Hep B Blog
Hepatitis Delta (HDV), Living with Hepatitis B

Ask An Expert: Managing Hepatitis Delta During Pregnancy

 

  What is the standard treatment for hepatitis delta and how long is it taken?

 

Although there are no standard guidelines for the treatment of hepatitis delta, pegylated interferon has been shown to be effective for some patients. It is usually administered via weekly injections for 1 year or more and is able to cure roughly 15-40% depending on the length of time that treatment is administered. Although many patients see declines in their hepatitis delta virus levels, most do not maintain long-term control following the conclusion of treatment.

Can pregnant hepatitis delta patients be treated with interferon?

 

Interferon has not been proven to be safe for administration during pregnancy and should not be administered. It may be harmful to the baby.

 

What is the best way to manage a hepatitis delta infection during pregnancy, if interferon cannot be used?

 

A liver specialist may continue to manage the hepatitis B infection during pregnancy through antiviral treatment. The American Association for the Study of Liver Diseases (AASLD) recommends antiviral treatment during the third trimester of pregnancy for women with high hepatitis B viral loads.

How can hepatitis B and delta transmission be prevented to the baby?

 

Because a hepatitis B infection is required for someone to become infected with hepatitis delta, transmission from mother to child can be prevented with the hepatitis B vaccine. Centers for Disease Control and Prevention (CDC) guidelines recommend the first dose within 12 hours of birth, along with and a dose of HBIG (hepatitis B immunoglobulin), followed by the additional 2 vaccine shots; one at 1 month and the final one at 6 months old. The vaccine, along with HBIG and hepatitis B antiviral treatment (if necessary) greatly reduce the risk of transmission to the baby. In resource-limited countries, the World Health Organization (WHO) recommends the first dose of the hepatitis B vaccine within 24 hours of birth, followed by the additional shots on the recommended schedule. Once the vaccination series is completed, the baby should be protected for life against hepatitis B and delta.

If hepatitis delta cannot be treated during pregnancy, do most women have progression of their liver disease during pregnancy?

 

 While some women may see progression of their liver disease, due to the relative short length of pregnancy, most women do not show clinical signs of advancing liver disease.

 

What treatment should follow delivery? 

 

 

Following delivery, the mother may resume interferon treatment as long as she is not breastfeeding. Interferon treatment while breastfeeding could be harmful to the baby. As for all patients, keeping up-to-date on the latest hepatitis delta clinical trials could provide access to new, experimental treatments that may be more effective. For a global list of clinical trials for hepatitis delta, visit the clinicaltrials.gov web page.

It is very important for all pregnant women who are hepatitis B and delta positive to be managed by a liver specialist who is familiar with managing coinfected patients. For assistance in locating a specialist near you, please visit our Physician Directory page. For additional questions, please visit www.hepdconnect.org or email connect@hepdconnect.org.

Living with Hepatitis B, News

Talk with Dr. Block: An Expert’s Insight into a Hepatitis B Cure- Part 1

 

 

This November, the Hepatitis B Foundation attended The Liver Meeting – an annual conference hosted by the American Association for the Study of Liver Disease (AASLD). Inspired by the enlightening presentations and conversations at the conference, hepatitis B expert Timothy Block, Ph.D, co-founder and President of the Hepatitis B Foundation, took a moment to talk to us about the complexities of the hepatitis B virus and the status of a hepatitis B cure!  

This is part one of a two-part series.

  Why is finding a cure for chronic hepatitis B so challenging?    

       

That’s the big question. A cure is only complicated until we  are able to figure it out. Once we understand it, it will be simple! Hepatitis B is curable, but finding a cure for it is complex for two reasons. The first is that it is not a simple matter of virology. The virus establishes itself in a stable nest inside of the liver – called the covalently closed circular DNA (cccDNA) – and successfully invades the immune system. To do this, the virus enters a healthy cell and plants itself inside of the cell’s DNA – a component of the cell that allows it to function properly and produce more healthy cells. This makes it difficult – but not impossible – to create a treatment that will attack the hepatitis B virus while not damaging the rest of the healthy cell.

