Originally published in The Quarterly Magazine, Spring 2015 issue
A deadly disease lurks in the blood of nearly 1 in 50 people in Los Angeles. The silent killer is the Hepatitis B virus (HBV). And a simple blood test for those who are more prone can easily be the first step in eliminating the devastating effects.
Though some may feel shame in being a potential carrier, this misconception carries a greater shame in not being tested and facing death. The truth is that Hepatitis B (Hep B) is a sickness like any other, passed between average people. But unlike other illnesses, the virus often progresses without any notice to its victim. 85% of carriers have no symptoms. Undetected, HBV quietly replicates, eventually targeting the liver. “The main cause of death from Hepatitis B is liver failure and the development of liver cancer,” says Dr. Myron Tong, M.D., Ph.D., Director of Asian Liver Center and Clinical Hepatology at UCLA and Chief of the Liver Center at Huntington Medical Research Institutes (HMRI) in Pasadena.
This insidious attack can continue for decades until the damage is so great that the individual begins to experience severe fatigue, abdominal pain, or jaundice (deep yellowing of the skin or eyes). These are only a sample of symptoms caused by a distressed liver. “By this time, you’re pretty sick,” says Tong. Those affected “don’t feel sick so they don’t feel an urgency to be screened. [With advances in testing and medication,] we don’t need to see people dying of Hep B anymore,” says Mimi Chang, Senior Nurse Practitioner, Asian Pacific Liver Center in LA.
Because the virus is transmitted through blood and bodily fluids (like semen and vaginal fluids), one cannot get Hep B through casual contact (hand shakes, sneezing or sharing utensils). However, HBV is 50-100% more contagious than HIV. 50% of HBV is vertically transmitted from mother to child during the birthing process. Intravenous drug users, men who have sex with other men, and those with multiple sex partners are also at risk.
Immigrants (even second and third generation) from and those traveling to areas around the world where there are high rates of HBV carriers are also at greater risk. Some high-risk regions include, but are not limited to, East Asia, Latin America, sub-Saharan Africa, Eastern Europe, the Middle East and the Indian subcontinent. 75% of carriers around the world are Asian, according to Tong. So in LA where Asians make up nearly 15% of the population, the number of people who don’ t know they have Hep B is an issue.
One of the saddest cases seen by Susan Lewis, RN and Clinical Hepatology Coordinator at USC, was in an educated family man of 28, raised in the US, who didn’t know he had Hep B but came to the hospital when symptoms finally appeared. He died of liver complications before his 30th birthday. But this stark outcome can easily be avoided.
“Chronic hepatitis B is a treatable infection. Screening of at-risk persons, early detection and treatment, when indicated, can lessen the risks of illness, liver cirrhosis, liver cancer and death from liver disease,” says Dr. John Donovan, M.D., Assistant Professor of Medicine, Gastrointestinal and Liver Diseases, Keck School of Medicine at USC. With education and careful attention to Hep B, Tong believes this health concern can even be eradicated in the next few decades.
Since 1991, all children born in the US routinely receive the Hep B vaccination (in existence since the early 1980s), effectively protecting 95% of those inoculated. But for those who did not receive the vaccine, it is still a necessity, so long as the virus is not in their system (only found by a blood test) and they are born to a family from outside the US where Hep B is endemic. For instance, a person born in the US in the 70s to a parent who immigrated from southeast Asia should be tested because even though the parent did not show outward signs of Hep B, they could have passed down the virus to their children. The vaccine is useless if an individual was already exposed to HBV and is an asymptomatic carrier. For these people, a blood test is necessary to be screened for the virus.
A doctor can then determine if a person needs the vaccine based on family history, or if found positive, the type of treatment needed (usually one pill each day until the HBV is under control.) The sooner it’s caught, the less damage to the liver and the higher the chance of survival. All pregnant women in the US are tested for Hep B. If they are found positive, the baby has a chance at a Hep B-free life if treated at the time of delivery.
If anyone has a family history of liver cancer or falls in the categories above, screening is necessary. Since physicians may not exactly know the people groups who need testing, it is up to the public to become aware and ask for the test. And money should not be an issue. For those who need it, there are free clinics where testing can be done and if necessary, funding for treatment as well. Visit AsianPacificLiverCenter.Org for more on testing in LA, regardless of race. Having a discussion about family origins and medical history can begin the awareness toward testing for a potentially hazardous illness that is completely treatable if found well before symptoms arise.
Join others on May 19, National Hepatitis Testing Day and be an advocate for a “Hep B Free LA” (a volunteer organization to help educate and promote screenings).
A special thank you to Dr. Tong for his expertise in Hep B and extensive help in research for this article.