High Prevalence of Chronic Hepatitis B – Silent Disease and Risk

Chronic Hepatitis B is one of the most common diseases among Asians, including Filipinos. Hepatitis B infection has a long incubation period and usually does not have any symptoms. If it is not diagnosed early, there is a very high chance of developing life-threatening liver diseases including liver cancer. The best way to prevent liver cancer is to get tested and monitored for Hepatitis B. Realizing that Hepatitis B and related liver diseases are a serious health issues in Canada, the government of British Columbia and the Vancouver-based immigrant support organization, S.U.C.C.E.S.S., collaborated to deliver the Hepatitis B Public Education Program to raise the awareness and knowledge of this silent killer.

What is Hepatitis B?
According to the World Health Organization, hepatitis is the inflammation of the liver, with viral infection as the most common cause of hepatitis. There are five main types of the hepatitis virus: A, B, C, D, and E. Not only have Hepatitis B and C infected hundreds of millions of people chronically, these two viruses are also the main causes of cirrhosis and liver cancer. Chronic Hepatitis B is very common among Asian populations including Filipinos. According to the Hepatology Society of the Philippines, approximately 7.3 million Filipinos are chronically infected with Hepatitis B. Although generally uncommon in Canada, Hepatitis B infection rates approach that of Asia in areas where there are large Asian communities, such as the British Columbia (B.C.) lower mainland. There is an estimated 60,000 Hepatitis B infected individuals in B.C. in which 70% of them are immigrants and among those, Filipino immigrants account for about 10%.

Hepatitis B transmits through contaminated blood, semen or other bodily fluids. Another common route is from mother to infant during birth. Other routes of transmission include contaminated blood products, unclean needles during medical procedures, and intravenous drug. Hepatitis B may also pose a risk for health care professionals due to accidental needle injury during care for Hepatitis B infected individuals.

Acute VS Chronic Hepatitis B
Hepatitis B attacks the liver causing either acute or chronic Hepatitis B infection.

Acute Hepatitis B
The virus could have already been in your body for days, months, or years before you develop any symptoms, sickness or discomfort. Even more commonly, you will have the virus in your body without actually having any symptoms at all. During this time, the infected individuals are highly infectious and may unknowingly transmit the virus to others. Some of the severe symptoms during the acute hepatitis phase include: body fatigue, tiredness, fever, vomit and yellowness of eye and skin (jaundice). Most people require medical treatment and rest for several weeks or even months before returning to normal life and work. If your immune system is unable to clear the virus, you will develop chronic Hepatitis B.

However, condition for some of these people may turn for the worse causing hepatic failure or even death.

Chronic Hepatitis B
Chronic Hepatitis B is the most common hepatitis and infected individuals may not have any symptoms at all. However, chronic hepatitis B is the main risk factor for liver diseases including liver cancer. A chronic carrier has 1-in-4 chance of developing liver diseases and liver cancer if the chronic Hepatitis B is not monitored regularly and properly treated. Furthermore, if left untreated, an individual with liver cancer has as low as only 10% chance of survival within the first 5 years of discovering the cancer. Compared to non-infected individuals, a chronic hepatitis B carrier has 100 times higher risk of developing liver cancer. Since chronic Hepatitis B have a long latency period and are often asymptomatic, a large proportion of chronic carriers aren’t even diagnosed until the liver is severely damaged and too late for effective treatment. Taking care of your liver through vaccination, regular monitoring and practicing of healthy behaviours save lives.

Lack of Hepatitis B Awareness & Knowledge among Filipino Immigrants
Recognizing this devastating, yet overlooked, silent disease in our communities, S.U.C.C.E.S.S. worked with medical experts from the University of British Columbia and was successful at advocating for better Hepatitis B treatment policies in B.C. To further understand the needs and the depth of the Hepatitis B issue among Asians, S.U.C.C.E.S.S., again, collaborated with the B.C. Hepatitis Program and the Division of Gastroenterology of University of British Columbia in 2012 to conduct a Hepatitis B Awareness survey focusing on Asian communities in B.C. More than half of the Filipinos respondents had low awareness of the consequences of Hepatitis B infection, and were unaware that Hepatitis B was a leading cause of liver cancer. Furthermore, roughly 40% of the Filipino immigrants have not been tested and/or vaccinated for Hepatitis B, suggesting a large group of the Filipino community are at risk of Hepatitis B, as well as developing liver diseases including liver cancer. Other cultural barriers, such as stigma and costs, have also been reported preventing members of the Filipino community from getting tested for Hepatitis B. Finally, of those who identified themselves as Filipino and as chronic Hepatitis B carriers, 73% were not being treated by their doctors. This health burden on Filipino communities is likely due to the lack of systematic testing, vaccination, and culturally appropriate health education about Hepatitis B.