Another reason that finding a cure is so difficult is because of the body’s immune response. Typically, your body can recognize a virus as a potentially harmful invader, or something that is not supposed to be within your body. This triggers something called an “immune response”, which is when your body sends fighter cells to destroy the virus. With hepatitis B, the proper immune response often does not occur. Your body does not completely recognize the virus as a threat. Instead of eliminating the virus as it is supposed to, your body responds by creating an inflammatory reaction in the liver, which is called hepatitis. The incomplete attack on the virus allows it to replicate inside of healthy cells and kill them. Together, the cccDNA and the body’s incomplete immune response create a challenge for scientists and researchers.

    What will a hepatitis B cure look like?

As a patient advocate, I believe that the term “cure” should be reserved for when a person is no longer at risk for illness or death due to the infection. Having said that, I also realize the need for more practical definitions. You don’t know how effective a drug is until it’s been used for a long time, so it is important to use a definition that can encompass a wide range of possibilities.

A functional, practical cure would ideally be a drug that a person can take for a short amount of time. Once they have completed their prescribed dosage, they will stop taking the medication and still have the same benefits of the drug without having to take it. It would be great to eliminate the viral markers of the disease, such as the hepatitis B surface antigen (HbsAg), along with the reversal of liver disease and the return of normal liver function. 

 

 What is the Hepatitis B Foundation’s contribution to the cure?

 

When we started the Hepatitis B Foundation in 1991, there was very little interest in hepatitis B. Our goal was to help people with chronic hepatitis B and the diseases with which it was associated, like liver cancer and cirrhosis. We wanted to help people by finding a cure and by linking them to care. The Hepatitis B Foundation aims to help find a cure in two ways: through our own research institute – the Baruch S. Blumberg Institute – or by providing assistance to other researchers who are working towards a cure. Through the ups and downs of governmental and pharmaceutical interest, the Hepatitis B Foundation has remained committed and focused on solely addressing hepatitis B.

We created the Pennsylvania Biotechnology Center, which became a home for other hepatitis B companies, and we kept the interest strong. The Pennsylvania Biotechnology Center has now grown into a place for hepatitis B education and collaboration for professionals and students alike. We host regular seminars that provide updates on current research in the field and provide a welcoming environment for other hepatitis B experts to share their knowledge through presentations, guest lectures, and interactive discussions.

Nowadays, we have entered a clinical renaissance; people have a renewed interest in hepatitis B. Our job is to keep the attention focused on the infection and the people who are affected by it. We remain committed, resolved and steady. The Hepatitis B Foundation is the organization that is there for the patients.

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.

Living with Hepatitis B

Holidays with Hepatitis B: How to Tell Your Family

Image courtesy of Unsplash

As the holidays approach, families are planning parties and dinners and preparing to spend time with their loved ones. In such a merry atmosphere, the idea of discussing hepatitis B – whether its a recent diagnosis or the first time that you are ready to disclose your status – may be intimidating. However, it doesn’t have to be! In honor of  National Family Health History Day – which falls on Thanksgiving – we put together some tips to help you start the conversation.

 

  • Start Small – Facing your entire family at once can be frightening in any situation. Consider pulling one or two family members that you trust aside and speak with them first. They might offer advice on how to tell the rest of the family.
  • Come Prepared – Although chronic hepatitis B is the world’s most common risk factor for liver cancer, there is a universal lack of education and awareness about the infection. Use our fact sheets to help your loved ones understand what hepatitis B is, how it impacts your liver, and what it means to live with it.  For more fact sheets and to view them in different languages, click here. Be sure to let your family know that hepatitis B is spread by direct blood contact, not through casual interactions. They cannot be infected by sharing the same utensils as you, eating food prepared by you, or casual touches such as hugging.
  • Be Encouraging – Most people who are diagnosed with hepatitis B live long, healthy lives! Let your family know that you are monitoring the infection and taking the necessary precautions to prevent liver damage. Your family will be happy to know that you are in control of your health!
  • Let them know how to help – Although you may be able to
    Image courtesy of Canva

    manage hepatitis B by yourself, creating a support network is always a good idea! Do you have any active family members?  Exercise is great for the liver, so ask them to come along next time you go for a bike ride or hit the gym! Maybe you know someone who is great at cooking. Try cooking some healthy meals together!

