Join Michaela Jackson for A Day in the Life of a Public Health Coordinator as she takes you behind the scenes of Hep B United Philadelphia.
In this episode, the Hepatitis B Foundation joins Hep B United Philadelphia in the City for a Lunch & Learn session with Jefferson University APAMSA students.
By Sierra Pellechio, Hepatitis Delta Connect Coordinator
Since the 1990’s most of Eastern Europe has seen a decline in the prevalence of hepatitis D, a dangerous coinfection of hepatitis B, attributed to successful vaccination programs and government prioritization. Romania, which has the highest hepatitis B prevalence in the EU, has not seen such declines of hepatitis D, which affects 23% of its hepatitis B patients. Hepatitis D coinfection is considered hyperendemic to the country, and has some of the highest rates of coinfection globally1. Seventy percent of these 200,000 patients will progress to cirrhosis, often within only 10 years2, and face barriers to receiving effective treatment and management. Although the country enacted a national hepatitis B vaccination program for all newborns in 1995 and a catch-up program for school-age children in 1999, older populations already infected with hepatitis B and inadequately immunized young people represent susceptible groups for coinfection with hepatitis B and
disease.1,3. Additionally; lack of hepatitis B vaccination recommendations for high risk groups, low implementation of hepatitis B screening during pregnancy, supply shortages and vaccine hesitancy, have created opportunities for hepatitis B and D transmission. Exposure to infected blood or sexual fluids through blood transfusions or surgeries (before the 1990’s), tattoos, piercings, injection drug use, or sexual contact with an infected person, can expose people already living with hepatitis B to hepatitis D, or expose those who have not received the full hepatitis B vaccine series to both viruses. Control of hepatitis B and D coinfection has also been hindered by the lack of a national registry and surveillance system thus preventing an understanding of the accurate prevalence and public health burden1.
With health expenditure and life expectancy the lowest in the EU, Romania is battling large system-wide failures that have fostered the persistence of hepatitis B and D in its population5.
Dr. Florin Caruntu, of the National Institute of Infectious Diseases in Bucharest, has suggested that there is a general low level of awareness and screening among health care providers in Romania, 
which has led to late diagnoses and cost many patient lives. For patients who are diagnosed, investigational testing is not covered by the national insurance house, placing a financial burden on patients to pay out of pocket for the additional testing necessary to manage their coinfection. With pegylated interferon injections as the only semi-effective treatment option, even diagnosed patients struggle to effectively control their coinfection and even less are connected to clinical trials. Although there are 7 new drugs in clinical trials, progress has lagged behind patient need for new therapies, many of whom are living with cirrhosis.
Increased government investment in the healthcare system, including medical training and education programs for provider awareness, updated protocols and coverage of investigational testing, would pave the way for increased patient identification and navigation to successful care. As clinical trials continue to progress, it is critical that Romania be a top consideration for clinical trial sites, as patients anxiously await more effective treatment options.
For more information on HDV in Romania, please watch our webinar featuring expert speaker, Dr. Florin Caruntu, of the National Institute of Infectious Diseases in Bucharest, Romania.
For more information about hepatitis B/D coinfection and the Hepatitis Delta Connect program, please visit www.hepdconnect.org or email us at connect@hepdconnect.org. If you are a hepatitis delta patient, and wish to receive information about upcoming clinical trials, please enter your information here. Hepatitis Delta Connect seeks to provide information, resources and support for hepatitis B/D patients and their families through its website, social media, fact sheets, webinars and hepatitis D liver specialist directory.
1. Hepatitis delta virus infection in Romania: Prevalence and risk factors. (2015). Journal of Gastrointestinal and Liver Diseases, 24(4) doi:10.15403/jgld.2014.1121.244.dtv
2. Noureddin, M., & Gish, R. (2014). Hepatitis delta: Epidemiology, diagnosis and management 36 Years after discovery. Current Gastroenterology Reports, 16(1), 1-8. doi:10.1007/s11894-013-0365-x
3. Ruta, S. M., Matusa, R. F., Sultana, C., Manolescu, L., Kozinetz, C. A., Kline, M. W., & Cernescu, C. (2005). High prevalence of hepatitis B virus markers in Romanian adolescents with human immunodeficiency virus infection. Journal of the International AIDS Society, 7(1), 68-68. doi:10.1186/1758-2652-7-1-68
4. Gheorghe, L., Csiki, I. E., Iacob, S., & Gheorghe, C. (2013). The prevalence and risk factors of hepatitis B virus infection in an adult population in Romania: A nationwide survey. European Journal of Gastroenterology & Hepatology, 25(1), 56.
5. OECD/European Observatory on Health Systems and Policies (2017), Romania: Country Health Profile 2017, State of Health in the EU,OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels. http://dx.doi.org/10.1787/9789264283534-en
October is Liver Cancer Awareness Month! Despite the aggressive nature of this cancer – only one out of every five diagnosed patients survive beyond five years – liver cancer receives little attention from those outside of the health field. To help raise awareness and support those who have been affected, we are using our #justB campaign to share the stories of individuals who have been directly impacted by liver cancer throughout the month of October. The stories are featured throughout the month on the Hepatitis B Foundation, Liver Cancer Connect and Hep B United social media outlets. Check out Alice, Bunmi, Dai, and Kim’s stories.
