Ka Wai Ola - Office of Hawaiian Affairs, Volume 7, Number 4, 1 April 1990 — Hepatitis B-- a serious risk for residents of Hawaii [ARTICLE]

Hepatitis B-- a serious risk for residents of Hawaii

By Arthur Manoharan, M.D. Hepatitis B is a viral disease and the onset is usually insidious with vague abdominal discomfort, nausea and vomiting. This may progress to jaundice with a mild fever. The diagnosis is made by detecting antibodies to the Hepatitis B virus. Some patients develope chronic liver desease. It is estimated up to 80 percent of liver cancer world wide is due to Hepatitis B infection making it second only to lung cancer in prevalence. Some Hepatitis B patients become carriers and infants born to mothers who are carriers are likely to become infected and develop chronic Hepatitis B and liver cancer when they grow up. Recently an international conference was held in Honolulu to discuss the global problems associated with Hepatitis B infection and what action should be taken locally. Forty countries participated along with representatives from the World Health Organization headquarters in Geneva and regional offices in Manila and Washington, D.C. Hawai'i has the highest incidence of Hepatitis B infection compared to the other states in the United States of America. Hepatitis B occurs all over the world with the highest numbers in Asia, Africa and Latin America. Within Hawai'i those who eome from Asia and certain Pacific island communities show a higher incidence of infection. Native Hawaiians have not been hit hard, as yet, by the infection but with interracial marriages and the many carriers among some ethnic groups the risk of Hepatitis B is a serious risk to all residents of Hawai'i. In a recent study done by Kapiolani Medical Center for Hepatitis B among various ethnic groups, the percentages of carriers were: Chinese 9.5 percent, Filipinos 4.1 percent, Samoans 4.5

percent, and Hawaiians only .5 percent carriers. Most cases of Hepatitis B occur due to childhood infection. The virus is also transmitted through body fluids as may occur in needle-stick accidents, or among drug addicts who use or share needles. It is also transmitted during sexual contact. Anyone who has contact with blood products is at increased risk. Nurses, dentists, physicians, and those who work with dialysis patients all run a higher risk of contracting Hepatitis B infection. An effective vaccine is now available and usually three injections provide a good level of immunity against Hepatitis B infection. However, the cost of the vaccine has been prohibitive and this has prevented larqe-scale immunization. During the Honolulu conference, the strategy of controlling Hepatitis B infection was discussed and representatives from countries where the incidence is high felt that universal immunization of all children should begin plus vaccination of all adults in highrisk situations. The previous polic> • of vaccinating only those in high-risk situations is now eonsidered inadequate. One suggestion offered at the conference was the inclusion of Hepatitis B vaccine with diptheria, whooping cough, and tetanus immunization so it could be part of a combined immunization procedure with no separate visit necessary for Hepatitis B immunization. That could also reduce the cost of immunization. Cost of the vaccine has been coming down and is expected to decrease further if large-scale orders are placed with manufacturers. The vaceine is considered highly effective and safe, and does not interfere with other antibodies. Since Hawai'i is between Asia and the United

States, among Pacific Island communitiec whieh show a rather high frequence of infection, it is recommended that universal immunization of newborns and immunization of high-risk adultsshould be the policy here.