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North American Occupational Health and Safety Week (May 5-11) is a time to raise awareness about the importance of injury and illness prevention in the workplace! This week, we’re focusing on health and safety within the nail salon industry, specifically the risk for hepatitis B transmission and opportunities to increase awareness and education about hepatitis B among nail salon workers.

In the U.S., the nail salon workforce is comprised mostly of Vietnamese Americans, with many being immigrants. Refugee and immigrant communities are often susceptible to worker exploitation (including labor trafficking) and encounter cultural and linguistic barriers that may leave them vulnerable to occupational health and safety risks, including hepatitis B transmission.

During routine work, nail technicians may be exposed to a client’s blood or other bodily fluids. It is important for nail salon workers to take precautionary measures to protect themselves and their clients to prevent the potential spread of the hepatitis B virus. More importantly, the nail salon industry (including salon owners and state health departments or boards that regulate nail salons) should implement policies that support greater education, awareness, and prevention of hepatitis B transmission among its workforce.

In October of 2011, the American College of Gastroenterology urged the need for increased surveillance and information on disinfection and infectious disease prevention, particularly for hepatitis B and C in nail salons. Since then, no major research or analysis has been conducted to better understand hepatitis B transmission or the policies that protect nail salon workers. In a new report released by the Hepatitis B Foundation, “The Impact of Nail Salon Industry Policies and Regulations on Hepatitis B Awareness and Prevention,” we seek to further understand the nail salon industry landscape through analyzing state policies that govern nail salons and identify strategies to support increased hepatitis B education, awareness, and prevention.

The nail salon industry is regulated at the state level by a regulatory Board of Cosmetology that oversees and ensures nail technicians and nail salons comply with all rules and regulations. In this report, we analyze the nail salon workforce and industry regulations and provide recommendations that can address specific concerns. We conducted phone interviews with health clinics, public health workers, and other relevant stakeholders to better understand the challenges this population encounters when accessing hepatitis B education and care. In addition, we conducted a policy analysis of each state’s Board of Cosmetology to assess their effectiveness in protecting workers from exposure to bloodborne pathogens, specifically hepatitis B. In our analysis, we found that several states may not adequately protect workers from workplace hazards that may increase their risk of hepatitis B exposure. With sanitation and disinfection requirements that greatly vary between states, low compliance can leave workers susceptible to the transmission of bloodborne pathogens, including the hepatitis B virus.

We offered the following recommendations to provide industry changes and community initiatives that can help protect workers or link them to care:

• Build partnerships between community organizations and nail salons to increase hepatitis B education, testing, and vaccination among nail salon workers
• Integrate hepatitis B education into the nail technician licensing curriculum
• Implement continuing education (CE) requirements around hepatitis B prevention and uphold sanitation requirements
• Provide multilingual course training materials and written licensing exams
• Adopt a sanitation rating system

Additionally, through our analysis, we found that four states have policies that discriminate against nail salon workers affected by hepatitis B by barring them from working in nail salons. Even with federal legal protections from the Americans with Disabilities Act, the continued discrimination in this industry presents a clear need to increase hepatitis B knowledge and awareness. Further state-level advocacy will be needed to address discriminatory policies. We must hold states accountable and advocate for policies and regulations that protect individuals affected by hepatitis B and prevent transmission of hepatitis B in the nail salon workplace.

Be sure to check out our full report for a detailed analysis of current state regulations and policies to assess their impact on educating and protecting nail salon workers and preventing hepatitis B transmission in the workplace.

Whether you work in a nail salon or visit one for a manicure or pedicure, be knowledgeable about the steps you can take to protect yourself. For further information about nail salon hazards and a complete guide to protecting your health and preventing injury in the workplace, check out OSHA’s guide here.

In the last Talk with Dr. Block blog post, hepatitis B expert Timothy Block, Ph.D., co-founder, and President of the Hepatitis B Foundation, sat down to discuss the status of a hepatitis B cure and how the foundation is contributing to the cure efforts. In this second installment, he provides an inside look into what a cure could possibly look like and a potential cure timeline!

This is the final post in a two-part series.

 We keep hearing that a combination of drugs will be necessary to cure HBV. What will these therapies look like?

A combination of drugs is likely not necessary for everyone. We already know that a small number of people who are treated with one drug can do fairly well.  However, most people will likely need a combination of drugs only because of precision medicine. Precision medicine allows a healthcare specialist or provider to develop treatments on an individual scale based upon an understanding of that person’s response to the disease. Some patients might respond better to specific drugs and specific doses due to differences such as age or underlying health conditions. We should take advantage of precision medicine and match specific drugs with the specific clinical state that someone is in. I do not believe that an immunomodulator, or medications that help to regulate the immune system, will be necessary for most people. It may, however, accelerate a cure and help us create a cure cocktail that will be effective in a large number of patients.