  • Give them time – Hearing about a medical diagnosis can be difficult for everyone involved and may also be a sensitive topic for some. Don’t let this discourage you! Try showing them a few of our #justB campaign videos, which feature real people who have been impacted by hepatitis B. Some stories, like Alan’s, discuss how people often do not realize that hepatitis B and liver cancer are related. Other stories, like Alice’s, showcase the importance of being honest with your loved ones and explain how to turn a diagnosis into an educational opportunity. Viewing  #justB stories might help your family members feel more comfortable talking about the infection and encourage them to learn their own hepatitis B status.

National Family Health History Day

Image courtesy of Canva

In 2004, the Surgeon General declared Thanksgiving Day to be National Family Health History Day. It’s meant as a time for families to discuss health issues that appear to run in the family. While hepatitis B cannot be passed from generation to generation like genetic diseases, it is commonly spread within families due to how the virus is transmitted. The most common mode of transmission is from mother-to-child during childbirth, often because the mother was unaware that she was infected and that certain precautions needed to be taken to prevent transmission to the baby. As hepatitis B rarely has any symptoms, many people do not discover that they are infected until a family member is diagnosed or they develop liver damage.  Approaching the topic and starting the conversation can help to break this cycle of transmission within families.

The good news is that hepatitis B is preventable and, if detected early, liver damage can be prevented! Offer to help your loved ones make an appointment with their doctor or to accompany them when they go to get tested or vaccinated; they’ll appreciate the extra support!  

Also, consider making some time this Thanksgiving to fill out My Family Health Portrait – a free tool that maps out your family’s history of health conditions and identifies what you may be at risk for.

The topic of health is important all year round; you don’t have to wait for the holiday season to bring it up! Start the conversation today and help your family find the information they need to protect themselves and stay healthy!

 

Hepatitis B Prevention

Know the Risk: Transmission Through Tattoos & Piercings

Tattoos and piercings are a popular mode of self-expression. Oftentimes, they hold cultural and societal significance. Rarely are they thought about in relation to public health. In the United States, there are no federal regulations for tattoos or piercings apart from age restrictions. This means that tattoo and piercing parlors may have different sanitation and sterilization standards in accordance with how strictly a state chooses to manage the industry. For example, Nevada does not regulate tattoo or piercing shops, but New Jersey requires each shop to meet certain equipment sterilization and sanitation standards. Many people also decide to forgo a professional setting and receive body art from their friends, which can be especially dangerous. This lack of universal regulations and sanitation laws increases the risk of spreading bloodborne infections like hepatitis B.  

Image Courtesy of Unsplash

How Tattoos and Piercings Work: A tattoo is created by sharp needles repeatedly piercing the skin to embed ink into your body. While this ensures a permanent image, it also exposes your blood directly to the needle and anything that might remain on the needle from its previous usage. As hepatitis B is spread by direct blood contact, getting a tattoo poses a risk of infection if the equipment is not single use has not been properly sanitized, preferably using an autoclave. A fresh tattoo is an open wound, so it is important to properly bandage the area and keep it away from shared items that could potentially have blood on it, such as razors.

When you get a body part pierced, an artist typically uses a piercing gun with a very sharp needle that pokes a hole into the desired area and earrings or body jewelry are placed into the hole to make sure that the body tissue does not close. Earrings or body jewelry pose another possible risk of direct blood contact if they have been previously worn by another individual, so it is always best to use a new pair of earrings when getting pierced. In general, it is best to avoid sharing earrings and body jewelry. It is important to remember that hepatitis B often has no symptoms, so most people who are infected do not know that they have it. Safety precautions should be taken for everyone receiving a tattoo or piercing to prevent accidental transmission of the infection.

Do Your Research: Making a permanent decision can be difficult and the risk of contracting an infection can complicate matters; it is not something that you want to rush into it. Completing background research can narrow down your choices and help you feel more confident in your ultimate decision. Look at reviews of the shops and see what customers have said. If you see a review about a rash or an infection, it could be a sign that the establishment is not meeting basic safety standards. If you are in America, you can also check the state laws for body art and ask to see a parlor’s compliance certificates if they are not displayed. Don’t be afraid to ask questions! Ask to see the autoclave and ensure equipment bags are opened in front of you.

