A "B" for Effort

When Mimi Luu’s husband was diagnosed with hepatitis B, she was stunned: He'd been vaccinated for the disease when he arrived in the U.S. from Vietnam 20 years ago, and had never shown symptoms. As anxiety replaced shock, the rest of the Luu family received booster shots to remain immune to the viral disease and weighed the high costs of treatment. “If I lost my husband due to hepatitis B, it would be very difficult for me to go through life,” said Luu, a longtime Houston resident. “He supports the family.”

Luu’s husband is one of many Asian-Americans living with hepatitis B. One in 10 Asian-Americans has the disease, according to the Centers for Disease Control and Prevention, a rate that is 20 times higher than the rest of the population. These numbers are surely pronounced in Houston, which has the fourth-largest Asian population of any U.S. metropolitan area. But public health officials struggle to get funding for vaccinations and outreach.

An inflammation of the liver that can lead to liver disease and cancer, hepatitis B is rampant among Asian-Americans due to the high prevalence of the disease in countries from which they emigrate. It's 100 times more infectious than HIV and can be contracted through exchanges of bodily fluids and blood, but the most common mode of transmission among Asian-Americans is from mother to child. If an affected individual allows the virus to go untreated, the disease becomes incurable. 

The solutions to lowering the number of new cases of hepatitis B, some Texas doctors say, is a more expansive and affordable adult vaccination program, more funding for outreach and improved reporting of disease incidences to state health departments. By state law, children must be vaccinated for hepatitis B before attending a child care facility or school, as must students enrolled in health-related or veterinary courses. The Texas Department of State Health Services offers frees hepatitis B vaccinations through federally and state-subsidized programs for qualified children and some high-risk adults, though the adult funding is expected to phase out this year. 

Dr. Richard Andrews, the medical director of Houston's HOPE Clinic — which delivers culturally sensitive care to the Asian-American community — said it's imperative that the state have affordable vaccines available not just for children but for high-risk adults. A typical person usually loses immunity to hepatitis B every few years after being immunized for it, Andrews says. “If you have a huge chunk of the population immunized, then you’re going to be cutting down on the spread,” he says. 

But obtaining federal and state funding for hepatitis B prevention programs has been a challenge for public health officials. Unlike HIV/AIDS programs, few federal or state dollars are earmarked specifically for hepatitis B. Though Texas has both a state coordinator and a Houston-based coordinator for adult viral hepatitis, local public health officials in most cases do not have the funds required to initiate hepatitis B education, outreach and screening campaigns, especially among high-risk populations. 

“You have to be creative and really engage the people that have interest and try to keep spreading the word,” says Tamara Brickham, the adult viral hepatitis prevention coordinator at the Houston Department of Health and Human Services.

The cause of this lack of funding, experts suggest, is underreporting of the disease. According to statistics on new acute cases of hepatitis B in 2009, only one afflicted Asian-American in Harris County was reported to the Texas Department of State Health Services. The HOPE Clinic says this number should be far higher. That same year, Brickham screened 1,003 Houston-area Asian-Americans for the disease and found that 364 had already been exposed to it — meaning they either had chronic hepatitis B or had recovered from it.

In some cases, the cause of this underreporting is cultural. Immigrants from countries like Vietnam have a misconception that hepatitis B is simply a way of life for Asians and not very serious, Luu says. Many don't get diagnosed because of the stigma associated with being sick.

“People don’t want to lose face when it comes to diseases. We have ladies who are going through cancer treatment and wearing a lopsided wig and still will not fess up about having cancer,” says Shane Chen, a spokeswoman for the HOPE Clinic, who also has family members afflicted with hepatitis B. “Rather than being proud you’ve beat a chronic disease, people think it is shameful having any illness, hence making you weak or dirty.”

In other cases, the disease is underreported because of how data is collected. The state only gathers data on acute cases of hepatitis B, which means that a patient is displaying symptoms of recent onset of the disease, including yellowing of the skin and eyes, nausea, vomiting and fatigue. The failure to report chronic hepatitis B cases — patients who have had the disease for at least six months but do not necessarily display symptoms — leaves many of those afflicted off the radar, says Dr. Daniel Leung, director of the Texas Children’s Viral Hepatitis Clinic and assistant professor of pediatrics at the Baylor College of Medicine. This is especially the case with children, Leung says: 85 percent of all children who have chronic hepatitis B either never get reported or are diagnosed later.

“Chronic hepatitis B is a silent killer,” says Leung, who is spearheading an effort to collect pediatric hepatitis data in the Houston area. “Lack of symptoms does not mean a lack of disease. In fact, the viral load and liver enzymes could be at their highest even when children are symptom-free.”

Andrews says reporting cases of chronic hepatitis B — the most common kind — would give a far more accurate snapshot of rates of infection among Asian-Americans. But the state health department says large underreporting would still occur, because affected patients “don’t have symptoms and would likely not be tested or diagnosed.”  

Luu says Asian-Americans in Houston should remain vigilant of the disease and get tested when possible. When her husband fell ill, she and her children realized that their own hepatitis B vaccines were no longer effective. 

“Some Asians think it’s very common and not serious to have this disease because we’re Asian," she says. "But it can destroy a family’s happiness.”