Hepatitis tests crucial for Vietnamese American
Groups run education campaigns to reach this at-risk population.
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 Kevin Tr?n learned by chance that he suffers from chronic hepatitis B virus (HBV) that, if left untreated, can lead to deadly liver cancer. Tr?n, 52, of Huntington Beach, Calif., was told he had the disease during a routine checkup when he moved to the United States in 1994. But when the English-speaking doctor used the word “sleeps” to describe the dormant virus, Traàn said through an interpreter that he wasn’t very concerned. It was not until 2000, that he learned, again purely by accident, that his condition had turned into full-blown chronic hepatitis B. This time he had gone to see a doctor for a quarterly checkup for his diabetes, taking various blood tests. The results showed an abnormal liver function. Since then, Tr?n has had to live his life knowing full well that he cannot stray from his daily medicine regime or routine ultrasounds needed to ensure that any sign of liver cancer is caught early enough to avert a likely death sentence. Because it can go undetected for years and often is not evident until liver problems become untreatable, HBV is considered a silent killer that is 100 times more contagious than HIV, the virus that can lead to AIDS. This disease lurks quietly in the bodies of thousands of Vietnamese Americans — about one in every 10 — occurring more than it does in any other ethnic group, experts say. For many of those afflicted, the result is death. But many believe those deaths are preventable, thanks to what the World Health Organization and other medical experts tout as the “first anti-cancer vaccine.” Dr. Baruch Blumberg and microbiologist Irving Millman developed the first HBV vaccine in 1969, four years after Blumberg received a Nobel Prize for discovering the virus. The current form of the vaccine, a second-generation version, was approved by the Food and Drug Administration in 1986. Experts stress that it is crucial for all Vietnamese Americans and anyone else at high risk for HBV — including other Asians and people in institutional settings like prisons and mental health clinics — to get screened for the virus and to get the anti-HBV vaccine if test results are negative. And groups are working to spread that word. The non-profit Asian Liver Center at Stanford University provides those in at-risk communities with HBV education, screening clinics and research, said Tôn Th?t Tu?n Anh, the center’s global projects coordinator. “Our ultimate goal is to achieve global eradication of hepatitis B,” Tôn said, adding that as a part of its effort, the center in 2001 launched its Jade Ribbon Campaign to “increase awareness and provide ethnic-sensitive health information to the API community and health professionals in an effort to reduce this major health disparity and improve API health.” The campaign uses a multimedia approach, including brochures, posters, bus ads and public-service announcements to spread its message, with some brochures and other materials available in Vietnamese and other Asian languages, she said. The Fountain Valley, Calif.-based Vietnamese American Cancer Foundation also distributes information on HBV worldwide and offers free screenings locally, said Rick Leâ, a foundation spokesman. “Through our Website (www.vacf.org, in English, or www.UngThu.org, in Vietnamese) we help people all over the world, to Europe, Canada, Australia, wherever Vietnamese live” outside of Vi?t Nam, he said. “Like cancer, early screening is the key” to avoiding or surviving HBV, Lê said. “If you feel sick, it’s pretty tough. A high rate of cure and prolonged life is (possible with) early detection and education.” Without appropriate management and screening, one in four hepatitis B carriers dies from liver cancer or cirrhosis, which is liver damage leading to scarring and eventually death from liver failure, said Dr. Tr?n Duy Tôn of San Diego, who has worked with HBV patients for 10 years. “Some develop cancer as early as 30 years of age,” with approximately 1 million people worldwide dying from the disease annually because they are diagnosed past the point where current treatment can be effective, he said. Hepatitis B also is found in relatively large numbers in people from Africa, South America’s Amazon Basin, the Pacific Islands, Eastern Europe and the Middle East, according to the Hepatitis B Initiative, another group that works to spread HBV awareness and provide free screenings to high-risk people, with a focus the API communities in Boston Washington, D.C. While these groups wage a public-relations campaign to inform people of the risks, doctors are working on the front lines, helping those already infected. People who test positive for HBV in its non-chronic form should get treatment right away to be rendered immune to the virus, said Dr. Sôn Ð? of Dallas, a gastroenterology and hematology specialist who has worked with HBV and liver cancer patients for the last 14 years. But if the test shows that they are chronic carriers, they must be screened for liver cancer every six months. For Vietnamese Americans, it is likely that “you have to ask for the (screening) test (and often) the doctor asks why you need it. It’s all misunderstandings. If you go to a doctor who knows, he will screen you. It is very important that you take some personal responsibility” to ask for the test, he said. For those individuals who are not already infected, the HBV vaccine is the only way to obtain lifelong immunity from the virus that, when contracted as an infant or young child, usually becomes chronic, Ð? said. The virus causes approximately 80 percent of all liver cancer cases, he added. The virus can be spread from mother to baby, usually at the time of birth, accounting for most of the HBV infections in Asian and Pacific Islander (API) Americans, Ð? said. The hepatitis B virus is not spread by air, food, water, breastfeeding, casual contact in an office setting, kissing, hugging, coughing, sneezing or sharing eating utensils or drinking glasses, said Tôn, a past president of the Vietnamese American Medical Association (VAMA). It often is transmitted through direct contact with blood of infected individuals either by open wounds touching each other or through the sharing of contaminated toothbrushes, razors or medical/dental tools; the use of non-sterilized manicure implements; the sharing of non-sterilized needles and syringes in poor healthcare facilities, and by having unprotected sex with an HBV carrier, said Ð?, a former VAMA vice president. Unlike HIV, the HBV virus can stay alive for a week or more outside of the body, he said. “Say you get a drop of (infected) blood on the counter. It can stay there for seven days and the virus is still active. If you touch that drop of blood with a cut on your hand, (even after a few days from when the cut occurred) you can get HBV. “A lot of people don’t know that. A lot of Asians don’t know that,” Ð? said, adding that “you may have been the person to pass it on for several years, and by the time you have symptoms, it’s too late.” Asian Americans, in general, and Vietnamese Americans in particular, are more at risk for HBV than are people from any other background because they come from countries with endemic rates of the virus, although it is not known why Vietnamese Americans have the highest rates of any group, Ð? said. Because of this, liver cancer rates in Vietnamese Americans also are higher than they are for people of any other ethnicity — 13 times higher than the rates among white Americans, for example, he said. Medical and work-loss costs for HBV-related conditions total more than $700 million per year in the U.S. where, while 0.3 percent of the general population has chronic HBV, Asians and Pacific Islanders make up more than half of the 1.3 million to 1.5 million known HBV carriers in the country, Tôn said. “This is a disease,” Ð? said. “There used to be nothing we could do about it, but now we can. Get screened, at least to get treated if you have it, but also get screened and vaccinated to prevent it (from spreading to your loved ones),” he said. For Vietnamese Americans the chances are “moderately high, if you have 10 relatives, that (at least) one of them will have hepatitis B. You may save them from getting liver cancer or liver disease” by getting screened and having them get screened as well, he said. “A lot of people think that if they have hepatitis B, that there is nothing they can do. Asian Americans, there is something they can do about it. Get screened and vaccinated,” Ð? reiterated.
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