Hepatitis B in
Asian-Americans
 Statistics
 What You Should Do
 HBV Blood Tests
 Hepatitis B Vaccination
 What Every Carrier
Should Know
 Liver Cancer
 Hepatitis A
 Physicians and Healthcare Workers
 Hepatitis B Myths
 Patient's Rights
 Educational Materials
 Personal Experiences

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- Total Population: 299.972 million
- Asian: 13.503 million (4.6%)
- Native Hawaiian and other Pacific Islander: 959,603 (0.33%)
- 34.1% of Asians in the U.S. live in California and constitute 64.4% were born in Asia. Out of these, 12.6% were born in China. See the Census Press Release for more information.

Rates of Hepatitis B

- Prevalence of chronic HBV infection in U.S. and Western Europe (lowest): 0.1-0.5%

- Prevalence of chronic HBV infection in Asia, Pacific and sub-Saharan Africa: 10% (5-20%)

- Prevalence of chronic HBV infection in API Americans: 7% (approximately 840,000)

Foreign born API: 9% (range 5-15%)

U.S. born API: 1.4%

- Prevalence of chronic HBV infection in Caucasian, Hispanic, or African-Americans: 0.1%, 0.1%, 0.5%

Incidence of pregnant women positive for HBsAg in the US by ethnicity in 2002 (Data from CDC)

Maternal race/ethnicity	Estimated Incidence(%)
White, non-Hispanic	0.13
African-American	.5
Asian/Pacific Islander Foriegn Born	8.9
Asian/Pacific Islander US Born	1.4
Hispanic	.09
Other	.5

- The two major objectives of this federal initiative are to improve the health of all people, and to reduce the health disparity between the different ethnic and racial groups in the population by the year 2010.
- The greatest health disparity between Asian Americans and Caucasian Americans is liver cancer; 60% of liver cancer in Asian Americans is caused by chronic hepatitis B virus infection. (Parkin 2006)
- Liver cancer rates among males are 9 times higher in Vietnamese Americans, 4 times higher in Chinese or Korean Americans, and 2 times higher in Japanese Americans than in non-Hispanic White Americans.

- The Jade Ribbon Campaign to prevent and fight hepatitis B and liver cancer was launched in the San Francisco BayArea in May 2001, Asian Pacific American Heritage Month. The objective of the campaign is to increase awareness and provide ethnic-sensitive health information to the API community and health professionals in an effort to reduce this major disparity.
- Partners of the Jade Ribbon Campaign include over 400 diverse groups of community organizations and federal agencies including the Centers for Disease Control and Prevention, National Task Force on Hepatitis B Immunization, Focus on APIs and Health Resources and Services Administration and its affiliated agencies in the U.S. Department of Health and Human Services.

- One third of the world's total population (2 billion) has been infected with hepatitis B virus.
- There are approximately 400 million people with chronic HBV infection (lifelong infection). 67% (275 million) reside in Asia and the Pacific Islands. By comparison, there are 170 million people with chronic hepatitis C and 40 million people with HIV/AIDS in the world.
- In many Asian countries, 10% (5-20%) of the population are HBV carriers.
- About 1 million people die each year (equivalent to 2800 deaths/day, 115 deaths/hour, or 1-2 deaths/minute) from liver cancer or liver failure caused by HBV.

HBV World Incidence Map

HBV China Incidence Map

- In the United States, an estimated 130,000 people become infected with HBV each year.
- 5000 people die each year from HBV related liver cancer or cirrhosis with liver failure.
- Medical and work loss costs for HBV-related conditions total more than $700 million per year in the United States.
- An estimated 1.4 million Americans are chronically infected with HBV. Over half are API Americans.
- As many as 1 out of 10 API Americans are chronically infected with HBV (ranging from 5-15% based on country of origin), compared with 0.1% of Caucasian Americans.
- Up to 20,000 women in the United States who give birth each year have chronic HBV infection. 54% are API.

