawaii, Thaddeus Pham, co-director, Hep Free Hawaii, and viral hepatitis prevention coordinator, Hawaii Department of Health. Northern Virginia, Amy Trang, PhD, MEd, administrator, National Task Force on Hepatitis B: Focus on Asian & Pacific Islander Americans; founder and CEO, Social Capital Solutions Inc. Berkeley, Calif., Carol Brosgart, MD, consultant, Biotechnology, Public Health and Public Policy. Doylestown, Pa., Joan M. Block, RN, BSN, co-founder/co-chair emeritus and senior advisor. There is information about our local partners here on the Foundation website, including a list of partners and links to their websites. For more information, please send a note to info@hepb.org.

    https://www.hepb.org/news-and-events/news-2/cdc-awards-a-1-375-million-five-year-grant-to-the-hepatitis-b-foundation-for-expansion-of-hep-b-united-a-nationwide-coalition/
  • Hepatitis B Foundation Joins Forces with Grace Meng and NYC Hep B Coalition to Promote Awareness in Asian American Community

    Meng Lauded for Leadership in Hep B Cure Campaign FLUSHING, NY (May 2, 2018) – The Hepatitis B Foundation (HBF) and the New York City Hep B Coalition, founded by the New York City Department of Health and Mental Hygiene, co-sponsored a community forum on “Eliminating Hepatitis B in New York City,” at the Flushing Branch of the Queens Library in Flushing, NY. U.S. Representative Grace Meng (D-6th CD, Queens), the keynote speaker, stated that “hepatitis B is a major health issue that disproportionately impacts Asian Americans and Pacific Islanders (AAPI).” Meng added that “the virus can lead to cirrhosis, liver failure, or liver cancer if left untreated. That is why it’s critical for AAPI communities to become more aware of hepatitis B, and the importance of getting tested. I hope that this forum will help accomplish that goal, and I encourage my constituents to attend.” Ms. Meng, who co-chairs the Congressional Hepatitis Caucus, pointed out that her congressional district is 42% Asian American and in Flushing, Asian Americans make up 67% (48,500) of her constituents. “I am deeply concerned that most people living with chronic hepatitis B are not aware that they have this life-threatening infection, and most of those who have been diagnosed are not being treated” said Meng. “I hope that this forum will help get the word out and begin to turn that around and I believe this can be achieved with the excellent healthcare resources we have at the Charles B. Wang Community Health Centers and many other health professionals, and with citywide and community-based members of the NYC Hep B coalition committed to eliminating hepatitis B.” Dr. Ann Winters, Medical Director of the Viral Hepatitis Program at New York City’s Department of Health and Mental Hygiene said that the department is working to ensure that all New Yorkers at risk are screened for hepatitis B, including the uninsured.“We urge providers to screen patients from countries with high prevalence for hepatitis,” said Winters. “Patients diagnosed with chronic hepatitis B should have a complete medical evaluation including an evaluation for fibrosis, should receive antiviral treatment if indicated, and should be screened for hepatocellular carcinoma according to guidelines. There are many programs in NYC that provide affordable care for the uninsured.” The Hepatitis B Foundation’s (HBF) vice president for public policy, Alan P. Brownstein, supported Meng’s call for hepatitis B awareness, and pointed out “there is still no cure for hepatitis B.” He praised “Congresswoman Meng’s congressional leadership in the nationwide Hep B Cure Campaign.”Brownstein presented HBF’s Hep B Cure Campaign, which features a “Roadmap for a Cure” based on priority research recommendations of top scientists convened by HBF. Brownstein said “Congresswoman Meng helped launch the Hep B Cure Campaign at a congressional briefing in Washington, D.C. last May. And in just one year, we were able to achieve: • Congressional support for funding hepatitis B cure research;• Support from the National Institutes of Health (NIH) for hepatitis B cure research; and,• Publication of two scientific papers in prestigious medical journals on HBF’s ‘Roadmap for a Cure.” Brownstein cautioned that ”this is just the beginning and we have defined what more needs to be done to accomplish our goal” concluding that “a cure for hepatitis B is a ‘winnable battle’ that will be accomplished with sustained science-driven advocacy.” The cornerstone of the Hep B Cure Campaign is a consensus “Roadmap for a Cure” that is contained in reports developed by the Hepatitis B Foundation (HBF), which convened a virtual workshop of 35 of the world’s leading scientists to determine what research is needed to find a cure for hepatitis B. The two reports, “Research Priorities for the Discovery of a Cure for Chronic Hepatitis B: Report of a Workshop”(Antiviral Research, 2018)” and “A Research Agenda for Curing Chronic Hepatitis B Virus Infection,” (Hepatology, 2018) identify specific research projects in virology, immunology, and liver cancer, as well as strategies for expanding clinical research for therapeutic drug testing. Despite the magnitude of hepatitis B, NIH funding for hepatitis B is only $49 million per year and has declined almost 16% since 2012. By applying the scientific projects identified into existing NIH research funding mechanisms, a “professional judgment budget” was developed, documenting the need for an estimated additional $39 million a year for six years over current NIH research funding for hepatitis B and liver cancer to fund the priority projects identified by HBF. The Hepatitis B Forum in Flushing was opened by Chari Cohen, DrPH, MPH, HBF’s vice president for public health, who cited statistics about chronic hepatitis B affecting 2 million Americans and 292 million worldwide, leading to nearly 800,000 deaths each year, primarily from liver cancer—the second leading cause of cancer deaths worldwide. She also cited the recent reports from the World Health Organization (WHO, 2016) and the U.S. National Academies of Sciences, Engineering, and Medicine (NASEM, 2017) declaring that with appropriate action, the elimination of hepatitis B is now possible. “Increased awareness and advocacy for a cure are necessary if we hope to eliminate hepatitis B,” said Dr. Cohen. ### About the Hepatitis B Foundation: The Hepatitis B Foundation is the leading national organization solely dedicated to finding a cure for hepatitis B and improving the quality of life for those affected worldwide through research, education and patient advocacy. To learn more, visit Web site - www.hepb.org; blog - hepb.org/blog; Twitter - @HepBFoundation; Facebook - facebook.com/hepbfoundation; or call, 215-489-4900. About the NYC Hep B Coalition: The NYC HEP B Coalition coordinates efforts to prevent, manage and reduce hepatitis B among all residents of New York City. The coalition seeks to foster an inclusive collaboration among all stakeholders to advance hepatitis B awareness, screening, access to care, and vaccination through education, outreach, advocacy and support of research.