Image Courtesy of Unsplash

Although it may be tempting to have a friend or family member complete your body art in the comfort of a familiar setting, it also poses a higher risk for exposure to infections like hepatitis B. It is likely that such a setting does not have the proper tools, sterilization equipment, or training to clean the needles as they should be cleaned. Completing the hepatitis B vaccine series is strongly recommended for everyone, but especially to those who participate in activities with higher chances of blood exposure, such as getting body art in unregulated areas. After completing the vaccine series, most people are protected from hepatitis B for life, but other infections – like hepatitis C or HIV – still pose a risk.

If you need help identifying safe establishments, the Association for Professional Piercers is an international non-profit organization that allows you to search for shops in your area that meet certain health standards and answers any questions you may have about piercing. The Alliance for Professional Tattooists, Inc. is another international non-profit that can also help you find safe shops. Both have been approved by the Centers for Disease Control and Prevention (CDC). For more information from the CDC about hepatitis B or other bloodborne infections, click here.

What to look for in a Tattoo or Piercing Parlor:

  • Gloves – The artist should be wearing disposable gloves to keep the risk of contamination and blood exposure as low as possible. In addition, they should change their gloves each time they leave their work area or switch to a new client.
  • Disinfectant – Does the artist wipe down their work area when they are done with a client? Make sure that any area that they have set a tool on has been properly cleaned as well. The hepatitis B virus can survive on a surface for up to a week, so it is extremely important that any surface a tool comes into contact with has been sanitized.
  • Clean Equipment – Many tattoos and piercing shops have reusable needles and piercing guns. These objects are sharp and draw the clients’ blood, so they should always be thoroughly cleaned before being used again. If you notice that an artist works on one client and does not disinfect or change their tool before accepting a new client, there is an extremely high risk for blood exchange. Be sure to ask about the autoclave.
  • Certifications – Oftentimes, shops will have their certifications displayed on the wall. This shows that they have either been properly trained or are required to meet certain standards by law. Depending on the certification, this could mean that the shop is well-educated in preventing and knows how to properly sterilize their tools.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened. To a find a place near you where you can get tested in the U.S., visit www.hepbunited.org.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service.

Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.

Hepatitis B Advocacy, Hepatitis B Prevention

Vlog: Lunch & Learn Session with Jefferson APAMSA

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.

Hepatitis Delta (HDV)

Nearly 1 in 4 Romanians with Hepatitis B also Infected with Hepatitis D

 

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

 

Uncategorized

The Link Between Hepatitis B and Liver Cancer

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.

Liver Cancer

Join us for a Twitter Chat for Liver Cancer Awareness Month!

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.

  • Q1:What are things everyone should know about liver cancer, and also the link between hepatitis and liver cancer?
  • Q2: What can people do to prevent hepatitis, or for those living with hepatitis, what can be done to protect the liver and prevent liver cancer?
  • Q3: What are the barriers that keep people from getting screened for hepatitis and liver cancer and how can they be addressed?
  • Q4: Why are some populations more vulnerable to hepatitis and liver cancer, and how do we address the disparities?
  • Q5: What resources are available to educate others about hepatitis B & C and liver cancer? What resources are needed?
  • Q6: Who are your key partners in addressing liver cancer? Who would you like to engage more in your work? (Tag them here!)
  • Q7: What is one lesson learned or piece of advice for others who want to expand their work on the link between viral hepatitis and liver cancer?

Co-hosts and featured partners of the chat include:

  • Hepatitis B Foundation – @hepbfoundation
  • NASTAD – @NASTAD
  • CDC Division of Viral Hepatitis – @cdchep
  • Prevent Cancer Foundation – @preventcancer
  • Hep B United Philadelphia – @hepbunitedphila
  • Iowa Harm Reduction Coalition – @IAHarmReduction
  • CDCNPIN will be moderating the chat – @cdcnpin

Confirmed participants and their handles include:

  • Hep B United  – @hepbunited
  • Coalition Against Hepatitis For People of African Origin – @CHIPO_HBV
  • Liver Cancer Connect – @livercancerconn
  • CDC’s Division of Cancer Prevention and Control – @CDC_Cancer
  • Hep Free Hawaii – @HepFreeHawaii
  • HBI-DC – @HBIDC
  • HepFreeNYC – @hepfreenyc
  • NAIRHHA Day – @NAIRHHADAY
  • Minnesota Department of Health – @mnhealth
  • Philly Hep C Coalition – @hep_CAP

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!