A functional cure for hepatitis B will likely be defined as the absence of the hepatitis B virus in the cells. This means that the person will have a sustained loss of surface antigen (HBsAg negative) and undetectable viral load (HBV DNA).  I look forward to a time where we have drugs that are both functionally and clinically curative. It is difficult to say if the cure will be in pill form, an injection, or an infusion. The hope is to eventually have a cure that will be taken orally for a short amount of time like the hepatitis C cure. More research needs to be done in order to truly determine what form the cure might take.

   How long do you anticipate someone will need to be treated?

A person would likely need to be treated for a few years. I base this time frame on the lifespan of an infected cell and how long I think it would take to safely replace the infected cells with healthy, uninfected cells. However, it is important to remember that people with chronic hepatitis B differ by the number of infected cells they have in their liver; some people may have most of their liver infected while others might have a smaller portion of their liver infected. The replication of the virus in the body and immune response also differ from person to person. Due to these factors, treatment will likely be administered by some form of response-guided therapy (RGT). This type of treatment means that a doctor will monitor the patient as they take the medication and adjust it as needed. Some patients will respond rapidly to the drugs and will be able to end treatment sooner than others.

When can we anticipate a combination of therapies resulting in a cure?

I’m very optimistic. At the moment, it looks like we might see the approval of one to two new drugs for hepatitis B or hepatitis Delta between the next 18 months and 2 years. The approval of these potential drugs is dependent upon the research conducted in clinical trials, but there are several drugs set to enter Phase 3 of their trials, which is promising! I expect that entry inhibitors – antiretroviral drugs that block a virus from infecting a healthy cell – will be among the first round of new drugs to be approved by the Food and Drug Administration (FDA). It is difficult to say if they will be a cure, but they will likely be a big step in the right direction!

Disclaimer: The information provided in this article is based upon recent research and updates in the field. Please note that timelines and specific information regarding hepatitis B drugs are estimations and are subject to change as new research emerges.

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:

• 10% of the world’s liver transplants are due to hepatitis B
• 60% of liver cancer diagnoses are due to cases of chronic hepatitis B
• 43% of liver cancer deaths are due to chronic hepatitis B
• 788,000 people die from liver cancer annually
• 15% – 25% of people who were infected with hepatitis B at birth will die prematurely from cirrhosis, liver failure, or hepatocellular carcinoma, if their hepatitis B is not diagnosed and appropriately managed
• 80% of liver cancer patients are in sub-Saharan Africa & in Eastern Asia

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.

The Hepatitis B Foundation (HBF) is joining the Africans for Improved Access (AFIA) program at the Multicultural Aids Coalition (MAC), the Coalition Against Hepatitis for People of African Origin (CHIPO), the New England AIDS Education and Training Center (NEAETC), and the Harvard University Center for AIDS Research (CFAR) in continuing the national fight for federal recognition of National African Immigrant and Refugee HIV and Hepatitis Awareness Day (NAIRAHHA).

Founded during one of the African National HIV Alliance’s (ANHA) strategic planning summits, NAIRAHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. This year,  NAIRHHA Day commemoration began on September 1st. Quotes collected from #justB storytellers, healthcare providers, and health educators are currently being circulated across social media accounts to start a virtual conversation. The hashtags #StigmaCantWin and #NAIRHHADay2018 are being used to organize the discussion and raise awareness on Twitter. The quotes are centered upon addressing stigma and myths surrounding HIV and hepatitis in African immigrant communities. Some quotes remind viewers that despite how it may feel, many reliable HIV and hepatitis B resources are present around the country. Other quotes – like this one from #justB storyteller Bright – offer words of encouragement and support to those who may feel alone.

A comprehensive webinar, titled Stigma Can’t Win: HIV and Hep B Among African Immigrants, will take place on Wednesday, Sept. 20 from 3 p.m. – 4:30 p.m.  and will complete the commemoration of NAIRHHA Day 2018. You can register for the webinar here. In addition to stigma’s impact on access to care and screening for HIV and hepatitis, viewers will learn about the root causes of these particular stigmas and how prevention-related stigma differs from the stigma of living with a certain disease. These topics are essential to the process of global eliminating viral hepatitis by 2030 – a goal set by the World Health Organization (WHO). Healthcare providers and community members will share their experiences with the audience during this interactive webinar.

In America, it is estimated that 5% – 15% of the African immigrant population is living with chronic hepatitis B. Less than 20% are aware of their infection. Unfortunately, these numbers are thought to be a low estimate due to lack of awareness, surveillance, and knowledge about modes of transmission. NAIRHHA Day was founded to help 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 the 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.

Last year, the Hepatitis B Foundation launched a project in partnership with CHIPO and the Centers for Disease Control and Prevention (CDC) to raise hepatitis B awareness among African immigrant communities. The project seeks to improve hepatitis B awareness, linkage to care, screening rates, and vaccination rates. The first phase of the project, which was completed in 2017, assessed the needs of African immigrant communities – including cultural beliefs, religious beliefs and common barriers to accessing healthcare. The second phase is currently underway and focuses on the development of educational materials to be disseminated amongst community leaders and healthcare professionals to further their understanding of both hepatitis B and the needs of the specific communities they are working with. Materials are anticipated to be released in early 2019.