    https://www.hepb.org/news-and-events/news-2/hepatitis-b-foundation-joins-forces-with-grace-meng-and-nyc-hep-b-coalition-to-promote-awareness-in-asian-american-community/
  • Treatment Options for Hepatitis B

    People living with chronic hepatitis B infection should expect to live a long and healthy life. There are decisions people can make to protect their livers such as seeing a liver specialist or health care provider regularly, avoiding alcohol and tobacco, and eating healthy foods. There are also approved drugs for both adults and children that control the hepatitis B virus, which helps reduce the risk of developing more serious liver disease, but there is still no complete cure. Current treatments for hepatitis B fall into two general categories:   Immune modulator Drugs – These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. They are given as a shot (similar to how insulin is given to people with diabetes) over 6 months to 1 year. Antiviral Drugs – These are drugs that stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. These are taken as a pill once a day for at least 1 year and usually longer. It is important to know that not everyone with chronic hepatitis B infection needs to be treated. This can be difficult to accept when first diagnosed because taking a drug to get rid of the virus seems like the first step to getting better. Current treatments, however, are generally found to be most effective in those who show signs of active liver disease (e.g. through a physical exam, blood tests and imaging studies such as an ultrasound). So talk to your health care provider about whether you are a good candidate for any of the approved drugs. In addition, ask your provider if they participate in any clinical trials that are testing several new hepatitis B drugs. Learn more about Hepatitis B Clinical Trials. Whether you start treatment or not, it is very important to be regularly seen by a liver specialist or a health care provider who is knowledgeable about hepatitis B. The standard recommendation is every 6 months, but some people may be checked more often or even just once a year. During these check-up visits, your provider will monitor your health through a physical exam, blood tests and imaging studies (such as an ultrasound, FibroScan [Transient Elastography] or CT scan). The goal of these check-ups is to make sure that you are staying healthy and to detect any liver problems as early as possible.   Hepatitis B Drug Watch The Hepatitis B Foundation created the HBF Drug Watch to keep track of approved and promising new treatments. In 1991, “interferon alpha” was the first drug approved for hepatitis B and given as a series of injections over 1 year. In 1998, “lamivudine” was approved as the first oral antiviral drug taken once a day.   There are now 7 approved drugs for hepatitis B in the United States -- 2 types of injectable interferons and 5 oral antivirals – that control the hepatitis B virus. A cure, however, may be in the near future because there is exciting research being done today to generate promising new drugs. These new drugs all work differently than the approved treatments, so a possible cure could include a combination of the old and new drugs. Several of the new drugs are already being tested in people. Learn more about HBV Clinical Trials. Visit the HBF Drug Watch for a complete list of the approved treatments for hepatitis B and promising new drugs in development.

    https://www.hepb.org/treatment-and-management/treatment/
  • Adoption

    The key to successful adoption of a child with hepatitis B is to be prepared with accurate information about the disease, and to protect yourself and other members of your household with the hepatitis B vaccine prior to the child's arrival. International and Domestic Adoption Many people wish to adopt children from countries where hepatitis B infections are common: Asia, South America, Eastern Europe, and some parts of Africa. Children from these regions are often infected with the virus from their birth mothers who have hepatitis B and unknowingly pass the disease on to their children during delivery. In addition, many of these countries re-use needles for medications or blood tests, a practice that places children at risk if they have not already been infected at birth. Domestic adoptions also present some risk to potential adoptive families. Children born to women in high-risk groups (e.g. illicit drug users, multiple sexual partners, etc.) could have been infected with hepatitis B at birth. In addition, children from group homes are at increased risk for hepatitis B infection. Hepatitis B Testing Your agency should be able to tell you if a child has been tested for hepatitis B. With an international adoption, it is advised that you do not request that your child be tested since the blood test itself could be a source of infection. If you are concerned about the results of these tests, please contact us to speak with our knowledgeable staff. We can also refer you to a parent who has adopted a child with hepatitis B. Reassurance for Adoptive Parents Finding out that the child you wish to adopt has chronic hepatitis B can be upsetting, but should not be cause for alarm or stopping an adoption. We hope that a hepatitis B diagnosis will not change your decision to adopt a child. You can be reassured that most children will enjoy a long and healthy life. Hepatitis B does not usually affect a child's normal growth and development, and there are generally no physical disabilities or restrictions associated with this diagnosis.

    https://www.hepb.org/treatment-and-management/children-with-hepatitis-b/adoption/