Fresno, CA: Hepatitis B a silent epidemic among Hmong
By Barbara Anderson. Almost 17% of Fresno Co. Hmong have hepatitis B, but most don't know they're infected. One of six Hmong in Fresno County could be infected with hepatitis, according to a new health survey that has shocked community leaders and added urgency to the fight against the liver disease.
But it won't be easy: Most don't realize they're infected.
The study, conducted by Dr. Muhammad Y. Sheikh, an associate professor of clinical medicine at the UCSF-Fresno Medical Education Program, found that almost 17% of Hmong in Fresno County have the hepatitis B virus. Infection can damage the liver and lead to cirrhosis.
And it's a major cause of liver cancer -- the No. 1 cancer killer of Laotian men in California.
Few studies have looked at hepatitis B infection among the Hmong, who came to the United States in large numbers after the Vietnam War as refugees. Between 20,000 to 30,000 now live in Fresno County.
Most studies of Asian and Pacific Islanders don't break out Hmong as a distinct group. The Fresno County study showed that the Hmong had a higher infection rate than foreign-born Asians as a whole. An estimated 10% of Asians and Pacific Islanders nationwide -- which includes Hmong -- are chronically infected. For the general U.S. population, it's less than 1%, according to government estimates.
It doesn't have to be that way, community health advocates say. Hepatitis B is preventable. There is a vaccine to fight its spread -- and medicines to prevent liver damage.
The problems are awareness, education and access to health care, they say. For example, many Hmong immigrants don't have primary-care doctors to test for the virus. About 62% of the people screened in the Fresno County study said they had not been vaccinated or were unsure if they had been. And, the advocates say, many don't understand the seriousness of finding out if they are infected.
The extent of the disease isn't well known in Fresno County, said the Rev. Sharon Stanley, executive director of Fresno Interdenominational Refugee Ministries and a member of the Central Valley Hmong Health Collaborative, which works to improve access to health care.
Members of the collaborative are making hepatitis B prevention a priority, Stanley said. They were stunned when they learned of infection rates during a presentation by a doctor from the Asian Liver Center at Stanford University School of Medicine, she said.
"There was an audible gasp in the room among all the Hmong attendees," she said.
Hepatitis B experts say the disease could be even more widespread than studies suggest.
The virus is stealthy. About two-thirds who carry the infection don't know it. Many don't find out until they become seriously ill from cirrhosis of the liver or liver cancer.
Liver cancer is the leading cause of cancer deaths for Laotian men and the second leading cause of cancer deaths of Vietnamese men in California, according to the California Adult Viral Hepatitis Prevention Strategic Plan 2010-2014.
For white men, liver cancer is "not even in the top 10" causes of cancer death, said Dr. Samuel So, director of the nonprofit Asian Liver Center at Stanford University School of Medicine.
Without early symptoms, it's difficult to persuade someone to be tested for the virus, said Sheikh, chief of gastroenterology at the University of California at San Francisco-Fresno Medical Education Program.
There also is a stigma associated with the disease.
Hepatitis B is a blood-borne infection spread by sexual contact with an infected person, the sharing of needles during drug use, sharing of household items such as razors -- or from mother to baby during birth.