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					SF Hep B Free Community
Education Workshop Series
                 February 15th, 2008

             Erin M. Bachus
           Adult Immunization Coordinator
       Communicable Disease Prevention Unit
      San Francisco Department of Public Health
      Purpose of this workshop
 Educateparticipants about hepatitis B and
 the SF Hep B Free Campaign
     Testing
     Vaccination
     Treatment
 Empower  YOU to educate members of
 your organization(s) about hepatitis B and
 the importance of getting tested
          What is Hepatitis B?
 Hepatitis  B is a virus that causes serious
  liver disease.
 The word “hepatitis” means inflammation
  of the liver.
 Anyone can get hepatitis B.
                      Hepatitis B
 How    is it transmitted?
    Hep B is 100x more infections than HIV
    Via blood and body fluids
      • BBS
            Birth: from an infected mother to her infant
            Blood: direct contact with infected blood
            Sex: unprotected sex
                              Hepatitis B
   Symptoms of acute HBV
       Experienced by 30% of people
         •   Jaundice
         •   Fatigue
         •   Abdominal pain
         •   Anorexia
         •   Nausea
         •   Diarrhea
         •   Fever

   Hep B can cause lifelong (chronic) infection,
    cirrhosis (scarring) of the liver, liver cancer, liver
    failure, and death
         • Serologic testing and lifelong monitoring of chronically
           infected persons is essential for the prevention of severe liver
                         Hepatitis B
   Who is at highest risk?
       Persons with multiple sex partners
       Men who have sex with men
       Sex contacts of infected persons
       Injection-drug users
       Persons born in HBV endemic areas *
       Household contacts of chronically infected persons
       Infants born to infected mothers
       Infants/children of immigrants from areas with high rates of HBV
       Health care and public safety workers with exposure to blood
       Hemodialysis patients
Hepatitis B Endemic Countries

Get Vaccinated!
 Among the safest and most effective available
 Hepatitis A
       2 dose series
         • Each dose separated by 6 months
   Hepatitis B
       3 dose series
         • Schedule: 0,1,4-6 months
   Combination hep A / hep B
       Twinrix
       3 dose series
         • Schedule: 0,1,6 months
         *Minimum intervals only! Vaccine series never have to be restarted!*
    Hepatitis B and Chronic Infection
   < 1% of general population develops chronic infection
   Chronic infection risk decreases with age
       Up to 90% of infants infected at birth
       30-50% of those infected between age 1 and 5 years
       5% of those infected as adults
   Persons born in endemic countries have higher risk of
    chronic infection
       1 in 10 people!
       Not related to genetics
   1 in 4 of those with chronic infection will die prematurely
    from cirrhosis or liver cancer
 Health Disparity in API Communities

 10-15% in APIA communities vs. <1% in
 general population
     1.3 million people infected in U.S.
     More than half are APIA
     New acute cases in U.S. down from 250,00/year in
      1993 to 65,000 due to vaccination
     5,000 HBV related deaths/year unchanged
Health Disparity in API Communities

  Chronic HBV and liver cancer
       considered greatest
 health disparities between APIs
      and other Americans!
Why Asians?
    • Infection occurs at birth
    through vertical transmission,
    or in early childhood

    • No genetic component is
    known at this time

    • Key is area of origin
    Ramifications of chronic HBV
   Without proper monitoring and treatment, 1 in 4
    will die prematurely
       A simple blood test detects infection

               Adrian Elkins (1983-2003)        Dr. Mark Lim (1969-2003)
               Sophomore at So. Oregon          Internist, UCSF
               University                       “Healthy hepatitis B carrier”
               Adoptee from India
               Founder of Answer to Cancer      Diagnosed with advanced
               Race                             liver cancer at 31years of
               Diagnosed with advanced
               liver cancer at 20 years of      Died before 32nd birthday.
               age; had 6 weeks to live.

