Hep B Blog

Category Archives: About Hepatitis B

About Hepatitis B, Liver, Liver Health, Living with Hepatitis B

Holidays and Hepatitis B: Treat Your Liver Right

 

 

The holiday season is here! November and December are full with holidays like Diwali, Canadian Thanksgiving, American Thanksgiving, Hanukkah, Kwanzaa, Christmas, and the New Year just to name a few. This time is often filled with love, happiness, and delicious food. If you or a family member is living with hepatitis B, it is important to eat mindfully during this festive time. Eating healthy is not always a possible option – not with delicious smells filling your kitchen, but you can make healthier choices! Here is a list of action items you can do to help maintain a healthy liver during the holidays:

  1. You can contribute a healthy dish – something filled with lean meats, hearty vegetables,  and is low in sodium.
  2. Try your best to avoid alcohol and go for drinks with lower amounts of added sugar.
    • Coffee has been associated with improvement in liver enzymes!
    • You can bring your own non-alcoholic beverage like a sparkling flavored drink.
  3. Choose fiber-rich foods like beets, Brussels sprouts, broccoli, and beans – your plate should look colorful!
    • Click on the veggies for some delicious and healthy recipes!
  4. Stay active – take a walk with your family/someone in your COVID social circle or do a free online exercise video.

Most importantly, do not feel guilty. Try your best to make healthy choices and not over-indulge, but do not beat yourself up if you do – your next meal can be healthier!

Remember that everything you consume is filtered through your liver; your liver never gets a break! The lifestyle tips listed above may seem simple, but they can have a large, positive impact on your health. Sticking to a regular healthy routine even during the holiday season will make it easier to continue those habits all year long! You can also check out our healthy liver tips to see what other actions can be taken to protect your liver.

Author: Evangeline Wang, Program Coordinator

Contact Information: info@hepb.org

About Hepatitis B, HBV, Living with Hepatitis B

Adoption and Hepatitis B

 

November is National Adoption Month! National Adoption Month’s ultimate goal is to increase national awareness of the need for permanent families for children and youth in the U.S. foster care system. Most importantly, this month acknowledges the birth families who make the difficult decision to give up their children for adoption, the foster families who care for children from various backgrounds, and the adoptive families who love and care for their adoptive children.

Adoption and Hepatitis B

 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. It is advised that you do not request your child to be tested for hepatitis B in their birth country, since the blood test itself could be a source of infection.

Domestic adoptions also present some risk to potential adoptees. Children born to women in high-risk groups could have been infected with hepatitis B at birth. In addition, children from group homes are at increased risk for hepatitis B infection.

Many children who have hepatitis B do not have symptoms of the viral infection. This makes it difficult for adoptive parents to know their child is sick without a blood test! This simple 3-part blood panel will inform you if your child has an active infection, had a previous infection and recovered, has “immunity”, or needs a vaccine. The good news is that your adoption agency should be able to tell you if a child has been tested for hepatitis B. If you have questions or concerns about the test results 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.

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 with hepatitis B 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.

Reference

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

Author: Evangeline Wang, Program Coordinator

Contact Information: info@hepb.org

About Hepatitis B, HBV, Living with Hepatitis B, Relationships

National Family Caregivers Month and Hepatitis B

November is National Family Caregivers Month! There are over 40 million Americans who are unpaid caregivers to their families, friends, and neighbors1. This month we celebrate and support all the caregivers who work tirelessly to keep our family and communities strong.

Caregivers and Hepatitis B

 Caregiving can be a tough, but noble job. It is often unpaid, long hours, and can cause burnout. However, caregivers selflessly work to provide their friends or family with the best care possible. Hepatitis B just does not affect the person living with the virus; it affects their family, friends, coworkers, and community members. Someone who lives with an individual who has hepatitis B might be put in a caregiver position.

Caring for an individual living with hepatitis B might be difficult if the person has advanced liver disease or is experiencing side effects from medication. While it may not always be physically demanding, caring for a person with hepatitis B can be emotionally overwhelming. Caring for an individual living with hepatitis B and other related complications can stir up heavy emotions which can take a toll on a caregiver’s mental health. Managing medications, diet, and healthy lifestyle for people living with hepatitis B during the COVID-19 pandemic can especially feel stressful. Luckily, there are resources available to help reduce feelings of stress and being overwhelmed.

