Hepatitis B a Deadly Threat to U.S. Asians

Hepatitis B, a relatively rare disease in the United States, is a “silent killer” of people of Asian descent, who are 20 to 30 times more likely to be infected than any other ethnic group.

Although they make up 3.6% of the U.S. population, Asians account for half of the nation’s patients with the viral disease, which can lead to cirrhosis of the liver, liver cancer and death.

From 5% to 15% of people in U.S. Asian communities are infected, depending on the locale. A recent UC Irvine study of 828 Vietnamese people in Orange County who are 18 and older found that 13% had hepatitis B and 69% had been exposed to it.

“This is a silent epidemic and a silent killer in the Asian American community,” said Dr. Samuel So, director of the Asian Liver Center and Liver Cancer Program at Stanford University.

Laws in 31 states now require that children be vaccinated for the disease when they enter middle school, but some people are asking why federal and local authorities aren’t spending more money to warn older children and young adults -- particularly in Asian communities -- about the need to be tested and vaccinated.

“If you’re a 17-year-old Vietnamese kid, you’ve probably slipped through without being immunized,” said Steven McPhee, a professor of medicine at UC San Francisco and principal investigator at the Vietnamese Health Promotion Project. “That’s a population where they’re beginning to get sexually active and have children. Then it’s too late.”

In Orange County’s Little Saigon, home to the largest number of Vietnamese outside of their homeland, doctors and community activists say they hear the subject discussed on Vietnamese-language TV and radio. Vietnamese men have the highest rate of liver cancer in the world, much of it caused by hepatitis B, McPhee said.

But Diep Tran, program coordinator at the Orange County Asian and Pacific Islander Community Alliance in Garden Grove, said she knows of no government outreach programs.

“There hasn’t been a strong movement on that side,” she said. “The community is aware of hepatitis B and liver cancer, but they don’t know the extent of how the disease spreads, how you contract it or what the treatment is. There needs to be a lot more education, a lot more outreach.”

The federal Centers for Disease Control and Prevention has said that hepatitis B and liver cancer account for the greatest health disparity between Asian and white Americans. CDC officials say their agency spends $250,000 a year on hepatitis B education.

Although both affect the liver, hepatitis B is a far more dangerous disease than the more common hepatitis A. Hepatitis A is transmitted through fecal matter and oral contact, and is usually spread when carriers don’t wash their hands, or through contaminated food or water, although it can be passed sexually. Most people with hepatitis A recover within three months and have lifetime immunity.

Hepatitis B is also spread by oral or sexual contact. In the United States, it is most often associated with multiple sex partners and needle-sharing by drug users.

Among Asians, the problem has a different genesis. The disease is endemic in much of Asia. When immigrants move to the United States, they bring hepatitis B with them. Many are exposed during birth. It also is passed from child to child because of childhood scrapes, skin diseases like scabies, or kids sharing toothbrushes.

The hepatitis B virus is 100 times more easily transmitted than HIV, said Dr. Gary Euler, an epidemiologist for the National Immunization Project at the CDC, and can remain viable in a microscopic speck of blood for more than a week.

The younger a person is when exposed to the virus, the more likely that person is to get the disease. For children exposed at birth, the rate is greater than 90%, compared to 1% to 5% for adults. The disease may not result in symptoms for several decades. “Month after month, I see these people in their 30s and 40s with advanced liver cancer because no one tested them for hepatitis B,” said Stanford’s So.

Health officers have been successful in instituting measures to prevent hepatitis B in children. Since 1991, California doctors are required to screen pregnant women for the disease. In nearly all cases, giving newborns the first of the three-shot vaccination series shortly after birth, along with hyperimmune globulin, protects them from developing the disease.

Since 1997, California children must be vaccinated against the disease to enter day care or kindergarten. Two years later, a catch-up provision was added to the law, requiring that all seventh-graders be immunized, and that students attending state universities be immunized if they are 18 or younger.

Euler said the latest estimates are that at least two-thirds of children of Asian origin between ages 2 and 18 have been vaccinated. It appears to be having an effect. Celia Woodfill of the state Department of Health Services said there were only 10 reported cases of hepatitis B in people under 19 last year. They ranged in age from 16 to 18, ages not covered by state laws.

Those are the ones, along with a continuing stream of immigrants, who most worry doctors and activists. They also fear that people who don’t know they have the disease until it develops into a life-threatening condition have missed the chance for treatment with new, more effective drugs and can pass it to spouses and children.

Andrew Giap, a liver specialist at Kaiser Permanente in Anaheim, said the vaccination laws are helping doctors reach their primary targets: young children.

“But we’re missing a lot -- the population of late teens and college students,” Giap said. “This is the population at the highest risk.”

The hepatitis B vaccine series costs about $150, beyond the means of many people without health insurance, said Tran of the Orange County Asian and Pacific Islander Community Alliance. Any similar effort to raise awareness of hepatitis B must be in the language of the people at risk, she added.

Pressed by Dr. Quynh Kieu, president of the Orange County chapter of the American Academy of Pediatrics, schools in Westminster and Garden Grove soon may offer vaccination clinics for students, mostly high school juniors and seniors, who haven’t been immunized, said Rob Bachmann, health coordinator for the county Department of Education.

Others, though, say hepatitis B programs need to be offered to a much broader population.

“We have one or two generations walking around that never had benefit of protection,” So said.