One of six Hmong in Fresno County could be infected with hepatitis, according to a new health survey that has shocked community leaders and added urgency to the fight against the liver disease.
But it won't be easy: Most don't realize they're infected.
The study, conducted by Dr. Muhammad Y. Sheikh, an associate professor of clinical medicine at the UCSF-Fresno Medical Education Program, found that almost 17% of Hmong in Fresno County have the hepatitis B virus. Infection can damage the liver and lead to cirrhosis.
And it's a major cause of liver cancer -- the No. 1 cancer killer of Laotian men in California.
Few studies have looked at hepatitis B infection among the Hmong, who came to the United States in large numbers after the Vietnam War as refugees. Between 20,000 to 30,000 now live in Fresno County.
Most studies of Asian and Pacific Islanders don't break out Hmong as a distinct group. The Fresno County study showed that the Hmong had a higher infection rate than foreign-born Asians as a whole. An estimated 10% of Asians and Pacific Islanders nationwide -- which includes Hmong -- are chronically infected. For the general U.S. population, it's less than 1%, according to government estimates.
It doesn't have to be that way, community health advocates say. Hepatitis B is preventable. There is a vaccine to fight its spread -- and medicines to prevent liver damage.
The problems are awareness, education and access to health care, they say. For example, many Hmong immigrants don't have primary-care doctors to test for the virus. About 62% of the people screened in the Fresno County study said they had not been vaccinated or were unsure if they had been. And, the advocates say, many don't understand the seriousness of finding out if they are infected.
The extent of the disease isn't well known in Fresno County, said the Rev. Sharon Stanley, executive director of Fresno Interdenominat
ional Refugee Ministries and a member of the Central Valley Hmong Health Collaborative, which works to improve access to health care.
Members of the collaborative are making hepatitis B prevention a priority, Stanley said. They were stunned when they learned of infection rates during a presentation by a doctor from the Asian Liver Center at Stanford University School of Medicine, she said.
"There was an audible gasp in the room among all the Hmong attendees," she said.
Hidden victimsHepatitis B experts say the disease could be even more widespread than studies suggest.
The virus is stealthy. About two-thirds who carry the infection don't know it. Many don't find out until they become seriously ill from cirrhosis of the liver or liver cancer.
Liver cancer is the leading cause of cancer deaths for Laotian men and the second leading cause of cancer deaths of Vietnamese men in California, according to the California Adult Viral Hepatitis Prevention Strategic Plan 2010-2014.
For white men, liver cancer is "not even in the top 10" causes of cancer death, said Dr. Samuel So, director of the nonprofit Asian Liver Center at Stanford University School of Medicine.
Without early symptoms, it's difficult to persuade someone to be tested for the virus, said Sheikh, chief of gastroenterolo
gy at the University of California at San Francisco-Fresno Medical Education Program.
There also is a stigma associated with the disease.
Hepatitis B is a blood-borne infection spread by sexual contact with an infected person, the sharing of needles during drug use, sharing of household items such as razors -- or from mother to baby during birth.
Sheikh did not evaluate the mode of transmission among the 534 Hmong he screened for hepatitis B in Fresno County, but he has a good idea most of the infections occurred at the time of birth.
Hepatitis B is widespread in Asian countries, Sheikh said. And nearly 92% of the Hmong who tested positive were born outside the United States -- about 87% of them from Laos, according to his survey.
"Engaging in high-risk behavior, such as having multiple sex partners, tattooing, and injecting drugs, are not common practices in this community," Sheikh wrote in the study. The study paper was published this month in the Journal of Community Health.
It's difficult for Hmong to talk about hepatitis B, said Lue Yang, executive director of the Fresno Center for New Americans, a nonprofit that helps immigrants.
"They feel, 'If I have such a disease, people may hate me,' " Yang said. " 'People may not welcome me. They may be afraid I could spread the disease to them.' "
A mother's painThe Fresno Hmong community learned more about the threat posed by hepatitis B in January, when well-known kick boxer, Yia "The Bull" Mua, died after battling liver cancer. He was 34.
"The reality of the Bull's death raised up the issue in a particularly stark way," Stanley said.