 

 

 

Hepatitis Delta (HDV), Liver Cancer, Uncategorized

Where is Hepatitis D? High Prevalence of Hepatitis B/D Coinfection in Central Africa

By Sierra Pellechio, Hepatitis Delta Connect Coordinator

While hepatitis B is known to be highly endemic to sub-Saharan Africa and is estimated to affect 5-20% of the general population, the burden of hepatitis D, a dangerous coinfection of hepatitis B, has largely been left undescribed. Since the virus’s discovery 40 years ago, Africa has faced structural barriers that have contributed to the ongoing prevalence of the virus in this region. Widespread instability, under-resourced health systems, and poor surveillance have contributed to inadequate research and a lack of understanding about the health burden of hepatitis D on hepatitis B patients, particularly in Central Africa.

New data, however, reveals pockets of hepatitis B/D coinfection in this region, particularly in countries such as Cameroon, Central African Republic and Gabon. In a recently published study of nearly 2,000 hepatitis B infected blood samples from 2010-2016 in Cameroon, 46.7% tested positive for hepatitis D antibodies, a marker of past or current hepatitis D coinfection. Another study of 233 chronic hepatitis B carriers from 2008-2009 found a 17.6% positivity for hepatitis D antibodies. Other small studies from the Central African Republic have revealed 68.2% prevalence in hepatitis B patients, 50% coinfection in liver cancer patients and an 18.8% coinfection in hepatitis B infected pregnant women. Not only are new studies revealing evidence that there are groups at higher risk for hepatitis D, but a 2008 study on 124 community members in Gabon found 66% of them had markers for hepatitis D, proving this virus can also be circulating in the general population. Globally, hepatitis D is thought to affect about 5-10% of hepatitis B patients, making Central Africa an area of extremely high prevalence.

A diagnosis with hepatitis B and D can increase the risk for cirrhosis and liver cancer by nearly three times, and with only one available treatment, the future for coinfected patients if often uncertain. Although hepatitis B and D can be safely prevented by completing the hepatitis B vaccine series, which is available in many countries throughout Africa, the birth dose of the hepatitis B vaccine is often not given within the recommended 24 hours of birth. Lack of awareness, availability, and high cost mean many infants will not begin the vaccine series until 6 weeks of age, creating a window for exposure to hepatitis B. Greater than 95% of babies infected with hepatitis B will go on to develop chronic hepatitis B infections, leaving them susceptible to a future hepatitis D infection. Spread the same way as hepatitis B, through direct contact with infected blood and sexual fluids, hepatitis D can be contracted through unsterile medical and dental equipment and procedures, blood transfusions, shared razors and unprotected sex. Although the severity of disease varies greatly by hepatitis D genotype, coinfection always requires expert management by a knowledgeable liver specialist, which are often difficult to find.

As an increasing number of studies continue to describe the widespread endemicity of hepatitis B/D coinfection and its public health burden, researchers and the Hepatitis Delta International Network are calling on the World Health Organization (WHO) to declare hepatitis D a “threat” in this region in order to promote increased priority and awareness. Addressing hepatitis B/D coinfection prevention and management will be complex and require a multi-pronged approach through methods such as government prioritization, increased funding for health systems, hepatitis B vaccination awareness programs, birth dose prioritization, better sterilization techniques in hospitals, clinics, and barbers, and public awareness of the disease.

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. 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.

Hepatitis B Advocacy

Creating a #HepBFree Future in Arizona

Layal Rabat, Empowerment and Advocacy Manager at Asian Pacific Community in Action (APCA), provides an inside look into APCA’s hepatitis B efforts in Arizona.

Asian Pacific Community in Action (APCA) was formed in 2002 to meet the health-related needs of Asian Americans and Native Hawaiian and Pacific Islanders (AA & NHPI) residing in Arizona. Our vision is to inspire diverse communities to seek healthier futures. Our mission is to provide services, advocacy and education for diverse communities to help create a healthier and more empowered population seeking good health. In addition to hepatitis B testing, education, and referrals, APCA’s programs include Oral Health Advocacy, Advocacy Training, Policy Work, , Messaging/Storytelling , the Affordable Care Act, Medicaid, SNAP enrollment assistance, Civic Engagement, and Pop-up Health Fairs & Clinics.