Resources for Caregivers

Feeling stressed or overwhelmed with taking care of your friend or family member? It is also important to look after your own physical and mental health. Check out these resources from the How Right Now Initiative to help you manage your stress especially during COVID-19. Some suggestions include:

  1. Go for a quick walk or stretch
  2. Call, text, or video chat with friends or family
  3. Take several deep breaths

Does someone in your close circle have hepatitis B? Check out the Centers For Disease Control and Prevention’s Know Hepatitis B Campaign’s fact sheet, “When Someone in the Family has Hepatitis B”. This fact sheet has basic information about hepatitis B and the importance of testing and vaccinating family members. The fact sheet is available in 13 Asian and African languages as well as three English versions focused on Asian American, Native Hawaiian and Pacific Islander, and African Immigrant communities. Download the fact sheet here.

For more information about the Know Hepatitis B Campaign, visit the campaign website.

References

  1. https://www.whitehouse.gov/presidential-actions/proclamation-national-family-caregivers-month-2020/
  2. How Right Now Initiative
  3. CDC’s Know Hepatitis B Campaign

Author: Evangeline Wang, Program Coordinator

Contact Information: info@hepb.org

About Hepatitis B, HBV, Hepatitis B Research, Liver, Liver Health, Living with Hepatitis B, United States

Announcing the New Current Patient Opportunities Page on the HBF Website

A new page has been created on the Hepatitis B Foundation’s website that contains a compilation of various opportunities available for people living with hepatitis B. These opportunities can be for clinical trials, other types of research, or toolkits with information and resources for those living with hepatitis B and their loved ones and community members. All of these postings are produced or organized by entities external to HBF, but all are related to improved quality of life and liver health. The first two of these opportunities are listed below.

New Tool from CME Outfitters

A new HBV Patient Education Hub has been compiled by continuing medical education company CME Outfitters. The hub includes a great deal of valuable information, such as an overview of hepatitis B, a list of questions to ask your healthcare provider, a patient guide, information about hepatitis B co-infection, doctors’ advice on what to expect from treatment, and many other resources. All information is in an engaging and accessible format. Check it out today!

New Study Opportunity Available for People Living with Itching (Cholestatic Pruritus) Due to Liver Disease or Injury

A new paid opportunity has become available for those experiencing itching caused by hepatitis B, hepatitis C, drug-induced liver injury, auto-immune hepatitis, or primary sclerosing cholangitis (PSC). If you live in Canada or the US and have this condition, you may be eligible to participate in an interview to help researchers better understand your lived experience. The new research study is seeking participants ages 12-80 living in the US and Canada who are living with this itch. This is an opportunity to be involved in research and help advance scientific understanding! Contact the research coordinator for more information and to check if you are eligible. 

Please note that this study does not include treatment and pruritus must be at an intensity level of 4 on a scale of 1-10 for at least the past 8 weeks in order to participate. Patients cannot be pregnant or breastfeeding or have a diagnosis of primary biliary cholangitis. 

We are very excited to unveil this new section of our website and hope it will be a useful resource for many going forward! Please check back often, as more opportunities will be posted as they arise.

About Hepatitis B, HBV, Liver

SHEA Updated Guidelines: Health Care Personnel Living Hepatitis B, Hepatitis C, and HIV

SHEA Updated Guidelines on Health Care Workers Living With Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus

 Many health care students and professionals in the U.S. are living with hepatitis B, hepatitis C or HIV. Living with these conditions should not interfere with a person’s health care education or professional career. It is important that health care students and professionals are aware of their rights and responsibilities – and equally important that health care schools and institutions are aware of their responsibilities, as well. There are now new guidelines to help institutions understand how to manage health care professionals living with hepatitis B, hepatitis C or HIV.

The Society of Healthcare Epidemiology of America (SHEA) recently updated their guidelines on health care workers who are living with hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV). These updates reflect the advances in medical technologies and the low transmission risk health care workers living with HBV, HCV, and HIV pose. It is important to note, there have been very few cases of health care personnel (HCP) transmitting HBV,  HCV, or HIV to patients. These new guidelines, which align with the CDC’s Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students, can help reduce discrimination of health care students and personnel.

