COMMENTARY

CDC Expert Commentary: Screening Asian Patients for Chronic Hepatitis B

John Ward, MD

Disclosures

October 04, 2010

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Hello. I'm Dr. John Ward, the Director of the Division of Viral Hepatitis at the Centers for Disease Control and Prevention.

As part of Medscape's CDC Expert Commentary Series, I will be speaking with you about the CDC screening recommendations for chronic hepatitis B that were released in late 2008.

Approximately 1.2 million people in the US are living with chronic hepatitis B. Unfortunately, as many as two-thirds do not know that they are infected, since chronic hepatitis B can remain asymptomatic for years. If undiagnosed and untreated, up to 25% of infected persons will develop serious complications, including hepatocellular carcinoma and decompensated cirrhosis.

Over the last several years, however, antiviral therapy has become increasingly available and can slow, or even reverse, disease progression.

Who should be screened for chronic hepatitis B?

While our CDC guidelines cover a number of populations, I'm here today to talk about your patients of Asian heritage. It is estimated that 1 in every 12 Asian Americans is living with chronic hepatitis B. Best available data indicate that almost 70% of Asian Americans were born outside the United States.

Most Asian countries have high rates of chronic hepatitis B, due to transmission that occurs principally at birth and in early childhood. If not vaccinated at birth, up to 90% of infants infected at birth will develop chronic infection.

Most highly endemic countries have only recently begun infant or childhood vaccination programs, and many are still not providing vaccination at birth. The hepatitis B surface antigen or HBsAg is the first line in screening for chronic hepatitis B infection.

A positive HBsAg indicates that a patient has active HBV infection. A person who tests positive for HBsAg should be referred to a physician experienced in treating hepatitis B.

All persons with HBV infection will benefit from a physician's care and possibly antiviral therapy. His or her sexual partners and household contacts should be also tested and, if not immune, vaccinated.

The bottom line -- since most people of Asian heritage came to the US from endemic countries or were born to parents from these countries, they should be screened for chronic hepatitis B.

On our CDC website, we have a 2-page summary of the testing recommendations for hepatitis B, a reference sheet on the interpretation of hepatitis B serologic test results, patient education materials, and many other resources.

In 2008, NIH held a consensus conference on the Management of Hepatitis B and published treatment guidelines.

Thank you!

Web Resources

Geographic distribution of chronic hepatitis B virus infection

Hepatitis ABC Fact Sheet for Professionals

Interpretation of Hepatitis B Serologic Test Results

Recommendations for Identification and Public Health Management of Persons With Chronic Hepatitis B Virus Infection

Two-page summary table: recommendations for routine testing and vaccination for chronic hepatitis B virus infection

John Ward, MD, is Director of the Division of Viral Hepatitis at the CDC in Atlanta Georgia with responsibility for planning and directing national and international research, surveillance and public health programs related to viral hepatitis prevention and control. In addition to his work in viral hepatitis, Dr. Ward's experience includes 14 years in the field of HIV/AIDS conducting early studies of AIDS transmission, natural history and diagnosis, evaluating prevention measures to protect the blood supply and directing national HIV/AIDS surveillance. Dr. Ward has also served as Editor of the Morbidity and Mortality Weekly Report (MMWR), CDC's primary health publication. As Editor, Dr. Ward created the Epidemic Information Exchange (Epi-X), a secure, moderated system for public health officials to report and discusses disease outbreaks and other health events.

Dr. Ward has authored over 100 scientific publications and recently served as Editor for Silent Victories, a history of public health in the 20th century published in 2007 by Oxford University Press. Dr. Ward received his medical degree from the University of Alabama School of Medicine in Birmingham and completed an internship and residency in internal medicine at the University of Alabama Hospitals with additional postgraduate training at the London School of Tropical Medicine and Hygiene, CDC's Epidemic Intelligence Service and the infectious diseases fellowship program at the University of Washington Medical Center in Seattle. Dr. Ward holds a clinical faculty appointment with the Department of Medicine, Emory University.

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