Hepatitis B Public Education program
Recognizing S.U.C.C.E.S.S.’ previous advocacy work in Hepatitis B care and responding to the desperate need for accessible and cultural specific education on Hepatitis B for the Filipino communities in B.C., the Government of British Columbia has provided funding for the Hepatitis B Public Education Program.

This program aims to improve Hepatitis B awareness, knowledge, and preventative practices, specifically the screening of Hepatitis B, as well as to provide resources to Hepatitis B infected individuals to manage their health.

By encouraging the Filipino community to take an active role in their health management and to get tested for Hepatitis B, this project hopes to prevent people from discovering liver diseases too late when the liver is severely damaged. Our Hepatitis B education curriculum incorporates scientifically research based evidence and was developed following consultation with people from various ethnic populations and medical professionals. Major themes of the curriculum are described below.

1) Some of the biggest transcultural barriers preventing the public from talking about Hepatitis B and having correct perception and knowledge of Hepatitis B and Canadian healthcare system include: inability to communicate in English; fear of social stigma; unaware that pre-landing medical examination does not specifically check for Hepatitis B infection or liver diseases; unaware that a healthy lifestyle may only be masking your chronic Hepatitis B as Hepatitis B is damaging your liver without you knowing.

Since Hepatitis B does not transmit to one another through casual contact, such as hugging, shaking hands or sharing food, Hepatitis B should not be a feared topic. It is important to keep in mind that majority of the infected Filipinos contracted the disease at birth or in early childhood. In Canada, as long as pregnant woman who is infected with Hepatitis B can be identified early before she gives birth to her baby, doctors can provide preventative measures to her baby during and shortly after birth to help prevent the baby from getting infected with Hepatitis B.

2) Even if you are indeed infected, you don’t have to panic. In fact, more than 80% of people were tested for Hepatitis B because their family doctors, family members, and friends recommended it. You are not alone and you do not have to deal with Hepatitis B by yourself. Several translated materials and free vaccination or treatment options are also available to those who are eligible in B.C. Talk to your doctor about your risk of Hepatitis B and get tested for Hepatitis B.

To make it easier, Dr. Jessica Chan, a family physician who is actively promoting Hepatitis B awareness among her patients, has suggested the following three questions that you can ask your doctor the next time you make an appointment.

• Am I already a Hepatitis B carrier, and if so, what is my Hepatitis B viral load in the last 6

• What is my risk of getting liver cancer, and have I had an ultrasound within the last year to

• How often should I come and see the family doctor for Hepatitis B follow-up?

3) Testing of Hepatitis B, such as blood test and liver scan, are fast, safe, and effective at detecting Hepatitis B and liver diseases. Remember, Hepatitis B is preventable, treatable and manageable.

You can live healthily even if you are infected with Hepatitis B.

Dr. Eric Yoshida, the Head of the Division of Gastroenterology at the University of British Columbia, has the following advice for chronic Hepatitis B carriers:

• Talk to your doctor about Hepatitis B and visit your doctor regularly to monitor your disease

• Follow your doctor’s advice on treatment and management.

• Adhere to your treatment if you are given medication.

4) If someone is suspected to have Hepatitis B, family members and friends should be supportive and should not be afraid or ashamed to talk Hepatitis B. Mostly important, they should also get tested for Hepatitis B to prevent getting infected and to manage their own health. Even if you are not personally infected with hepatitis B, you may know someone who is. Encourage your loved ones to get tested for Hepatitis B because you may have just saved their lives.

Free Hepatitis B education workshops are offered in Tagalog, Mandarin, Punjabi, Korean, and English regularly throughout Greater Vancouver Region. Listed below are our upcoming workshops presented in Tagalog and English:

Saturday, May 24th
10:30 – 11:30am

Saturday, May 31st
10:30 – 11:30am

Multicultural helping House Society
4802 Fraser St. (corner of East 32nd MHHS Richmond 55+ Seniors Filipino Club 2nd Floor, 6910 No. 3 Road, Richmond (across from Richmond City Hall)

To register for our free workshops or to learn more about why Hepatitis B matters to you and our community, please visit http://HepB.successbc.ca. You can access various educational materials and resources about Hepatitis B in Tagalog and English. Our Let’s Talk section will give you an up-to-date discussion on Hepatitis B and personal stories shared by those affected by Hepatitis B. You can also follow us on Twitter or like our Facebook page where you can view pictures from previous Filipino workshops.

Through educating the public more about Hepatitis B, please join us in making a difference in the lives of those around you as well as your own. Talk to your doctor and get tested for Hepatitis B. We look forward to meeting all of you in the upcoming workshops and events.

Established in 1973, S.U.C.C.E.S.S. is one of the largest social service agencies in British Columbia. It is a charitable organization providing services in settlement, language training, employment, family and youth counseling, business and economic development, health care, housing and community development. For more details, please visit: www.success.bc.ca