Some of the important updated recommendations for health care workers living with hepatitis B include:

  • Pre-vaccination testing does not need to be done unless the individual has an increased risk of infection
  • Health care workers should have a complete vaccination series for hepatitis B. Learn more about the vaccination series
  • Health care professionals living with HBV who do not perform exposure-prone procedures should not be prohibited from participating in patient-care activities solely on the basis of their HBV infection
  • Health care personnel living with HBV should seek optimal medical management, including, when appropriate, treatment with effective antiviral agents
  • Consistent with CDC guidelines, there is no justification for, nor benefit gained from, notifying patients with regard to health care professionals living with HBV who are being managed through an institution’s oversight panel

Some of the important updated recommendations for health care workers living with hepatitis C includes:

  • Because of the opioid epidemic in the United States, consideration should always be given to the possibility of substance use disorder when health care professional-to-patient transmission of a bloodborne pathogen is detected
  • Health care professionals living with HCV should seek optimal medical management, including treatment with effective antiviral agents to achieve cure of the infection
  • Health care professionals living with HCV who received treatment resulting in ‘undetectable’ circulating HCV-RNA levels can perform exposure-prone procedures with some stipulations:
    • Has not been previously identified as having transmitted infection to patients following definitive therapy resulting in a sustained virologic response (SVR)
    • Provides the oversight panel with records and laboratory results (or permits the HCP’s personal physician to provide records and laboratory results) confirming receipt of treatment and SVR
    • Has achieved SVR by remaining HCV RNA negative for 12 weeks following the completion of therapy

Some of the important updated recommendations for health care workers living with HIV:

  • Health care professionals living with HIV and who, despite appropriate antiretroviral treatment, have a confirmed viral load >200 copies/mL should not perform exposure-prone procedures until they have achieved virologic suppression
  • Scientists acknowledge that when the viral load is undetectable = untransmittable
  • Health care professionals living with HIV whose confirmed viral load is below 200 copies/mL can perform exposure-prone procedures with some stipulations:
    • Has not been previously identified as having transmitted infection to patients while receiving appropriate suppressive therapy
    • Obtains advice from an oversight panel about recommended practices to minimize the risk of exposure events
    • Is followed by a physician who has expertise in the management of HIV infection and who is allowed by the individual to participate in or communicate with the oversight panel about the individual’s clinical status
    • Is monitored on a periodic basis (eg, every 6 months) to assure that the HIV RNA remains below the level of detection, with results provided to the oversight panel.
    • Is followed closely by their physician and the oversight panel instances in which fluctuations in HIV viremia occur, including appropriate retesting as discussed above to reevaluate the HCP’s viral load
    • Agrees, in writing, to follow the recommendations of the oversight panel

Read more about the guidance and information on how hospitals, professional schools, and institutions should proceed for healthcare workers living with HBV, HCV, and HIV. You can also read more about the rights and protections for health care students and professionals living with hepatitis B in the U.S.

 

Reference

Henderson, D., Dembry, L., Sifri, C., Palmore, T., Dellinger, E., Yokoe, D., . . . Babcock, H. (2020). Management of healthcare personnel living with hepatitis B, hepatitis C, or human immunodeficiency virus in US healthcare institutions. Infection Control & Hospital Epidemiology, 1-9. doi:10.1017/ice.2020.458

Author: Evangeline Wang, Program Coordinator, Hepatitis B Foundation

Contact Information: info@hepb.org

About Hepatitis B, HBV, Liver, Liver Cancer, Liver Health

Your Liver and Hepatitis B

 

Your Liver and Hepatitis B

 Happy Liver Cancer Awareness Month! Your liver is an important organ for digesting food and breaking down toxins. Its main functions include: filtering blood from the digestive tract and transporting it back to the rest of the body, removing toxins from the blood, and storing important nutrients that keep the body healthy.

Hepatitis B is a viral infection of your liver that can cause serious damage over time. Chronic infection with the hepatitis B virus (HBV) can ultimately lead to scarring, cirrhosis, liver cancer, and liver failure. Liver cancer is the 3rd deadliest cancer worldwide, with 5-year survival rates of only 19%. There are few effective treatments for liver cancer, and we, therefore, must rely on prevention and early detection in order to save lives. Chronic hepatitis B infection causes approximately 78% of hepatocellular carcinoma (HCC), or primary liver cancer. The key to saving lives is ensuring that individuals infected with HBV are diagnosed and linked with appropriate care, including regular screening for liver cancer.

