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Vaccination, Education Key to Stemming Asian Hepatitis Outbreaks

Spencer Michels reports on the campaigns to fight hepatitis B among Asian populations worldwide. The potentially fatal liver disease is100 times more likely to afflict Asians than non-Asians.

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    And to another story affecting millions of Chinese, as well as one in 10 Asian Americans.

    "NewsHour" correspondent Spencer Michels looks at the disease called hepatitis B.

  • DR. SAMUEL SO, Stanford University:

    Good morning, Mr. Zhang. How are you?

  • GREG ZHANG, patient:

    Good morning, Dr. So.


    How's your appetite?


    Very good. Very good.


    Forty-six-year-old Greg Zhang, who works in California's Silicon Valley, is recovering from a recent operation to remove a tumor from his liver, a result of his lifelong infection with hepatitis B. It's a disease that strikes Asians 100 times more than non-Asians.


    The incision is well-healed. Everything looks good. No problem.


    Yes. Yes.


    Zhang's surgeon, Stanford liver specialist Dr. Samuel So, was concerned about a C.T. scan which revealed several new growths.


    On this side, you can see one, two, three, four, at least.




    The hepatitis B virus is found in blood and bodily fluids. Many people can live with the virus and never get sick, but 25 percent of those infected get severe liver damage or cancer.

    The virus can be transmitted by unsafe sex and unsterile needles, but most people who suffer from the disease, like Zhang, who was born in China, became infected at birth from their mothers.


    This is my brother with his two kids.


    His younger brother, Haiyang, also became infected at birth, but, like many of those with the disease, he had no symptoms until it was too late.

    Two years ago, at the age of 42, he went to see a doctor about a pain in his side. He was told he had advanced liver cancer, and there was nothing that doctors could do. Zhang flew his brother to Shanghai to try to get a liver transplant, but he died three days after arriving there.


    Well, he passed away. My sister-in-law and his two kids were on a plane going from here to Shanghai. He didn't make it.


    This is a cancer which often affects people at the prime of life, between 30 to 60 years of age.


    Dr. So has been leading efforts in the San Francisco Bay area and around the world to raise awareness about hep B. He has a research lab at Stanford focused on finding new ways to diagnose and treat liver cancer.

    There's no cure for hep B, although the virus can be kept in check with antiviral medicines. Those infected need to have yearly ultrasounds and blood tests to screen for early stages of liver cancer.

    Dr. So is the founder of the Asian Liver Center, dedicated to creating awareness about hep B both in the U.S. and overseas, especially in China.


    A hundred million people in China are chronically infected. So, there's a huge burden of disease in China. Every, you know, two, three minutes, someone in China is dying from liver cancer caused by this virus, which could be prevented by a vaccine. And, still, most people in the world are not vaccinated against it. It's just ridiculous.


    An effective vaccine for hep B has been available for almost 25 years.

    Newborns need a vaccination within the first day of life to prevent transmission of the virus from their mother. Two more doses are needed within the first six months for full immunity. And about half the babies in the U.S. do get vaccinated.

    But, in many countries where hep B is endemic, like China, vaccination programs for infants are often spotty. And there are hundreds of millions of adults worldwide born before the vaccine was developed who are infected.

    A recent documentary highlighted a program in China's Qinghai Province aimed at vaccinated more of the population, a campaign inspired by Dr. So. But one big hurdle in enacting reform in China has been the enormous social stigma associated with the disease.

  • WOMAN (through translator):

    If our neighbors knew our kids have hepatitis B, they wouldn't dare let their kids play with our kids.


    Those who test positive for hep B in China are often denied jobs, and infected children can be rejected from schools.

    Along with the disease itself, that stigma has crossed the ocean with immigrants to this country. Many Asian Americans don't want to discuss it or even learn their own status.

    What is unsettling is that many carriers of the hepatitis B virus are unaware that they are infected because the symptoms don't appear for many years. But what also bothers health officials in San Francisco and other cities with large Asian populations is that many Asians don't see the need to be tested for hepatitis B.

    With one of the largest Asian populations in the U.S. and the nation's highest rate of liver cancer, San Francisco is now waging an aggressive campaign to bring the disease out of the shadows at events like the Asian Heritage Festival.

  • WOMAN:

    There's free hepatitis B screening to the right over here. It's free. They just take a little bit of blood.


    The city's Hep B Free campaign offers free testing and vaccinations.

  • KEN MURRA, San Francisco:

    I believe myself, you know, I don't have that kind of problem, but I'm just making sure.


    Not only does the general population lack knowledge and awareness of the disease, but so does the medical community, according to a recent report from the Institute of Medicine.

    That's something that concerns Janet Zola, who is heading up the campaign for San Francisco's Department of Health. She says everyone, not just Asian Americans, should be aware of the disease.

    JANET ZOLA, San Francisco Department of Health: It affects everybody. People intermarry. People have a large employee base of Asian employees who can get sick. So, it isn't really just about one isolated sector of the population, even though they're at highest risk.


    One in 10 Asian Americans is infected with hepatitis B.


    A controversial ad now running on local TV stations and on billboards asks which of these 10 Asian beauty pageant contestants deserves to die.

    But, in the Asian community, such frankness is shocking. That attitude is something that California Assemblywoman Fiona Ma from San Francisco, who is hep B positive, is working hard to change.

    FIONA MA, California assemblywoman: My cousin, who was born in China, actually got very upset and said, please don't talk about it. People are going to think that you're sick, and they're not going to vote for you.

    And my message was, I am a public figure. This is my responsibility.


    Ma says San Francisco's program is working well, but the state needs to do more. She sponsored a bill to get the state to pay for hep B vaccinations and treatment, but was unsuccessful


    We should be trying to cover hepatitis B folks earlier in the process, instead of later. In California, Medi-Cal only covers you if you're in your last stages of liver cancer or require a liver transplant. Clearly, that's too late and it costs too much.


    Hep B is slowly starting to get more attention on a national level.


    Participants at a recent rally on Capitol Hill called for more federal funding for the disease. But Stanford's Dr. So, whose mother-in-law died from liver cancer, believes there's still not enough being done by the global health community or in the U.S.

    He says other diseases get more public attention and, therefore, more money.


    One in 20 people in the world are chronically infected, one in 20, 10 times more than people in the world infected with HIV. There's huge advocacy for the HIV community and very few advocates for hepatitis B.


    For now, the battle against hepatitis B is concentrated in communities with large Asian populations. Philadelphia and Los Angeles are among a handful of cities planning to replicate San Francisco's efforts.


    Spencer's story was part of a partnership with NPR. Their report will air on "Morning Edition" tomorrow.

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