The life you save . . .

I’m finding the New York Times to be a good source of public health information – usually with an interesting personal angle. I would recommend a recent story by Dr. Pauline Chen, entitled From Needle Stick to Cure for Hepatitis.

Within this relatively short question and answer piece, Dr. Chen offers insight into the occupational hazards of medicine, provides a brief history and clinical overview of hepatitis C, and chronicles the inspiring story of Dr. Douglas Dieterich – a physician infected for many years with hepatitis C (known as non-A, non-B hepatitis at the time of his exposure).

In brief, Dr. Dieterich’s story is a testament to courage, persistence and altruism. But go ahead and read the story. I would only add one comment that his recurrent symptoms of jaundice and fever are a bit atypical. Most individuals do not experience any symptoms due to hepatitis C infection, and often get sick only after it is too late for effective treatment. Early screening and detection is therefore a key to addressing hepatitis C.

As stated previously, APCA has recently been awarded a grant to conduct hepatitis C screening and education. It’s humbling to know that our screening program leverages the fact that effective treatment now exists for hepatitis C – through some of the very research conducted by Dr. Dieterich himself. Many, many people owe a debt of gratitude to Dr. Dieterich for his persistence and his optimism, as he states it: “I think it’s the beginning of the end of hepatitis C, and this is one of the happiest statements I can make.”

- Doug Hirano, MPH, APCA Executive Director

Good News About Hepatitis C

I’m happy to report that APCA has received notice that it will be receiving a grant from Vertex Pharmaceuticals to conduct hepatitis C screening and education. According to the CDC, hepatitis C is “the most common chronic bloodborne infection in the United States; an estimated 3.2 million persons are chronically infected.”

Receipt of this new grant award is good news on two fronts. First, we can always use some additional financial support in these difficult economic times, and second and more importantly, identifying individuals chronically infected with the hepatitis C virus is now more important than ever – given the recent progress in treating this infection. With the advent of new hepatitis C therapies, up to 80% of infected individuals can have the virus cleared from their bloodstream indefinitely (known as “sustained virologic response”). This is essentially curing the disease.

However, like chronic hepatitis B infection, infection with the hepatitis C virus (HCV) is very often asymptomatic, and most infected individuals are unaware that they carry the virus. Finding out one’s infection status through a simple blood test is therefore critically important and can provide an HCV-infected individual a very good chance of avoiding the severe liver disease (e.g., cirrhosis and liver cancer) often association with infection.

Consequently, we are pleased to be able to initiate a hepatitis C public education and screening program targeting local Asian Americans and Pacific Islanders through this new grant program and thank Vertex Pharmaceuticals for its support.

- Doug Hirano, MPH, APCA Executive Director

World Hepatitis Day Proclamation

WORLD HEPATITIS DAY, 2011

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION

Across our Nation, millions of Americans are living with viral hepatitis. As many as three-fourths of Americans living with the disease are unaware of their status and are not receiving care and treatment for their condition. Raising awareness about hepatitis is crucial to effectively fight stigmas, stem the tide of new infections, and ensure treatment reaches those who need it.

On World Hepatitis Day, we join with people across our country and around the globe in promoting strategies that will help save lives and prevent the spread of viral hepatitis.

Viral hepatitis is inflammation of the liver, and can cause a lifetime of health issues for people who contract it. Hepatitis B and C viruses are the cause of a growing number of new liver cancer cases and liver transplants. In the United States, hepatitis is a leading infectious cause of death, claiming the lives of thousands of Americans each year. While we have come far, work still needs to be done to prevent and treat this disease.

Viral hepatitis touches Americans of all backgrounds, but certain groups are at greater risk than others. Past recipients of donated blood, infants born to mothers infected with viral hepatitis, and persons with sexually transmitted diseases or behaviors such as injection-drug use have risks for viral hepatitis. Baby boomers and African Americans have higher rates than others of contracting hepatitis C. Half of all Americans living with hepatitis B today are of Asian American and Pacific Islander descent, and one-third of people living with HIV also have either hepatitis B or hepatitis C. Worldwide, one in twelve people is living with viral hepatitis.

We must make sure that this "silent epidemic" does not go unnoticed by health professionals or by communities across our country. Under the Affordable Care Act, services including hepatitis immunizations for adults and hepatitis screenings for pregnant women are fully covered by all new insurance plans. My Administration has also released a comprehensive Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. The plan brings together expertise and tools across government to coordinate our fight against this deadly disease. Our goal is to reduce the number of new infections, increase status awareness among people with hepatitis, and eliminate the transmission of hepatitis B from mothers to their children.