Ending stigma and bringing attention to these issues doesn’t only start with coalitions and organizations; it also starts with YOU! Everyday actions can help to increase the visibility of HIV and hepatitis B, and encourage others to speak up. Below are some tips for individuals on NAIRHHA Day – or any day!

How to help:

• • Start a conversation in real life: Take the information that you see and talk about it with your friends, families, and co-workers!
  • Know your facts: Don’t have a lot of time to read? Fact sheets like this  one for NAIRHHA Day provide brief, but informational summaries of why a cause is important! HIV and hepatitis infographics are also available on the CDC website and the Know Hepatitis B campaign even has short videos and free posters so you can pass the knowledge along!
  • Share what you see: Social media may seem trivial at times, but it can help spread the message. Retweet, like, and repost the quotes you see or any information that can help combat stigma!
  • Help get NAIRHHA Day federally recognized: Contact your local health departments, local and national HIV and hepatitis organizations, and the HIV.gov Team at @HIVGov and express the need for NAIRHHA Day!

Join Michaela Jackson for A Day in the Life of a Public Health Coordinator as she takes you behind the scenes of Advocacy Day – a day of speaking to Congress members and their staffers about hepatitis B.

In this episode, participants visit Capitol Hill to ask Congress to support funding for Hepatitis B research and to raise awareness on the topic. Advocacy Day takes place the day before the Hep B United Summit.

While World Immunization Week takes place during April, World Immunization Day is TODAY, November 10th! The World Health Organization (WHO) established the day to raise awareness for vaccines as a cost effective and low-tech method of preventing illness and disease.

Worldwide 84% of countries have hepatitis B immunization programs; yet only 39% provide the necessary birth dose to prevent hepatitis B. This is a huge gap that must be addressed if we are to meet hepatitis elimination goals by 2030.

To celebrate World Immunization Day, here are some facts about the hepatitis B vaccine!

The safe and effective vaccine provides lifetime protection against hepatitis B, the most serious common liver infection in the world.  The vaccine is a series of 3 shots given over a 6-month period, typically at 0, 1 and 6 months.

There are minimum time periods that are needed between each dose. The second dose is given at least 4 weeks after the first dose; the third dose is given at least 8 weeks after the second dose, and there must be at least 16 weeks between doses 1 and 3.

After the 1st dose of HBV vaccine, there can be up to 50% protection. After the 2nd dose of HBV vaccine, there can be up to 80% protection.  It is very important to receive the third shot to ensure maximum, long-term protection.

If your vaccine schedule has been delayed, you do not need to start the series over, you can continue from where you have left off – even if there have been years between doses.

CDC, AAP and WHO recommend the birth dose for ALL newborns within 24 hours of birth because newborns and babies are at the greatest risk of developing lifelong, chronic infection if they are exposed to the hepatitis B virus. Giving the “birth dose” of the hepatitis B vaccine after a baby is born helps to reduce the risk of transmission to this very vulnerable population.

Perinatal prevention is especially critical for babies born to women who are infected with hepatitis B. All pregnant women should be screened for HBV. If positive, mom should be referred to care, and her baby should receive the birth dose of the vaccine and shot of hepatitis B immune globulin (HBIG), if available, within 12 hours of birth.

In order to meet this requirement, the first dose of the hepatitis B vaccine must be the “monovalent vaccine,” which means it is only the hepatitis B vaccine.

Many countries provide the “pentavalent vaccine”, which protects against 5 diseases, including hepatitis B. Unfortunately, the first dose of the “pentavalent vaccine” is given at 6 weeks, which means babies are not protected at birth and during the first 6 weeks of life against the hepatitis B virus.

It is very important that babies receive the “monovalent” hepatitis B vaccine at birth (not the “pentavalent vaccine”) in order to protect against a lifelong chronic hepatitis B infection. Babies must complete the vaccine series according to schedule. This can be done singly with the HBV monovalent vaccination or in combination with other vaccines (pentavalent, hexavalent etc.) Babies born to mothers that are hepatitis B positive should follow up with post-serologic testing at 9 months or a year to ensure the baby is protected against the hepatitis B virus.

There is no second chance to protect a newborn or baby from hepatitis B!

If a child, adolescent or adult missed the hepatitis B vaccine, they can be vaccinated at any time. For adults, it is never too late to start the hepatitis B vaccine (unless you are already infected with the hepatitis B virus, or have recovered from a past infection).

For more information on hepatitis B vaccine in babies or children, consult the “Summary of Recommendations for Child/Teen Immunization.” For more information on hepatitis B vaccine in adults, consult CDC’s Recommended Adult Immunization Schedule.

Be sure to talk to your doctor about getting the hepatitis B vaccine (if you have not already). Not only does it protect against hepatitis B, but also hepatitis D and help prevent liver cancer!

References:

https://medgenomelabs.wordpress.com/2015/11/10/world-immunization-day/