In the U.S., liver cancer incidence and death rates are increasing at a faster rate than any other cancer and are projected to continue to rise through at least 2030. Up to 2.2 million people are chronically infected by HBV in the U.S. and the majority is unaware of their infection. Identifying, managing and treating those with HBV infection can help prevent liver cancer in many people. Additionally, regularly screening people with chronic hepatitis B  for liver cancer can aid with early detection and treatment of liver cancer. If diagnosed early, liver cancer can be treated and even cured.

Below are some practices you can easily incorporate into your daily life and routine to keep your liver healthy while living with hepatitis B.

Healthy Liver Tips

  1. Reduce alcohol intake: Alcoholic beverages can damage or destroy liver cells and create additional health problems.
  2. Eat a healthy diet: Increase the amount of whole foods in your diet like fruits and vegetables while decreasing the amount of refined carbohydrates (pastas, white rice, white bread), processed sugar, and saturated fats which can create a healthy environment for your liver.
  3. Daily exercise: It is recommended for adults to exercise at least 60 minutes per day. Not only does this have many other health benefits, but it can reduce the fat surrounding your liver which can decrease your risk of liver cancer.
  4. Avoid the use of illicit drugs: Drugs like marijuana, cocaine, heroin, inhalants, or hallucinogens put stress on your liver and reduce its functioning capability.
  5. Wash produce and read labels on household chemicals: Pesticides and other chemicals can contain toxins which are harmful to your liver.

Incorporating these healthy practices does not have to be difficult. Choose one of the five tips that is most convenient with your current lifestyle and use it as a starting point for a healthier routine. By gradually incorporating each healthy liver tip into your lifestyle, you can reduce your risk of a negative liver outcome creating a healthier you!

Resources for Liver Cancer and Hepatitis B

Please join Hepatitis B Foundation, Hep B United and Hep B United Philadelphia’s webinar on October 20th at 3PM ET to learn more about hepatitis B and liver cancer. Dr. Kenneth Rothestein, Director of Regional Outreach and Regional Hepatology from Penn Medicine will be highlighting the importance of liver cancer screening for prevention. Register here!

To promote and ultimately prevent liver cancer this October we are pleased to share the Centers for Disease Control and Prevention’s Know Hepatitis B (KHB) Campaign Product of the Month – the Infographic: “Get Tested for Hepatitis B.”

The CDC’s Know Hepatitis B Campaign’s infographic, “Get Tested for Hepatitis B” encourages Asian Americans and Pacific Islanders to get tested for hepatitis B. This 2-page downloadable document is available in English, Traditional Chinese, Vietnamese and Korean languages and answers commonly asked questions about hepatitis B.

For more information about the Know Hepatitis B Campaign, visit the campaign website.

 

Author: Evangeline Wang, Program Coordinator, Hepatitis B Foundation

Contact Information: info@hepb.org

About Hepatitis B, HBV, Liver

Smoking and Hepatitis B

Smoking and Hepatitis B 

Hepatitis B and Your Liver

Hepatitis B is the most common serious liver infection in the world. Your liver is a vital organ which functions as your body’s engine. It processes toxins, stores vitamins, controls production and removal of cholesterol, produces immune factors, and releases bile to assist proper digestion. Hepatitis B may greatly inflame and damage the liver so it cannot perform these important processes efficiently. If left untreated, hepatitis B can cause severe damage such as fibrosis, cirrhosis, and liver cancer and lead to liver failure.

Smoking and Your Liver

Smoking itself may not directly cause liver cancer, though it can dramatically increase the risk for cancer in individuals who have other risk factors, such as a chronic hepatitis B infection (1). Carcinogenic chemicals in cigarettes can cause further damage to liver cells that are already at risk for cancer due to hepatitis infection. Research has found a strong association between chronic hepatitis B and C infections and smoking cigarettes as established risk factors for liver cancer (2). For example, research has found that smoking contains chemicals with cytotoxic potential which increases necroinflammation and fibrosis. Additionally, smoking increases the production of proinflammatory cytokines that are involved in liver cell injury (2). 