Yeng Mua of Fresno, the kick boxer's mother, said her son had hepatitis B, which doctors said caused the liver cancer.
She doesn't know how he became infected. Maybe he came into contact with infected blood during a fight. She isn't infected. And neither are her other children. The family was tested about 18 years ago when she worked at a health clinic in Merced, she said.
Mua wants doctors to order hepatitis B tests, and so did her son, she said. "I would like the doctors to take care and check and help the patients," she said.
"Right now, I miss my son so much."
There is no complete cure for hepatitis B. Many times, the body fights off the virus. But for some it does not.
As many as 25% without care will die of liver cancer or liver disease. Medications can suppress the virus and keep it from damaging the liver. But that requires testing to find the infection.
Primary-care doctors should test for hepatitis B surface antigen, a marker that identifies chronic hepatitis B, for Asian and Pacific Islander patients, who are at higher risk for infection, said Sheikh of UCSF-Fresno.
The test can pick up infection and problems that wouldn't be caught by routine blood screenings during an annual physical examination, he said.
"Every Asian person deserves a test," Sheikh said.
Doctors recommend that patients who test positive should have an ultrasound test of the liver. An ultrasound should be repeated every six months to 12 months and a blood test done every six months to screen for liver cancer.
If liver cancer is caught early, "We can actually save a life," he said.
But only 37.5% of the Fresno County survey participants screened by Sheikh for hepatitis B had a primary-care doctor.
The result: Too many patients receive medical care when it's too late, Sheikh said.
Yang of the Center for New Americans said there is another reason Hmong may not seek early treatment.
"They do not know the disease could kill you, could harm you," he said. And they may be unaware that there is treatment they can receive, he said.
Protecting babiesVaccination for hepatitis B among children has greatly reduced the number of new cases of the disease.
In the Fresno County study, only adults were screened. More than 64% testing positive were older than 40.
But stopping the spread of hepatitis B from mother to baby among Asians is crucial, Sheikh said.
Babies are at high risk of infection at birth if their mothers are infected. And newborns are at high risk of developing chronic infection if they don't receive protection.
"If the mother has a lot of virus in her blood, as high as nine out of 10 of those babies will get infected," said So of the Asian Liver Center.
California has had a program to screen pregnant women for the hepatitis B virus since 1991. Doctors report positive test results to county health departments, where workers follow up with the women.
In Fresno County, about 200 pregnant women are infected, said Tom Booth, charge nurse for the county's immunization program. About 85% of the women are southeast Asian or Pacific Islanders, he said.
Statewide, about 77% of pregnant women found to be infected are Asians or Pacific Islanders, said Kathleen Winter, an epidemiologist at the California Department of Public Health.
The federal Centers for Disease Control and Prevention recommends newborns born to infected mothers receive two shots for protection within 12 hours of birth -- a dose of hepatitis B vaccine, and a dose of hepatitis B immunoglobulin
. The shots are 85% to 95% effective in preventing transmission of the virus to the babies. Infants need two more doses of hepatitis B vaccine at 1 month and 6 months of age to provide complete protection.
Hospitals in Fresno County say they give the shots within that time frame.
Kaiser Permanente Medical Center, for example, provides newborns of mothers who are positive for the virus with the two vaccines within 12 hours of birth, said public affairs director Rob Veneski.
And at Sierra Kings District Hospital in Reedley, "We immunize all our babies," said Carrie Bolton, chief nursing officer. "Every one of our babies has their first hepatitis B shot here at the hospital."
But not every hospital has a written policy to that effect, said Booth. County workers meet with hospital officials every year to remind them of the recommendation
s, he said.
The Central Valley Hmong Health Collaborative hopes to raise awareness about hepatitis B, Stanley said. "We now are gathering our resources," she said.
The collaborative and the Asian Liver Center have applied for a national grant to educate Hmong spiritual leaders about hepatitis B, she said.
Sheikh said the community needs to take action. "We need a designated education plan, and screening strategies for this specific Asian population," he said.
http://www.fresnobee.com/2010/06/27/1986989/hepatitis-b-a-silent-epidemic.html
Topic: Hepatitis B a silent epidemic among Hmong (Read 762 times)