Engagement Through Storytelling 

Over the years, we’ve prided ourselves on our creativity and thinking of ways to connect with communities through arts and innovative practices. This has led to the creation of  #HepBGirl and the HepBoo basketball fundraiser to support our hepatitis B efforts.

APCA’s most recent work has been centered around a mini-grant project generously funded by Hep B United – a national coalition to address and eliminate hepatitis B. The goals of the mini-grant were to help establish or contribute to hepatitis B prevention, education, linkage to care, and surveillance on a local level. APCA focused on education and empowerment by implementing the Hepatitis B Foundation’s (HBF)  #justB storytelling campaign into the community.

The project timeline was based on the recruitment of storytellers, conducting storytelling events, and conducting the analysis. The biggest lesson learned is that recruitment can take the most time out of all of the goals. We were aware of the stigma around talking about the infection and wanted to conduct our work in an ethical, sensitive way. To do this, we worked with a provider who helped by offering the opportunity for their patients to share their experiences. The patients could then choose whether to contact us or not. We also assured those that chose to speak that we would not publish any of the stories without their explicit approval and consent. To respect participant time and efforts and reduce the labor required of them for the event, APCA took great care to do as many of the preparations as possible, simplify the questions being asked, and conduct the events in a manner that respected their emotional labor and centered their explicit consent.

Hepatitis B In Arizona

Centered upon vulnerable populations such as older Asian American and Pacific Islander (AAPI) adults who were born before certain vaccine policies, APCA’s hepatitis B work includes addressing policy issues, access to care, and direct services. Direct services around hepatitis B included screenings, vaccinations, and referrals to care and treatment. In the past, APCA tested 2,869 people and found that 6.7% had active hepatitis B infections. An additional 31.2% were not vaccinated.                                                                                     

Arizona’s hepatitis B story mirrors that of the United States overall. From 2006 – 2015, an average of 979 chronic hepatitis B and 128 acute hepatitis B cases were reported each year in Arizona, though there has been a decrease in the number of acute hepatitis B cases identified in recent years. 
The rate of new reports of acute hepatitis B was highest among persons aged 40-44 years. Chronic hepatitis B rates were highest among those 30-34 years. 
The average annual rate of hepatitis B infection among Asians/ Pacific Islanders was much higher than other racial/ethnic groups (1,2). 

Looking Towards the Future

The mini-grant opportunity will help to launch #HepBFreeArizona – a campaign aimed at eradicating hepatitis B in the state. We hope to continue working with those that shared their stories to help build our future hepatitis B program and get it to a level where we can provide a space for patients living with hepatitis B to lead the way. The same barriers that prevent community members from accessing care also hinder their efforts to get involved in advocating for the policy changes that will alleviate those barriers. We are always learning how to balance community member autonomy and valuing their labor with respect to the time and effort they contribute and not taking more than we are giving.

Thank you to Layal Rabat for serving as our guest blogger this week! If you would like more information from Layal or the Asian Pacific Community in Action, please visit their website or contact them here.

 

Layal Rabat is a third culture kid who has spent years practicing the fine art of parachuting into projects as the need for her skills arises. She takes an intersectional approach to her work and does not shy away from any cause where injustice is present and her contribution is welcomed and necessary. Her experience lies in project management, traditional and digital communications using all mediums from her own voice to videos to writing to tweeting, assembling audience-specific information for delivery in an infinite amount of ways. An infinitely curious researcher and an obsessive collector and assembler of information, she is often seen playing a supportive role in the background and amplifying the voices of those directly affected by injustice in her community. Fluent in English & Arabic, intermediate in Spanish & knows a tiny bit of Armenian. Current issues are immigrant rights and public health. With a BS in Psychology & an MA in Social Justice & Human Rights, she is currently working as the Empowerment & Advocacy Manager at the Asian Pacific Community in Action, and volunteering her time as IT/Web & Social Media Coordinator at Phoenix Allies for Community Health. She also volunteers with the Restoration Project, Phoenix, and serves as a board member with Sonoran Prevention Works. In her spare time, she enjoys listening to music (& karaoke), reading, writing, photography, and traveling.

 

References

  1. 2016, Viral Hepatitis Epidemiologic Profile for Arizona
  2. 2016, Arizona Department of Health Services

 

Baruch S. Blumberg Institute