Hepatitis B: The Silent Killer of the Vietnamese American Community

By: Victoria N. Huynh

(Photo Credit: Roche.com)

In the United States, hepatitis B is estimated to affect approximately 4.3% of American adults. However, the Vietnamese community in the United States is known to be disproportionately affected by hepatitis B with estimated prevalence ranging from 4.8% to 13.8% of adults. Among Asian Americans in general, one in twelve Asian Americans have chronic hepatitis B and two out of three affected Asian Americans do not know they are affected.


What is Hepatitis B?


Hepatitis B is a vaccine-preventable infection of the liver caused by the hepatitis B virus (HBV). Initial symptoms of acute infections may be so mild that affected individuals and their doctors may not even recognize them. Despite the mild initial symptoms, acute hepatitis B infections can develop into chronic hepatitis B. This lifelong condition can cause liver failure, and existing literature has shown that hepatitis B is significantly associated with liver cirrhosis, which is the leading cause of hepatocellular carcinoma—the  third most common cause of cancer-related deaths. For those living with a chronic hepatitis B infection, the risk of developing hepatocellular carcinoma is 100 times higher than for those without chronic hepatitis B. However, it is often difficult to determine whether a patient has hepatocellular carcinoma as there are often no symptoms, and blood tests for liver enzymes may be normal. When symptoms, such as abdominal pain, do appear, it’s typically too late for treatment to be effective.


Hepatitis B Transmission


Hepatitis B can be transmitted via three primary modes: birth, blood, and sex. During birth, HBV can be transmitted from an infected mother to the child, and this is a common transmission mode among Asians in particular. Additionally, HBV can also be transmitted via direct contact with infected blood and unprotected sex with a person infected with hepatitis B.  


Screening and Vaccination for Hepatitis B


For these reasons, measures, such as vaccinations (three-dose series) and screenings, are especially important for communities where hepatitis B prevalence is elevated. However, despite the importance of preventative measures in the Vietnamese American community given the high prevalence of hepatitis B, existing studies have reported a wide range of the prevalence of testing for hepatitis B with somewhat conflicting data. For instance, some studies have found that 7.5% to 49% of Vietnamese Americans have tested for hepatitis B while other studies have estimated the prevalence of testing to be around 60%.


Additionally, the most effective preventative measure against hepatitis B is vaccination, which is both safe and effective. For children, the vaccine series requires three doses, while in adults, a new hepatitis B vaccine requires only two doses. However, despite the efficacy of the vaccine, considering the high prevalence of hepatitis B in the community, hepatitis B vaccine rates among Vietnamese Americans remain low with estimates ranging from 6.3% to 30.5% with completion rates estimated to be relatively lower.


In an effort to increase screening and vaccination among Vietnamese Americans, several studies have looked to identify predictors of screening and vaccination. Potential predictors include, but are not limited to English proficiency, having a regular medical provider, physician recommendation, knowledge of HBV, and insurance. However, small sample sizes and conflicting results appear to be an ongoing trend. Therefore, in order to properly address and increase screening and vaccination among the Vietnamese American community, both funding and research need to be increased by a notable amount.

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