Hepatitis B stalks Asian communities

By Jeff Gottlieb and Daniel Yi
Los Angeles Times

Hepatitis B, a relatively rare disease in the United States, is a "silent killer" of people of Asian descent, who are 20 to 30 times more likely to be infected than any other ethnic group.

Although they make up 3.6 percent of the U.S. population, Asians account for half the nation's patients with the viral disease, which can lead to cirrhosis of the liver and liver cancer. From 5 to 15 percent of people in U.S. Asian communities are infected. A recent University of California, Irvine, study of 828 Vietnamese Americans in Orange County who were 18 or older found that 13 percent had hepatitis B and 69 percent had been exposed to it.

"This is a silent epidemic and a silent killer in the Asian-American community," said Dr. Samuel So, director of the Asian Liver Center and Liver Cancer Program at Stanford University.

Laws in 31 states, including Washington, now require that all children be vaccinated for the disease when they enter middle school, but some people are asking why federal and local authorities aren't spending more money to warn older children and young adults — particularly in Asian-American communities — about the need to be tested and vaccinated.

"If you're a 17-year-old Vietnamese kid, you've probably slipped through without being immunized," said Steven McPhee, a professor of medicine at the University of California, San Francisco, and principal investigator at the Vietnamese Health Promotion Project. "That's a population where they're beginning to get sexually active and have children. Then it's too late."

Vietnamese men have the highest rate of liver cancer in the world, much of it caused by hepatitis B, McPhee said.

In Orange County's Little Saigon area, home to the largest number of Vietnamese outside of their homeland, doctors and community activists say they hear the subject discussed on Vietnamese-language TV and radio.

But Diep Tran, program coordinator at the Orange County Asian and Pacific Islander Community Alliance in Garden Grove, said she knows of no government-outreach programs.

"There hasn't been a strong movement on that side," she said. "The community is aware of hepatitis B and liver cancer, but they don't know the extent of how the disease spreads, how you contract it or what the treatment is. There needs to be a lot more education, a lot more outreach."

The federal Centers for Disease Control and Prevention (CDC) has said hepatitis B and liver cancer account for the greatest health disparity between Asian and white Americans. CDC officials say their agency spends $250,000 a year on hepatitis B education.

Although both affect the liver, hepatitis B is a far more dangerous disease than the more common hepatitis A. Hepatitis A is transmitted through fecal matter and oral contact, and is usually spread when carriers don't wash their hands, or through contaminated food or water, although it can be passed sexually. Most people with hepatitis A recover within three months and have lifetime immunity.

Hepatitis B also is spread by oral or sexual contact. In the United States, it is most often associated with multiple sex partners and needle-sharing by drug users.

Among Asians, the problem has a different genesis. The disease is endemic in much of Asia, and when immigrants move to the United States, they bring hepatitis B with them. Many are exposed during birth. It also is passed from child to child because of scrapes, skin diseases or kids sharing toothbrushes.

The hepatitis B virus is 100 times more easily transmitted than HIV, said Dr. Gary Euler, a CDC epidemiologist.

The younger a person is when exposed to the virus, the more likely that person is to get the disease. For children exposed at birth, the rate is greater than 90 percent, compared with 1 to 5 percent for adults. Those who fight off the disease acquire immunity.

The disease may not result in symptoms for decades. "Month after month, I see these people in their 30s and 40s with advanced liver cancer because no one tested them for hepatitis B," said Stanford's So.