- HBV is 50 to 100 times more infectious than HIV.
- The virus is found in highest concentrations in blood (as high as 10 billion viruses per mL); 10 to 100 times lower concentrations are found in semen and vaginal fluid.
- Hepatitis B virus is not spread by air, food, water, breastfeeding, casual contact in an office setting, kissing, hugging, coughing, sneezing, and sharing eating utensils or drinking glasses.
- Spread of HBV from mother to baby usually happens at the time of birth.
- Spread of HBV from mother-to-child accounts for most HBV infections in API Americans.
- Child-to-child spread most likely happens as a result of contact with skin sores, small breaks in the skin, or mucous membranes with blood. Spread within the household from sharing toothbrushes or razors may also occur because HBV can survive for at least 7 days outside the body.
- 90% of infants infected at birth with HBV will become chronically infected.
- 30-60% of children aged 1-5 years infected with HBV will become chronically infected.
- Up to 10% of older children and adults infected with HBV will become chronically infected.
- Most people from Asia, the Pacific Rim, and Africa become infected with HBV during childhood: from infected mother to child at birth, from child to child contact in household settings, and from reuse of non-sterilized needles and syringes in poor healthcare facilities.
- In contrast, most non-API Americans and Europeans who become infected do so during young adulthood through sexual activity and intravenous drug use. In addition, hepatitis B virus is the major infectious occupational hazard of health workers.
- More than 2/3 of HBV cases have no symptoms - or unrecognized symptoms - so most people who become chronically infected never know it.
- If symptoms develop, they are often mistaken for those of influenza - fever, fatigue, joint or muscle pain, loss of appetite, nausea, and vomiting. Jaundice (the yellow dis oloration of eyes and skin), which is usually a sign of liver damage, may not occur.

Age of Infection	% of those infected who become chronic carriers
0-1	90%
1-5	60%
Adults	10%

- To reiterate, the greatest health disparity between Asian Americans and Caucasian Americans is liver cancer, 80% of which is caused by chronic hepatitis B virus infection.
- In API men living in California, liver cancer ranks as a leading cause of cancer death: #1 in Laotian Americans, #2 in Vietnamese and Cambodian Americans, #4 in Chinese and Korean Americans, and #5 in Filipino Americans.
- One out of 4 people with chronic hepatitis B virus infection who became chronically infected during childhood (in other words, approximately 100 million of the 400 million chronic HBV infected people in the world) will die of HBV-related liver cancer or cirrhosis.
- Liver cancer is often fatal because when the cancer is small, there are no symptoms and thus, the diagnosis is generally made quite late.
- Liver cancer can occur in those with chronic HBV infection without cirrhosis; the risk is higher with cirrhosis, in men (3:1 male to female ratio), and with a family history of liver cancer.
- Liver cancer usually develops between 35 and 65 years of age, when people are maximally productive and with family responsibilities.
- An estimated 550,000 people each year die of liver cancer; 360,000 deaths each year are from countries in Eastern Asia alone (China, Hong Kong, Japan, Korea)
- Liver cancer is one of the top three causes of death by cancer in most of Asia, the Pacific, and sub-Saharan Africa, and at least 80% of liver cancer is caused by HBV. Worldwide, liver cancer is the fourth leading cause of cancer death in men, although uncommon in North America and Europe.

- HBV infection, especially during infancy and early childhood, is easy to prevent with the hepatitis B vaccine. Since 80% of liver cancer is HBV-related, the vaccine is considered the first 'anti-cancer vaccine.'
- Hepatitis B vaccine is safe and has been given to over 500 million people in the world.
- When given in infants within 12 hours of birth and at 2 months and 6 months, completion of the three-dose vaccine series induces a protective antibody response in 95% to 99% of vaccinated infants, even when the mother is a hepatitis B carrier. In addition, a direct reduction in liver cancer in cohorts of immunized children has already been demonstrated in Taiwan.
- Post-vaccination testing for immunity is not necessary after routine vaccination of infants, children, adolescents, or adults. Testing for immunity (anti-HBs) at 9-15 months of age after completing the series at 6 months of age is advised for infants born to mothers who are infected with HBV. Testing 1-2 months after completing the series is advised for healthcare workers, and persons with HIV infection. No booster shot is necessary after completion of the three-dose series.

- All newborns and children under 19 years of age in the United States are recommended to receive hepatitis B vaccination, particularly API children.
- Hepatitis B vaccine is free for children under 19 years of age through the federal Vaccines for Children program.
- Hepatitis B vaccination coverage among the high-risk API American children is an ongoing challenge. Completion rates for the first dose was 25-80% and for the three-dose series was only 14-67% in a 1998 survey of API children 4-14 years of age in six major U.S. cities.The cities with no vaccination programs targeting API children have the worst completion rates. Only one in ten API children now ages 15-19 have received their 3-dose hepatitis B vaccine series, in spite of national recommendations targeting these chi dren dating as far back as 1982.

California Cancer Facts and Figures 2007
World Health Organization
Centers for Disease Control and Prevention

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- Copyright 2005 Asian Liver Center at Stanford University -