               Died at age 20.
            Stats – did you know?
   Chronic hepatitis B is responsible for 80% of all liver cancers
   Less than 1 in 100 of the general U.S. population has chronic
    hepatitis B.
   An estimated 1 in 10 API has chronic hepatitis B infection,
    contracted at birth or early childhood.
   API residents comprise 34% of San Francisco’s population.
   Without proper care, 1 in 4 API living with chronic hepatitis B will die
    from liver cancer or liver failure.
   Liver cancer presents the greatest health disparity between Asian
    Americans and Caucasian Americans.
   Chronic hepatitis B is often asymptomatic. A simple blood test is
    necessary to detect the disease.
                 More stats
 Prior to wide spread use of vaccine, 120,000 –
  300,00 new hepatitis B acute infections / year in
 Currently, 65,000 new infections / year in US
 API have the highest rate of liver cancer for any
  racial/ethnic group, 6-13x higher depending on
  Asian ethnic group
 HCC ranks as a leading cause of death for API
         What are we doing in SF?

                 San Francisco Hep B Free
First city in U.S. to test and vaccinate all Asian and Pacific Islanders for hepatitis B
               SF Hep B Free
   An innovative collaboration of public/private
   Unmatched across the country
   Galvanized multiple constituents for
   Effective response to major local public health
   Partners encompass entire health care sector,
    universities, legislators, foundations, CBOs, and
    news agencies
                   SF Hep B Free

 To create public and healthcare provider awareness
  about the importance of testing & vaccinating Asian
  Pacific Islanders (API) for hepatitis B.
 To promote routine hepatitis B testing and vaccination
  within the primary care medical community.
 To ensure access to care for chronically infected
              SF Hep B Free

 Campaign     Strategies
     Public Awareness
     Screening
     Vaccination
     Follow-up / Treatment
Active Partners
Testing & vaccination sites
               Provider Education
   Study population
       196 PCP attendees of a university-based CME primary care
        Internal Medicine conferences (spring 2007)
 78% response rate
 Only 45% of clinicians correctly chose HBsAg as the
  screening test of choice for CHB
 46% were unaware that HBV can be controlled by
 Overestimate the relative prevalence of CHB: other at
  risk groups have a higher prevalence than Chinese
       HIV (40%), MSM (41%), IVDU (60%)
Provider Education
              Hep B Free Year in Review
   11/06: Board of Supervisors passes Fiona Ma’s resolution to test &
    vaccinate all API residents.
   12/06: Resolution endorsed by Health Commission. No funds allocated.
   01/07: Interagency Steering group established to create SF Hep B Free
   04/07: Campaign launched at dinner in Chinatown.
   05/07: SFHEPBFREE website launched.
   06/07: Planning Group with all key stakeholders convenes.
   07/07: Bus ads featuring Mayor Newsom & Assemblywoman Ma run
    throughout city.
   08/07: Community education plan developed.
   09/07: SFSU and CCSF commit to on campus testing & vaccination
   10/07: Eight CME events reach 230 primary care providers
   11/07: Seven new, low cost, public access testing & vaccination sites
                             HIGHLIGHTS of 2007

   Assemblywoman Fiona Ma signs on as Honorary Chairwoman.
   Mayor declares San Francisco to be model for hepatitis B prevention &
   Hospital Council and all major health care provider agencies join campaign.
   450 attend April launch dinner.
   150 community organizations pledge support.
   32 health related organizations actively participate in campaign.
   Planning Group of key stakeholders meet monthly to integrate resources &
   Public access low cost testing and vaccination sites established where none
    existed before.
   SFSU and CCSF commit to educate, test and vaccinate students, staff, and
   Participating entities raise just under one million dollars for own activities.
   Resources shared among participating organizations.
   Bus ad campaign runs for six consecutive months.
   Office of Minority Health grants Asian Liver Center funds for SF Hep B Free.
   Largest Asian ad firm in nation gives pro bono creative for 2008 public
    awareness campaign.
                CHALLENGES for 2008

 Raise funds for centralized evaluation and public
  awareness campaign.
 Generate large-scale public awareness through multi-
  level media outlets.
 Improve primary care clinician knowledge through
  educational opportunities.
 Provide grass roots educational opportunities for target
 Improve access to care for uninsured persons with
  chronic HBV.
 Improve access to vaccination for susceptible
 Expand campaign to large employers.
           How Can you Help?
 Get involved
 Volunteer
     Speakers, writers, coordinators
 Educate  your friends, family, neighbors
 Start a Team HBV on campus
 Get tested
 My   contact information
     Erin Bachus, Adult Immunization Coordinator
      San Francisco Dept of Public Health
      (415) 554-2798

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