The first step toward achieving these goals is raising public awareness of this life-threatening disease. We must work to reduce the stigma surrounding hepatitis, and to ensure that testing, information, counseling, and treatment are available to all who need it. The hard work and dedication of health-care professionals, researchers, and advocates will help bring us closer to this goal. On this day, we renew our support for those living with hepatitis, and for their families, friends, and communities who are working to create a brighter, healthier future.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim July 28, 2011, as World Hepatitis Day. I encourage citizens, Government agencies, nonprofit organizations, and communities across the Nation to join in activities that will increase awareness about hepatitis and what we can do to prevent it.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-seventh day of July, in the year of our Lord two thousand eleven, and of the Independence of the United States of America the two hundred and thirty-sixth.

BARACK OBAMA

- Doug Hirano, MPH, APCA Executive Director

Hello Mr. President . . .

I very recently received an invitation to a White House reception that will be recognizing Asian American and Pacific Islander heritage. It appears that President Obama and the First Lady will both be in attendance. Invitations were made to Asian American and Pacific Islander community leaders, and I’m proud to be considered in that grouping.

Will I be attending? Who could turn down an invitation that starts with “The President and Mrs. Obama request the pleasure of your company . . . ”?

In any case, if I have a chance to speak at any length with President Obama, I think I will remind him that five million Americans are currently infected with hepatitis B or hepatitis C, and that these individuals will need medical monitoring for the remainder of their lives because of their high risk for serious liver disease. I will let him know that many of these individuals are among the working poor or unemployed who do not have health insurance and cannot afford medical care. I will remind him that exemplary government programs like the Ryan White CARE Act support medical care and treatment for low-income individuals with HIV/AIDS, but no such program exists for individuals with hepatitis B or C. I will remind him that more than half of the 1.4 million individuals chronically infected with hepatitis B are Asian Americans and yet there is virtually no large-scale public health effort to encourage Asian Americans to get screened for hepatitis B or to educate physicians to offer screening to these individuals.

I think I will remind him that Title VI of the Civil Rights Act assures individuals of language access in health care facilities that receive federal dollars, yet thousands of individuals are denied these services on a daily basis in facilities throughout the nation. I will remind him that Asian Americans and Pacific Islanders are the fastest growing racial/ethnic groups in this country and that while health care facilities are doing better in offering culturally competent services to Hispanic Americans, Asian Americans and Pacific Islanders are a virtual afterthought when it comes to culturally competent care.

Lastly, I think I will thank him profusely (and offer a fist bump) for his leadership and vision on the Affordable Care Act and let him know that our agency is actively supporting its continuation. Having said that, I will let him know that the same political will exerted on the ACA will be more than sufficient to address the continuing health disparities related to hepatitis and language access. I will humbly offer my assistance, proffer my business card, and then wander off in search of hors d’oeuvres.

- Doug Hirano, MPH, APCA Executive Director

Rapid Hepatitis C Testing Now Available

The Food and Drug Administration (FDA) has just approved a rapid test to detect hepatitis C infection. This test, called OraQuick HCV Rapid Antibody Test, utilizes whole blood from a venous blood draw to generate a test result within 20 minutes. It does not require an instrument for diagnosis.

Orasure Technologies, the manufacturer of the test, hopes to receive FDA approval of the test version that utilizes oral fluid or whole blood from a fingerstick. This will make the test more palatable for individuals put off by a venous blood draw. The test is already approved in Europe for use with oral fluid and whole blood from a fingerstick.

In any case, this is a marked step forward in the fight to identify the many individuals who are unknowingly infected with hepatitis C. According to the Centers for Disease Control and Prevention, there are approximately 3.2 million people in the United States chronically infected with HCV and each year, about 17,000 people are newly infected. It is speculated that the majority of the 3.2 million individuals are unaware of their infection status. Earlier detection can lead to better treatment outcomes. Hepatitis C is a major cause of liver disease, leading to 12,000 deaths annually in the United States.

With more than 350 million people chronically infected with hepatitis B, it is hoped that progress can be made in developing rapid testing for hepatitis B as well. In the United States, an estimated 1.25 million individuals are infected with hepatitis B. The majority of these individuals are Asian Americans and Pacific Islanders and, as with hepatitis C, most individuals are unaware of their infection status.

-Doug Hirano, MPH, APCA Executive Director