It is estimated that 1.2 million, or 1 in 10 (10%)*, Asian Americans are chronically infected with the hepatitis B virus (HBV) based on the data from Center for Disease Control and Prevention in 2005. This disproportional prevalence of chronic hepatitis B among Asian Americans (10% in comparison to <0.5% for average Americans) is one of the greatest health disparities for Asian Americans. [*This number is now about 1 in 12 (8%) in 2020 due to the extremely fast growth of Asian Americans in the past 15 years.]
Chronic hepatitis B patients without early detection and proper medical attention will face a 25% higher risk of death from cirrhosis or liver cancer. Liver cancer is the second leading cancer death among Asian American men. Hepatitis B is also the leading cause of liver cancer among Asian Americans.
Many people with chronic HBV infection do not have symptoms and therefore are not aware that they have this deadly disease. However, there are actually simple tests for hepatitis B and also treatments that can help patients get the disease under control. In addition, there are vaccines that can protect un-infected people. The damage from hepatitis B can be minimized easily but it is surprising that so many Asian Americans still do not know about the disease and its consequences. Do you know if you are a hepatitis B patient?
HBV Project at Asian Center – SE MI
- To determine the prevalence of chronic HBV infection among Asian Americans in Michigan
- To bring awareness of this serious health threat to Asian Americans
- To help control (treatment) and reduce (vaccination) the disease in Michigan
HBV has been the longest running program at AC-SE MI. It includes research, studies and services to the Asian American community. Dr. Janilla Lee (founder and CEO of AC-SE MI) initiated the hepatitis B prevalence study in 2006 when she was working at the Healthy Asian Americans Projects at the University of Michigan, School of Nursing. She had the support of Dr. Anna Lok from the University of Michigan Health System, Department of Internal Medicine, as the physician authorizing clinical activities. The purpose of the study was to find out the prevalence of hepatitis B among Asian Americans in Michigan and then used it as the baseline assessment to help design education and interventions campaigns. The ultimate goal is to have this disease under control and to reduce the deadly liver cirrhosis and cancer in Michigan
To reach these goals, AC-SE MI offers the following HBV programs:
AC-SE MI has been offering free screening since 2006. The screening procedures include:
- Filling out registration form with a few questions of the family HBV history
- Answering a few personal HBV related questions
- Drawing 4 ml blood to test for HBV antigen and antibody
Usually, the lab results from the blood analyses come back in 2 to 3 days. AC-SE MI will process the analyses and send our recommendation letters in 2 weeks to the participants. The letter will be in English and the translation of the patient’s native language (Chinese, Korean or Vietnamese) to ensure both the patient and his/her PCP (primary care physician) can understand it for any follow-up.
The HBV screening service has usually been offered during health fairs, health seminars or health expos whenever there is a large gathering of Asian Americans. AC-SE MI has been offering health fairs several times a year. But in the past few years this need has been reduced as most of the Asian immigrants now can buy their own health insurance after the incorporation of the Obama Care. In our health fair data, it showed 75% of participants did not have health insurance in 2006; and that number dropped to 14% in 2016. The average age of our health fair participants has been 53 years old.
You can see our screening results in the report section under the HBV program:
It is very disheartening that so many Asian Americans do not know much about HBV and its disproportionate infection rate among Asian Americans. From the answers of those HBV questions we collected during the screenings, we have learned that education is extremely important and critical to Asian Americans. Seminars, small workshops and one-on-one personal discussion about the disease are all important ways to educate Asian Americans. Using a skit written by an award-winning writer, AC-SE MI produced a video with a group of theatrical students at the University of Michigan in 2018. The video can be found in the beginning of this page.
The targeted population for education also includes physicians (PCP especially) and public health workers. Patients usually listen to their PCP, who can order tests to determine their HBV disease status. The Asian American medical students at different universities have also been the recipients of our education efforts. They are the future physicians who can help get this disease under control.
Since 2010, free vaccines have been offered to those who qualify. The qualification is an HBV screening test report from a qualified biomedical test lab within 2 years showing negative on both surface antibody and antigen. The schedule is usually set up after a large health fair that has offered HBV screening. After the initial shot, participants will receive a paper slip, which records their initial shot info and their scheduled dates for the 2nd and 3rd shots. They will also receive a reminder call a few days prior to their shots. These shot records are keyed in the MCIR (Michigan Care Improvement Registry) as part of the participant’s immunization record.
However, free vaccinations are not always available. AC-SE MI can only offer free vaccines to the community when CDC provides free vaccines through Michigan Health and Human Services. During the absence of free vaccines, AC-SE MI recommends the participants go to their PCP or local health department to get the vaccine.
HBV Patient Navigation
A patient navigation system was set up in 2011 to help patients whose test result comes back positive from our screening or anyone who seeks advice for the HBV disease. This help includes:
- Send each patient a “Test Request” (to our contracted bio-medical test lab) for a comprehensive liver test
- Refer them to a hepatologist
- Enter them to a clinical study
- Assist them to apply for health insurance (e.g., Medicaid or Washtenaw County health insurance for Washtenaw residents)
- Assist them in applying for medication from patient assistant programs of a pharmaceutical company
- Assist them in setting up a free clinical appointment
With AC-SE MI’s limited resources, our effort is limited to the initial setup, and maybe follows up in 6 months or a year. Long-term patient-navigation is not possible.