By JUDITH EVANS
Hepatitis B is a disease of ethnic disparity, with Asian Americans about 50 times more likely to be infected than the general population in the United States, said Dr. Chul S. Hyun, medical director of the Asian Liver Center at Holy Name Medical Center in Teaneck, N.J. "As immigration has increased over the last several decades, this disease has also increased.
"One of the scariest things is that people can end up not only with liver cirrhosis but with liver cancer," he said. "We want to see people as early as possible so we can intervene."
With that in mind, the Asian Liver Center is in its fourth year of a campaign to identify and treat people who carry the hepatitis B virus. The campaign's budget is about $250,000 a year, with about half of the funding coming from donors and half from the medical center, said Kyung-Hee Choi, director of Holy Name's Korean Medical Program.
"The mission of this campaign is to educate our community members and bring awareness of the hepatitis issues," Choi said. "We want to educate them and make sure they are following through" with screenings, immunizations and treatments.
She estimates that about 250,000 Korean immigrants and their families live in New York City and nearby portions of New Jersey, New York and Connecticut. "We go out to Korean churches in our community, and after Sunday services, we ask pastors to give an educational program about hepatitis," she said.
Holy Name is the only hospital in the United States with a comprehensive Korean medical program, she said. At the center, which is on the hospital campus, patients can eat Korean food and watch Korean soap operas on television, and a crew of Korean-speaking drivers is available to transport elderly people. "It has become one of the important centers of excellence at Holy Name Medical Center," she said.
Staff members speak English and Korean, and a Chinese translator is available, Hyun said. "We offer a program that is not only linguistically comfortable but also culturally comfortable," he said.
Health disparity
About 0.2 percent of people in the United States carry the hepatitis B virus, Hyun said, but 10 percent of Asian Americans are infected. "In white American society, hepatitis C is more of an issue and gets more attention," he said. Non-Asians tend to be infected with hepatitis B as young adults, if at all, and their mature immune systems are better able to rid their bodies of the virus, Hyun said.
He said that hepatitis B had originated thousands of years ago in Asia and Africa and is prevalent among all Asian populations.
According to the Centers for Disease Control and Prevention, the disease is most commonly spread from an infected mother to her infant at birth through the mother's blood and other secretions. The CDC recommends that all infants receive a dose of the hepatitis B vaccine at birth and complete a series of three shots by age 6 to 18 months. Older children, not previously vaccinated, should also be given the hepatitis B vaccine, according to the CDC.
The hepatitis B vaccination has been available in the U.S. for more than 25 years, but it's only recently become available in other parts of the world, and there are still areas where it is unavailable. People born in most Asian and Pacific Island nations where hepatitis B is common are at higher risk for the disease, the CDC said.
The CDC states that the most common routes of transmission to adults are contact with blood in health care settings; sexual contact; the use of unclean needles or instruments used for acupuncture or tattoos; the use of shared needles during drug use; and sharing toothbrushes, razors, nail clippers or similar personal items with an infected person.
Mother-to-baby transmission
When a mother carries the virus, it poses a serious transmission risk to her infant at birth. Doctors vaccinate the newborn and administer hemoglobin shots to reduce the risk of infection. "Not all the infections can be prevented by that," Hyun said. "Say the mother has a very high virus load. When people get infected at a very early stage of their life, they tend to carry the virus for the rest of their life."
According to the CDC, without the post-exposure immunoprophylaxis, approximately 40 percent of infants born to infected mothers in the U.S. will develop chronic hepatitus B infection, and about one in four will eventually die from chronic liver disease.
Babies infected at birth might not show symptoms for 30, 40 or 50 years, Hyun said. "We have to identify people when they are young and still healthy and see if they can be (treated) with the antivirus therapies" intended to reduce viral load and liver damage, he said.
Silent disease process
Researchers estimate that 2 million people in the U.S. carry the hepatitis B virus, known as HBV, but only about 500,000 have been diagnosed, he said. "That means three-quarters of these people do not even know they are virus carriers. Out of those who have been diagnosed, only half of them, that is 250,000, are continuously being checked by doctors."
Some people who have been diagnosed have significant complications, and some are stable. Most have many questions for their doctors.
"This is a disease without many treatments," Hyun said, although he is seeing excellent results with two antiviral medications. When successful, treatment can reduce the viral load almost to zero. The CDC recommends that people with HBV receive lifelong treatment along with periodic liver tests to detect damage.
Choi said that the liver center's outreach effort screens about 2,000 people each year. Those who are not infected and who lack immunity to HBV are asked to come to the medical center for the three-shot series of immunizations.
Those who test positive for HBV are matched with a physician. "We basically play a role of connecting people to the proper care after evaluations," Hyun said.
In addition to hepatitis B screening, the Korean Medical Program has campaigns focusing on diabetes, mental health and breast cancer, and it sponsors an annual health fair. Last year, 1,500 people were seen by 63 doctors at the health fair. "Forty-seven percent of the population is prediabetic or diabetic," Choi said. "It's huge. It's so much higher than the general population here; also, it's so much worse than living in Korea."
She credits the focus on public health in the Korean community to Holy Name's mission and "caring spirit. We go way beyond the day-to-day taking care of patients," she said. "We always look for ways to give."