Smoking and Hepatitis B 

A 2010 study from the International Prevention Research Institute found an additive interaction between hepatitis B infections and cigarette smoking. Smoking seemed to interact with both hepatitis B and C infections, and the results of the study suggest a synergistic effect between smoking and hepatitis infections on the risk of liver cancer (1). For example, a study conducted in China found that individuals who smoke and live with hepatitis B have a higher risk for liver cancer because the liver’s processes are impaired from the toxic chemicals from long-term cigarette use (3). 

There is no “right” way to quit smoking; it can be cold turkey or gradual – it is your personal decision. If you are interested or considering quitting smoking or looking for alternatives to cigarettes, visit this website for some great tips and recommendations to help you quit.

 

References

  1.     Chuang, S. C., Lee, Y. C., Hashibe, M., Dai, M., Zheng, T., & Boffetta, P. (2010). Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: a meta-analysis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(5), 1261–1268. https://doi.org/10.1158/1055-9965.EPI-09-1297
  2.     El-Zayadi A. R. (2006). Heavy smoking and liver. World journal of gastroenterology, 12(38), 6098–6101. https://doi.org/10.3748/wjg.v12.i38.6098
  3.     Liu, X., Baecker, A., Wu, M., Zhou, J. Y., Yang, J., Han, R. Q., Wang, P. H., Jin, Z. Y., Liu, A. M., Gu, X., Zhang, X. F., Wang, X. S., Su, M., Hu, X., Sun, Z., Li, G., Mu, L., He, N., Li, L., Zhao, J. K., … Zhang, Z. F. (2018). Interaction between tobacco smoking and hepatitis B virus infection on the risk of liver cancer in a Chinese population. International journal of cancer, 142(8), 1560–1567. https://doi.org/10.1002/ijc.31181

 

Authors:

Shrey Patel, University of Pennsylvania School of Dental Medicine

Kelli Sloan, University of Pennsylvania School of Social Policy and Practice

Evangeline Wang, Public Health Program and Outreach Coordinator, Hepatitis B Foundation

Contact Information:

info@hepb.org

About Hepatitis B, HBV

ASCO: Updated Guidelines for Hepatitis B Screening

 

 

ASCO: Updated Guidelines for Hepatitis B Screening

The American Society of Clinical Oncology (ASCO), recently updated their hepatitis B screening guidelines. The Provisional Clinical Opinion on hepatitis B is based on a rigorous, evidence-based approach and is periodically updated to reflect recently published data.

Recommendations

The American Society of Clinical Oncology updated their 2020 guidelines on hepatitis B and cancer screening. Most importantly, ASCO recommends universal screening for hepatitis B for patients undergoing cancer therapy.  ASCO states that all cancer patients anticipating systemic anticancer therapy should be screened for hepatitis B through three tests. People living with chronic hepatitis B (HBV) receiving any systemic anticancer therapy should receive antiviral prophylaxis for the duration of anticancer therapy, as well as for at least 12 months after receipt of the last anticancer therapy. Antiviral therapy and management for cancer patients should follow national HBV guidelines, independent of cancer therapy, including management by a clinician experienced in HBV management for prevention of liver diseases such as cirrhosis or liver cancer. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after anticancer therapy ends. Patients with past HBV infection undergoing anticancer therapies that are not clearly associated with a high risk of HBV reactivation should be followed carefully during cancer treatment, with HBsAg and ALT testing every 3 months.

Risk Factors for HBV Reactivation

The article states a few risk factors for hepatitis B reactivation. These risk factors include types of cancers, various anticancer therapies, immunotherapy, radiation therapy and transarterial chemoembolization, other B-cell agents, and special situations. Because of these risk factors for hepatitis B reactivation, it is important for health care professionals to screen for hepatitis B prior to cancer treatment.

What Does This Mean for Providers

Oncologists and healthcare providers have a responsibility to screen their cancer patients for hepatitis B prior to treatment. Screening is especially important among vulnerable populations such as persons of Asian, Pacific Islander and African descent who are disproportionately affected by hepatitis B.

What Does This Mean for Patients

Patients with cancer should also advocate for themselves in healthcare settings to ask for a hepatitis B panel screening before treatment. Your provider will be able to interpret your test results, but here is a simple table to help you understand your hepatitis B panel screening results.

 

Read the full article here.