What is Liver Cancer?
Liver cancer occurs when normal liver cells begin to grow uncontrollably and form a mass called a tumor. Cancerous tumors are dangerous because they begin to damage healthy cells that make up the organ and impair the liver’s functionality. Of the nine different types of liver cancer, Hepatocellular carcinoma (HCC) is the most common and often results from chronic hepatitis B. In the United States, new cases of liver cancer and liver cancer deaths are steadily rising. In fact, a recent study has shown that there has been a 53% increase in liver cancer deaths since 2000.
Hepatitis B and Liver Cancer
Although liver cancer is the sixth most common cancer in the world, it is the second most common cause of cancer deaths. Many people do not realize that chronic hepatitis B is the primary global risk factor for developing liver cancer. Certain viruses, including hepatitis B, can cause hepatitis, which translates to “inflammation of liver.” The virus attacks the liver and weakens its ability to perform important tasks like filtering toxins from your blood and maintaining the level of sugar in your blood. Chronic (long-term) infection with hepatitis B or hepatitis C viruses can lead to liver cancer. Worldwide, hepatitis B is much more widespread than hepatitis C, making it a priority when it comes to the prevention of liver cancer. Approximately 292 million people around the world are living with hepatitis B.
Liver Cancer by the Numbers:
Preventing Liver Cancer
Educating oneself is the first step in preventing liver cancer! If you have hepatitis B, be aware of the risk factors and behaviors that can increase your likelihood of liver damage and liver cancer, such as consuming alcohol and high amounts of junk food. Groups such as the CDC Division of Viral Hepatitis, the American Cancer Foundation, the American Association for the Study of Liver Diseases, and the Cancer Support Community all provide free fact sheets, call lines, and literature by experts that can help you understand what may be occurring in your body and to make educated choices. You can also check out our Liver Cancer Connect resource for more information or for liver cancer support.
Did you know that the hepatitis B vaccine is the first anti-cancer vaccine ever created? That’s because it helps to prevent liver cancer! Remember that the vaccine is typically given in a set of 3 doses. It is extremely important to take all three in order to receive lifelong protection from hepatitis B-related liver cancer: with the first dose you 50% protected, with the second dose you are 80% protected, and with the third dose, you are 100% immune to hepatitis B. In the U.S., there is also a 2-dose vaccine available, so you can be fully protected with fewer doses! If you are worried about the cost of the birth dose for your infant or the vaccine for yourself, many countries have free health clinics that can administer it or link you to an organization that can help.
Another key to preventing liver cancer is to get screened for hepatitis B. If you have not received your vaccine and you think you fall into a high risk group, talk to your doctor about getting tested. Because hepatitis B often has no symptoms, it is important to get screened even if you do not feel ill. An early diagnosis means that you can begin treatment, if needed, sooner and prevent irreversible damage from occurring. Like the vaccines, your local doctor or health clinic may be able to test you for free or reduced cost – just ask! Some local community groups also provide free hepatitis B testing, so be sure to look out for flyers and announcements about them in your community as well!
Interested in learning more about the connection between hepatitis B and liver cancer? Join us on Tuesday, October 23rd from 2:00 pm – 3:00 pm ET for Hepatitis B is the Major Etiology of Liver Cancer: Is a Cure Possible? Is it Necessary? – a webinar by HBF’s co-founder Dr. Tim Block on hepatitis B, liver cancer, and where to go from the current research standpoint. Register for the webinar here.
October is Liver Cancer Awareness Month. Often we neglect to think about the link between hepatitis and liver cancer. Tuesday, Oct. 16, representatives from Hepatitis B Foundation, CDC’s Division of Viral Hepatitis, and NASTAD will co-host a twitter chat at 3 p.m. EST to discuss this important link.
Featured guests include Prevent Cancer Foundation, Hep B United Philadelphia (HBUP) and Iowa Harm Reduction Coalition. Prevent Cancer Foundation is a national nonprofit dedicated to cancer prevention and early detection. HBUP is a Hep B United partner committed to testing and vaccination to fight hepatitis B and liver cancer in Philadelphia. Iowa Harm Reduction Coalition is a non-profit organization providing non-judgmental and compassionate services that empower people to care for themselves and one another.
Below are the questions to be discussed during the chat. How can you contribute? Join the conversation that day and throughout the month with the hashtag #Liverchat. Share any resources or strategies you have that raise awareness about the link between liver cancer and hepatitis.
Co-hosts and featured partners of the chat include:
Confirmed participants and their handles include:
Just getting started with Twitter? Do you wish to join the conversation but you don’t know how? Type #Liverchat in the search box of the Twitter application to follow the chat, and click on “Latest”.
You can prepare your tweets in response to the topics listed above in advance, or you can also tweet on the fly, re-tweet, or Like a tweet during the chat.
The questions are labeled Q1, Q2, etc. so please respond/answer specific question by using A1, A2, etc. in front of your tweets. Remember to include the #Liverchat hashtag, which is not case sensitive, in all of your tweets.
If you plan to participate, please contact us at info@hepb.org and we’ll add you to the list of confirmed participants. Let us know if you have any other questions about joining the chat. We’re here to help!
