Fighting a Global Killer
Norma, a mother in Manila, noticed her stomach swelling. She thought she was pregnant again.
Ong-Pin, a janitor in Hong Kong, turned yellow and lost weight.
Hyo-Jin, a young man in Seoul, doesn’t recall symptoms at all. He simply knows that--at age 14--surgeons operated on his liver, carving out a tumor the size and shape of a baby’s fist.
What do these three people share, along with 350 million others worldwide? They share a virus called hepatitis B, a blood-borne ailment that kills 1 million to 2 million people every year. Hepatitis B is one of the top 10 causes of death worldwide. But unlike other lethal microbes that act over days or years, hepatitis B usually acts over decades. Consequently, when it deals its final blows--end-stage liver disease and liver cancer--many victims die never knowing its name.
In May 1999, I traveled to Asia, where one in 10 people has chronic hepatitis B, to interview doctors and patients for a medical film. That’s when I met Norma, Ong-Pin, and Hyo-Jin, among others who shared their stories. Today Hyo-Jin is a 6-foot college student majoring in engineering. Watching him roughhouse and play basketball with friends, you would never guess he was ill.
But Hyo-Jin’s battle with hepatitis B actually dates to age 4, when doctors first discovered inflammation and hardening (cirrhosis) of his liver caused by the virus. By his teens, he developed cancer. After surgery, he had follow-up scans.
Three years later, the news was bad. Hyo-Jin once again had a rocky mass in his liver, the plum-colored organ that is the largest filter and the largest protein-building factory in the human body.
But this time, surgery wasn’t possible. Therefore, a drastic new treatment was devised. Instead of attacking with scalpels, Hyo-Jin’s doctors decided to snake tubes through his arteries and squirt chemotherapy directly into his tumor. There was no other option for saving Hyo-Jin’s life.
Among Asian-born men, hepatocellular carcinoma--hepatoma for short--is the second leading malignancy after lung cancer. In more than 80% of cases, its seed is hepatitis B. Roughly half of these infections start at birth, the virus passing silently from infected mother to child. Others come from blood, body fluid or sexual contact with a carrier. Even dirty razor blades, dental equipment and tattoo needles can transfer the virus.
Hyo-Jin will never know for sure how hepatitis B entered his body, but there’s good evidence that it probably came from his mother during childbirth. She died when Hyo-Jin was in the fifth grade, first swelling, then turning yellow, and finally vomiting blood--all telltale signs of terminal liver disease.
Hyo-Jin is well for now, thanks to good medical care. Ong-Pin had been faring well until recently, when his hepatoma returned. Norma wanted nothing more than to leave the hospital and care for her family. But her liver disease was too advanced. One month after our interview, she died at age 41.
Today, we need to talk frankly about hepatitis B. First of all, it’s the only disease in the top 10 causes of death worldwide that can be prevented by a vaccine. There is reason to hope that, sometime in the coming century, vaccination will finally defeat it.
For now, however, hepatitis B vaccination is not universal, and no place is free of the disease. In Asia especially, but also in Africa and parts of Latin America, Eastern Europe and the Middle East, more than 1 in 20 people are already carriers. In the United States, 1 in 250 people are carriers. Here in Southern California, a modern-day melting pot, rates are even higher.
Wherever they live, most hepatitis B carriers don’t know they have the virus until it’s too late. Which means, over a period of years, they can continue infecting others while a deadly time bomb ticks within them.
To defuse that bomb, a blood test is the first step. Adults who test negative are candidates for vaccination. Adults who test positive are monitored and sometimes treated. Now simple drugs can actually halt hepatitis B before it causes irrevocable harm.
Somewhere in Los Angeles are other Normas, Ong-Pins and Hyo-Jins. Somewhere in Los Angeles are also unknown carriers--and people about to be infected. Could one of these be you? If you are at risk, based on geographic origin or possible exposure, why not take action this year? Be tested, be vaccinated--and spread the word.
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Claire Panosian Dunavan is an internist and infectious diseases specialist practicing in Los Angeles. She can be reached by e-mail at drclairep@aol.com.