 

Reference

Hwang, J. P., Feld, J. J., Hammond, S. P., Wang, S. H., Alston-Johnson, D. E., Cryer, D. R., Hershman, D. L., Loehrer, A. P., Sabichi, A. L., Symington, B. E., Terrault, N., Wong, M. L., Somerfield, M. R., & Artz, A. S. (2020). Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, JCO2001757. Advance online publication. https://doi.org/10.1200/JCO.20.01757

Author

Evangeline Wang, Public Health Program and Outreach Coordinator at the Hepatitis B Foundation

Contact Information: info@hepb.org

About Hepatitis B, HBV, Hepatitis B Awareness

NAIRHHA Day 2020

Commemorating National African Immigrant and Refugee HIV & Hepatitis Awareness (NAIRHHA) Day 2020

Each year in September, the Hepatitis B Foundation, along with partners around the U.S., recognizes National African Immigrant and Refugee HIV and Hepatitis Awareness (NAIRHHA) Day. Founded by advocates in Massachusetts, Washington D.C., and New York, NAIRHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. Although not yet nationally recognized, the Multicultural AIDS Coalition (MAC) and the Coalition Against Hepatitis for People of African Origin (CHIPO) are working to establish NAIRHHA day as its own federally designated awareness day. As explained by Chioma Nnaji, Director at the Multicultural AIDS Coalition’s Africans For Improved Access (AFIA) program, there is a great need to establish NAIRHHA day as its own day. “Several of the current awareness days are inclusive of African immigrant communities, but do not comprehensively address their unique social factors and cultural diversity, as well as divergent histories and experiences in the US.”

Why NAIRHHA Day?

People born outside of the U.S. often face different health challenges than those born in the country and face various barriers to accessing important healthcare services. African immigrants (AI) are disproportionately burdened by HIV and hepatitis B. Advocates for NAIRHHA Day recognized the need to address these health issues in the community and thought that a combined awareness day would be the most effective way to reach the largest number of people impacted.

Hepatitis B presents a significant public health burden for many African countries, and subsequent immigrant populations living in the United States. Although data is limited on hepatitis B infection among African immigrant (AI) and refugee communities in the U.S., studies have shown infection rates are high – between 5 and 18%1,2,3,4,5. One community study in Minnesota even found AIs accounting for 30% of chronic hepatitis B infections 6. AI communities are also known to be disproportionately affected by HIV/AIDS, with diagnosis rates six times higher than the general U.S. population7. Despite this alarming disparity, HIV and hepatitis B awareness, prioritization, and funding has remained limited for this population.

Two of the largest barriers to testing for HIV and hepatitis B among African immigrants are lack of awareness and stigma. Cultural and religious values shape the way people view illness, and there can be fears around testing and diagnosis of illness, and moral implications for why someone may feel they are at risk. While stigma about HIV/AIDS and hepatitis B often come from within one’s own community and culture, it is primarily driven by lack of awareness. Oftentimes, awareness is low in an individual’s home country because of limited hepatitis and HIV/AIDS education, resources, and healthcare infrastructure.  When they arrive in the U.S., awareness remains low for similar reasons. Community health workers and physicians are vital stakeholders to raise community awareness in a culturally sensitive way to help identify current infections and prevent future ones through vaccination.

Commemorating NAIRHHA Day in 2020

Recognizing NAIRHHA Day is important to address the numerous barriers to prevention and treatment that African immigrants face. It was also founded to acknowledge the cultural and ethnic differences that influence how African-born individuals interact with their medical community and the concept of illness. The specific goals of this day of recognition include:

  • Raising awareness about HIV/AIDS and viral hepatitis to eliminate stigma;
  • Learning about ways to protect against HIV, viral hepatitis and other related diseases;
  • Taking control by encouraging screenings and treatment, including viral hepatitis vaccination;
  • Advocating for policies and practices that promote healthy African immigrant communities, families, and individuals.

This year, CHIPO, Multicultural AIDS Coalition, Hepatitis B Foundation and CHIPO-NYC, developed a suite of social media materials to improve awareness and create action around hepatitis B. This year’s campaign is focused on the incorporation of African proverbs into health messaging around ending stigma and increasing hepatitis B and HIV awareness, screening, prevention, and treatment. All graphics and an accompanying list of posts and tweets to go with each one can be found in a Google Drive folder here.  We will be promoting the materials throughout the month of September, and we invite you to share them widely. Together, we can make a difference to address HIV and viral hepatitis among African immigrant communities!

