Screening for Hepatitis B – New Jersey’s Asian American Population

Chronic hepatitis B is a serious viral infection that can lead to liver cirrhosis, liver cancer and other complications, affecting more than 240 million people worldwide. In the U.S., as many as 2 million people live with chronic hepatitis B virus (HBV) infection. Yet many of those infected are unaware they have the disease – over 60 percent – while a good number of individuals who are HBV positive aren’t linked to medical care. In the Asian-American population, the prevalence of chronic HBV infection is much higher than it is for Caucasians, 5 – 10 percent compared to 0.2 percent, respectively.

Holy Name Medical Center in Teaneck, N.J., has prioritized making HBV education, screenings and access to care easily available to our Asian-American population. Holy Name’s culturally and linguistically sensitive care has also helped Asian Americans feel comfortable seeking medical attention at the hospital.

We started by going out into the community and providing, through the nonprofit community-based Center for Viral Hepatitis and the Asian Liver Center at Holy Name, screenings at churches, health fairs and community centers. Between December 2009 and December 2015, a total of 11,177 Asian Americans were tested. Of those screened, 340 were infected with HBV and 3,988 were susceptible, or not protected against infection with the virus. Those infected were referred to specialists within the community and those who were not protected were encouraged to get vaccinated. 

The good news is that the HBV prevalence rate in our Asian-American population, 3.2 percent, was lower than expected. It seems to be mirroring the rate in South Korea, which is also declining. Both decreasing numbers are attributed to immunization programs and other preventive strategies. But the cases still reflect a much higher prevalence in this population, requiring ongoing attention and care.

Unfortunately, of the individuals who are HBV positive, only about 10 percent have been successfully linked to a physician for follow-up. The biggest challenge in linking patients to care for HBV infection is finding qualified providers who offer linguistically and culturally sensitive care. In addition, there is limited availability of bilingual patient navigators in the community who are trained to facilitate linkage to care for HBV-positive individuals.

As part of our efforts to educate clinicians on the issue, Dr. Chul S. Hyun, a gastroenterologist at Holy Name, recently published a paper, Chronic Hepatitis B In Korean Americans: Decreased Prevalence and Poor Linkage to Care, using the data from 7,157 Korean Americans in our study.

“The current study on one of the largest HBV screening campaigns among Korean Americans demonstrates a significantly decreased HBV prevalence of 2.4%. The study also reveals a poor LTC [linkage to care] for those HBV infected subjects, who require monitoring and/or medical treatments. A comprehensive, community-based screening and evaluation program described in this report may be effectively implemented in other ethnic populations to facilitate hepatitis B care.”

Dr. Hyun’s conclusion explains the path we’ve taken to help decrease the chance of liver related morbidity and mortality from HBV in the Asian American population in our own region and provides a model for other providers to follow. Holy Name Medical Center is steadfast in its commitment to this life saving work and to continuing to drive down rates of HBV infection, improve linkage to care, and prevent liver-related morbidity and mortality in the communities we serve.