To change national policies and the attitudes of healthcare providers towards hepatitis B and liver cancer prevention, we must provide policymakers with sound, evidence-based information from vigorous research, including community-based studies.
Perinatal Hepatitis B Prevention
In 2007, we received a federal grant award to design and implement strategies to prevent mother-to-child transmission of hepatitis B in Alameda and Santa Clara counties, where the combined population of about 3.2 million experiences some of the highest rates of chronic hepatitis B and liver cancer in the US.
Our project aims to accomplish the following:
- To increase timely reporting (to public health departments) of pregnant women who test positive for hepatitis B;
- To increase the enrollment of exposed newborns in public health case management services;
- To increase post- vaccination serologic testing for hepatitis B among exposed newborns;
- To improve standardized procedures for medical management of pregnant women with hepatitis B, their newborns, and their other close contacts;
- To improve knowledge and awareness about hepatitis B among chronically infected pregnant women; and
- To assess the cost-effectiveness of our proposed strategy for perinatal hepatitis B prevention.
SF Hep B Free
In 2007, we also received a separate federal grant to build partnerships in a city-wide campaign to make San Francisco the first city in the US to test, vaccinate, and treat all at-risk residents for hepatitis B (see http://www.sfhepbfree.org/).
In this project, we aim to accomplish the following:
- To promote routine serologic testing for hepatitis B in all Asians and Pacific Islanders in San Francisco, and thus to increase the reporting of positive hepatitis B test results to the San Francisco Department of Public Health;
- To improve referrals and access to medical management for individuals who test positive for chronic hepatitis B;
- To increase the number of San Francisco hospitals that participate in low-cost or free community screening and/or vaccination for hepatitis B; and
- To increase knowledge and awareness about hepatitis B, including the need for lifelong management of chronic hepatitis B, among primary care medical providers.
Community Research Publications
In 2007, we published seven research papers in scientific journals, including three landmark studies. For more, see Recent Publications.
- "Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B" (Annals of Internal Medicine 2007, vol. 147 p.460-9)
This study compared the cost-effectiveness of four different hepatitis B screening and vaccination programs for Asian and Pacific Islander adults in the United States. We found two cost-effective strategies: one combines universal screening with treatment of individuals with chronic hepatitis B; the other combines universal screening, treatment of chronically infected individuals, and ring vaccination of close contacts of chronically infected individuals. Thus, hepatitis B screening programs among Asian and Pacific Islander adults in the U.S. are likely to be cost-effective, and can greatly reduce the burden of hepatitis-B-associated liver cancer and chronic liver disease in this population.
- "The burden of liver cancer in Asians and Pacific Islanders in the Greater San Francisco Bay Area, 1990 through 2004" (Cancer)
This study evaluated trends in liver cancer incidence among Chinese, Filipino, Japanese, Korean, and Vietnamese men and women in the Greater San Francisco Bay Area between 2000 and 2004. We found that incidence rates and trends varied among Asian ethnic subgroups, with non-significant declines in Chinese men, Japanese men, and Japanese women, but consistently high rates in Vietnamese, Korean, and Filipino men and women. Thus, liver cancer continues to affect Asian/Pacific Islander Americans disproportionately, with consistently high incidence rates in most ethnic subgroups.
- "Why we should routinely screen Asian American adults for hepatitis B: a cross-sectional study of Asians in California" (Hepatology)
This study examined the prevalence of chronic hepatitis B among 3,163 Asian American adults in the San Francisco Bay Area tested between 2001 and 2006. Overall, 8.9% were chronically infected, including 10.7% of those born in Asia or the Pacific Islands. Up to two-thirds (65.4%) of chronically infected adults were unaware that they were infected. Of those who were not chronically infected, nearly half (44.8%) lacked protective antibodies against hepatitis B. In addition, self-reporting of prior vaccination was inaccurate: one-fifth (20.3%) of those who said they had been vaccinated in fact lacked protective antibodies, and one-twentieth (5.2%) were chronically infected. In summary, given the high prevalence of undiagnosed chronic hepatitis B among Asian American adults, this population should be routinely screened for hepatitis B infection, regardless of vaccination status.
