September 19, 2008
Federal health officials Thursday made public new recommendations designed to reduce the toll of chronic hepatitis B, particularly among Asian Americans and others considered at high risk for the disease that's known as a silent killer.
For the first time, government guidelines will focus on treatment, education and long-term care of infected patients. Until now, recommendations from the U.S. Centers for Disease Control and Prevention have centered on screening and testing.
Hepatitis B, which affects an estimated 25,000 Asians and Pacific Islanders in San Francisco alone, is a major cause of liver cancer, cirrhosis or liver failure - and often strikes without apparent symptoms. It is preventable with a simple vaccine.
The CDC's new guidelines recommend testing all people in the United States who were born in Asia and Africa. Additionally, testing should be done for "at-risk" people, including men who have sex with other men and injection-drug users.
"There are better treatments (available) than ever before," said Dr. John W. Ward, director of the CDC's division of viral hepatitis, during a news conference Thursday at the Chinatown Public Health Center.
San Francisco was chosen as the site for the announcement in part because of the effectiveness of the San Francisco Hep B Free campaign, which was started in April 2007. So far, 4,000 people have been vaccinated through the project, a collaboration of the city, private health care and community organizations. The program, the goal of which is to eradicate the virus in the city, is considered a model nationally.
San Francisco, like other Bay Area cities, is a gateway for immigrants from China and other Asian countries where there is a high prevalence of the infection. The city has the nation's highest rate of liver cancer.
Nationally, health experts believe that as many as 1.4 million Americans may unknowingly be infected by hepatitis B. About 2,000 to 4,000 people die each year in the United States from cirrhosis and liver cancer, and chronic hepatitis B is the underlying cause.
According to the CDC, 1 in 12 Asians and Pacific Islanders in the United States is infected.
The new guidelines "will offer that much more oomph," said Dr. Mitch Katz, director of the San Francisco Department of Public Health. "This is a disease that is both preventable for many and treatable."
State Assemblywoman Fiona Ma, D-San Francisco, learned when she was 22 that she had the infection, contracted from her mother as an infant. But only in the past two years, she said, has she learned much about the disease and taken steps to slow its progression. She quit drinking and started getting an annual sonogram of her liver.
Now she's trying to destigmatize it for others.
"Our culture is not to talk about disease," she said. "People should not keep this a secret. I was walking around for 20 years not knowing what to do about my own health. I have a 1 in 4 probability of developing liver cancer. I'm hopeful that the disease won't affect me in my lifetime."
-- It is caused by the hepatitis B virus. If untreated, it can lead to liver cirrhosis, liver cancer and liver failure.
-- It can be passed from a mother to her child during childbirth, the most common way that Asians and Pacific Islanders acquire the disease. It also can be spread by unprotected sex and contact with razors or toothbrushes or other items that harbor infected blood.
-- It can be detected through a simple blood test.
-- A highly effective vaccine is available.
-- 350 million to 400 million people in the world are chronically infected.
-- 1.4 million of them are Americans.
-- 1 in 10 San Francisco Asians and Pacific Islanders have the disease.
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Source: San Francisco Hep B Free and the Centers for Disease Control and Prevention