References:

  1. Kowdley KV, Wang CC, Welch S, Roberts H, Brosgart CL. (2012). Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology, 56(2), 422-433. And Painter. 2011. The increasing burden of imported chronic hepatitis B—United States, 1974-2008. PLoS ONE 6(12): e27717.
  2. Chandrasekar, E., Song, S., Johnson, M., Harris, A. M., Kaufman, G. I., Freedman, D., et al. (2016). A novel strategy to increase identification of African-born people with chronic hepatitis B virus infection in the Chicago metropolitan area, 2012-2014. Preventing Chronic Disease, 13, E118.
  3.  Edberg, M., Cleary, S., & Vyas, A. (2011). A trajectory model for understanding and assessing health disparities in Immigrant/Refugee communities. Journal of Immigrant and Minority Health, 13(3), 576-584.
  4.  Kowdley, K. V., Wang, C. C., Welch, S., Roberts, H., & Brosgart, C. L. (2012). Prevalence of chronic hepatitis B among foreign‐born persons living in the united states by country of origin. Hepatology, 56(2), 422-433.
  5.  Ugwu, C., Varkey, P., Bagniewski, S., & Lesnick, T. (2008). Sero-epidemiology of hepatitis B among new refugees to Minnesota. Journal of Immigrant and Minority Health, 10(5), 469-474.
  6.  Kim WR, Benson JT, Therneau TM, Torgerson HA, Yawn BP, Melton LJ 3d. Changing epidemiology of hepatitis B in a U.S. community. Hepatology 2004;39(3):811–6.
  7.  Blanas, D. A., Nichols, K., Bekele, M., Lugg, A., Kerani, R. P., & Horowitz, C. R. (2013). HIV/AIDS among African-born residents in the United States. Journal of immigrant and minority health, 15(4), 718–724.

About Hepatitis B, HBV, Hepatitis B Prevention, Liver

Addressing Hepatitis B in Africa

Conference on Liver Disease in Africa

To discuss the latest advances in addressing viral hepatitis and other liver diseases in Africa,  there will be a virtual Conference on Liver Disease in Africa (COLDA) from September 10th to 12th, 2020. COLDA is organized by Virology Education on behalf of the organizing committee led by Drs. Manal Al-Sayed, Mark Nelson, and Papa Saliou Mbaye. This virtual conference will gather clinicians, patients, other healthcare professionals, and policymakers from African regions, with international experts to support and exchange innovative ideas and knowledge about liver disease. The conference will consist of lectures discussing viral hepatitis infections, hepatitis co-infections, non-viral hepatitis-related infections, non-infectious induced liver disease, hepatocellular carcinoma, and end-stage liver disease. This virtual conference is important for addressing viral hepatitis since fewer than 1 in 10 people in Africa has access to testing and treatment for viral hepatitis. The World Health Organization (WHO) states that viral hepatitis is a bigger threat to Africa than HIV/AIDS, malaria, or tuberculosis with over 1.34 million deaths a year attributed to it.1 Over 60 million people in Africa have hepatitis B which annually accounts for an estimated 68,870 deaths.1 These statistics demonstrate the need for conferences like COLDA to discuss best practices and reduce viral hepatitis in Africa.

Mother-to-Child and Early Childhood Transmission

Hepatitis B is commonly transmitted from mother-to-child and close contact with infected individuals during the first 5 years of life. These modes of infection transmission are preventable with proper birth prophylaxis. There are two types of mother-to-child and early childhood transmission of hepatitis B resulting in chronic infection: vertical and horizontal. Vertical transmission refers to the transmission of hepatitis B from an infected mother to her baby during delivery. Horizontal transmission refers to infection with hepatitis B from direct blood-to-blood contact with an infected individual. Most early childhood transmission cases in sub-Saharan Africa are from horizontal transmission especially during the first 5 years of life from contact with family members or close friends infected with hepatitis B2, though vertical transmission from a hepatitis B infected mother to her baby is also common and completely preventable with birth prophylaxis.

