Asian & Pacific Islanders
Asian and Pacific Islanders are at higher risk for Hepatitis B, which can lead to liver cancer. Early diagnosis of Hepatitis B and access to lifesaving medical care can help reduce these inequalities.
Dr. Koh’s YouTube Message
In this CDC YouTube video Dr. Howard K. Koh, MD, MPH, Assistant Secretary for Health (2009-2014), U.S. Department of Health and Human Services, addresses Asian Americans about the importance of talking to their doctor about testing for Hepatitis B.
Chronic Hepatitis B Facts
- Global public health problem: There are an estimated 240 million people living around the world with chronic Hepatitis B, with an estimated 1.2 million living in the United States.
- Can lead to liver cancer: Approximately 15% to 25% of people with chronic Hepatitis B develop serious liver damage, including liver cancer.
- Transmission: Hepatitis B is usually spread when someone comes in contact with blood from a person who has the disease. Hepatitis B can be passed from an infected mother to her baby at birth, or from a family member to young children.
- Vaccination: The Hepatitis B vaccine prevents people who have never had the disease from getting it. It is given to all newborns. As a result, new Hepatitis B infections among children and adolescents have decreased by 95% since 1990.
- Currently living with Hepatitis B: Millions of people currently living with chronic Hepatitis B were infected as infants or during early childhood. These infections occurred before the vaccine was available and widely used.
- Silent disease: Chronic Hepatitis B is often “silent” and many people can go decades without symptoms.
- Most don’t know it: Up to two-thirds of Americans living with chronic Hepatitis B do not know they are infected.
Hepatitis B and APIs
Asian and Pacific Islanders (APIs) refer to a diverse group of people from many regions throughout the world. These regions include the Far East, Southeast Asia, Hawaii, Guam, Samoa, Marshall and other Pacific Islands.
Asian and Pacific Islanders (APIs) make up less than 5% of the total population in the United States, but account for more than 50% of Americans living with chronic Hepatitis B. Despite these high rates, many APIs are not tested for Hepatitis B. They are unaware of their infection and many recent immigrants do not have access to medical services that can help save lives. As a result, chronic Hepatitis B and associated liver cancer in APIs is one of the most serious health disparities in the United States.
- Nearly 70% of APIs living the US were born, or have parents who were born, in countries where Hepatitis B is common. These countries are shaded dark blue in the map above.
- Most APIs with Hepatitis B were infected as infants or young children.
- Approximately 1 in 12 APIs are living with chronic Hepatitis B, but most do not know it.
- Hepatitis B-related liver cancer incidence is highest among APIs. It is a leading cause of cancer deaths in this population.
- The death rate from Hepatitis B among APIs is 7 times greater than rates among whites.
CDC recommends testing for the following groups:
- All people born in countries where Hepatitis B is common
- All people born in the United States, who were not vaccinated at birth, and who have at least one parent born in a country with high Hepatitis B rates
- People who live with someone with Hepatitis B
Testing identifies people living with chronic Hepatitis B and helps them access lifesaving medical care. This also helps find other people, such as household contacts, who may be at risk for getting the disease. For this reason, all pregnant women are screened for Hepatitis B. People who are at risk for getting the disease should be vaccinated. The vaccine is highly successful at preventing new Hepatitis B cases, which is why all newborns are vaccinated.
Barriers to Hepatitis B Screenings
- Knowledge: Knowledge of Hepatitis B varies greatly in the API community and there are many misperceptions about the disease. Lack of knowledge and awareness contributes to the low testing rates in the API population.
- Cultural stigma: Many immigrants may hold on to cultural beliefs and practices, including fear of the stigma attached to a positive Hepatitis B diagnosis.
- Language: Immigrants with limited English may avoid or delay visits to healthcare providers. This prevents them from seeking or receiving Hepatitis B related care and services.
- System-level: A lack of health insurance and discomfort with the western medical system may contribute to low testing rates for Hepatitis B among the API community.
Importance of Service/Community Organizations
There are numerous organizations throughout the Unites States that play critical roles in community health promotion, education, health advocacy, and capacity building to improve the health of Asian and Pacific Islander communities. Many of these organizations focus specifically on Hepatitis B or have Hepatitis B as a major component of their organization because of the high prevalence in the community.
Many organizations that serve the API community employ culturally and linguistically appropriate health programs to reach their targeted audience. For instance, screenings and vaccination clinics can be held at locations that are both familiar and easily accessible to community members and employ staff who can communicate with clients in their primary language. Providing appropriate linkage to care for either the hepatitis B vaccine or medical follow-up for chronic infection is also a crucial component in reducing the burden of Hepatitis B.
Know Hepatitis B Campaign
Know Hepatitis B is a national communications campaign promoting Hepatitis B testing among Asian Americans and Pacific Islanders (AAPIs). This campaign has materials such as fast sheets, posters, video PSAs, and infographics in English, Chinese, Korean, Vietnamese as well as some materials in Burmese, Hmong, Khmer, and Lao.
|Chronic Hepatitis B|
|Hepatitis B - Are You at Risk?||Chinese||Chinese|
|When Someone Close to You has Hepatitis B||Chinese||Chinese|
Perinatal Patient Education
|When a Pregnant Woman Has Hepatitis B||± View List|
|Hepatitis B and Your Baby||Spanish||Spanish|
This slide set is audio-visual educational tool that describes the importance of getting babies vaccinated against hepatitis B if a mother has hepatitis B infection. The 13 page slide set uses simple language and has audio in: Mandarin Chinese, Hmong, Korean, and Vietnamese, as well as English. Tagalog, in the form of Taglish, is available in a written format only.
Hepatitis B and Your Healthy Baby
This slide set is a 24 page visual-only educational tool for pregnant women who have Hepatitis B. The slide set explains the importance of getting babies vaccinated against Hepatitis B to prevent transmission of the disease. The slide set is written in easy to understand English. This slide set is also available in a Spanish version.
Health Care Provider Resources
Testing Asian Americans and Pacific Islanders for Hepatitis B [PDF - 2 pages]
This two page fact sheet for health care providers on Hepatitis B and Asian Americans and Pacific Islanders outlines who should be tested and the recommended follow-up for a positive HbsAg.
Guidelines and Recommendations
Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection,
MMWR 2008;57(RR-8) [PDF - 28 pages]
Geographic Distribution of Chronic Hepatitis B virus (HBV)
Worldwide, 2006 Map: [PDF- 1 page]
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States
Part 1: Immunization of Infants, Children, and Adolescents
MMWR 2005;54(RR-16) [PDF - 39 pages]
Part 2: Immunization of Adults
MMWR 2006;55(RR-16) [PDF - 40 pages]