 The best way to prevent the transmission of hepatitis B (HBV) from mother to child is through a “birth-dose”, meaning infants are vaccinated against hepatitis B within 24 hours of birth. However, in the WHO Africa region, only 6% of infants are administered the birth-dose.1 Only three countries in Africa: Cameroon, Rwanda, and Mauritania, have national guidelines addressing mother-to-child transmission of hepatitis B.2 Additionally, healthcare providers do not routinely screen future mothers for hepatitis B which contributes to a higher burden.2 This lack of screening demonstrates the need for universal guidelines to provide information to future mothers about hepatitis B. The World Health Organization recently released updated guidelines for hepatitis B which recommends a universal birth dose for all infants, as soon as possible, preferably within 24 hours followed by an additional 2-3 doses (often fulfilled with the pentavalent vaccine). Additionally, the WHO newly recommends that pregnant women testing positive for a hepatitis B infection (HBsAg positive) with an HBV DNA ≥ 5.3 log10 IU/mL (≥ 200,000 IU/mL) receive tenofovir from the 28th week of pregnancy until at least birth, to prevent mother-to-child transmission of HBV.4 This is in addition to the three-dose hepatitis B vaccination in all infants, including the timely birth dose. The WHO also strongly recommends that in settings in which antenatal (pre-birth) HBV DNA testing is not available, HBeAg testing can be used as an alternative to HBV DNA testing to determine eligibility for tenofovir prophylaxis to prevent mother-to-child transmission of HBV.4 Testing for hepatitis B in early pregnancy, a timely birth-dose, pentavalent vaccination, and administration of antivirals in the last trimester if needed would prevent vertical transmission and in turn, prevent horizontal transmission.

HIV/HBV Co-infection

There is a high burden of HIV/HBV co-infection in African countries because both diseases share similar transmission routes such as mother-to-child, unsafe medical and injection practices, and unscreened blood transfusions.2 Chronic HIV/HBV infection is reported in up to 36% of people who are HIV positive, with the highest prevalence reported in west Africa and southern Africa. The co-infection of HIV and HBV is especially dangerous because it accelerates liver disease such as fibrosis and cirrhosis. In fact, liver-related mortality is twice as high among people with an HIV/ HBV co-infection.2

Nosocomial Transmission

Another common way hepatitis B is transmitted in Africa is through nosocomial transmission or transmission from a hospital setting.3 The World Health Organization estimates 24% of blood donations in lower-income countries are not systematically screened for hepatitis B or hepatitis C. Additionally, countries have inconsistent screening procedures and use non-WHO prequalified test kits. Implementation of screening guidelines would significantly assist in reducing the risk of transmitting hepatitis B.

Barriers

 There are numerous barriers to eliminating hepatitis B in African countries. Screening is costly and often inaccessible, especially in rural areas. Moreover, there is an irregular supply of test kits for screening for healthcare providers.2,3 Lack of public awareness and often provider knowledge also contributes to the higher hepatitis B burden. Research has found that less than 1% of Gambian adults previously knew their status when tested positive for HBsAg.3 Additionally, there are financial constraints when it comes to hepatitis B treatment and care. The World Hepatitis Alliance and the WHO found that 41% of the world’s population live in countries where there is no public funding for hepatitis B treatments.3 This financial barrier prevents people from accessing important screening and vaccination prevention services. A collaborative effort among governments, local health officials, and community members is needed to manage hepatitis B in African countries.

Importance of Conference

Hepatitis B disproportionately affects the WHO Africa Region where 6.1% of the adult population is infected.1 The Conference on Liver Disease in Africa will address problems and discuss potential solutions for this neglected preventable disease. COLDA will help to make eliminating hepatitis B in Africa a reality by engaging the global community to collaborate on public health efforts, develop innovative ideas, and discuss best practices to reduce barriers. We hope to see you there!

Learn more and register for the conference.

 

References:

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  2. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohouès-Kouacou, M. J., Mbaye, P. S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye, A. B., … Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The lancet. Gastroenterology & hepatology, 2(12), 900–909. https://doi.org/10.1016/S2468-1253(17)30295-9
  3. Maud Lemoine, Serge Eholié, Karine Lacombe, Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach, Journal of Hepatology, Volume 62, Issue 2, 2015, Pages 469-476, ISSN 0168-8278, https://doi.org/10.1016/j.jhep.2014.10.008
  4. Prevention of mother-to-child transmission of hepatitis B virus: guidelines on antiviral prophylaxis in pregnancy. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

Baruch S. Blumberg Institute