Philadelphia Medicine Fall/Winter 2019 - 24

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wellness corner

HBV PreVNTT:

The Latest effort to try
to Combat Hepatitis B
in Philadelphia
By: Chari Cohen, DrPH, MPH, Senior Vice President, Hepatitis B Foundation; Catherine Freeland, MPH, Public Health
Program Manager, Hepatitis B Foundation; Meredith Henne, MPH, Hepatitis B Project Coordinator, Philadelphia Department
of Public Health; Danica Kuncio, PhD, Viral Hepatitis Program Manager, Philadelphia Department of Public Health

ast year, a 32-year-old African man in Philadelphia woke up
with pain in his side. By the afternoon the pain intensified,
and he went to the ER. An MRI revealed that he had
hepatocellular carcinoma, and blood tests found that he had
chronic hepatitis B virus infection (hepatitis B). Unfortunately,
the liver cancer was too advanced, and he died within three
weeks. He did not know that he had hepatitis B, even though
he likely lived with it for years. Had he been diagnosed, he
could have been medically managed to prevent the liver cancer,
or to detect it early.
Unfortunately, this is not an isolated incident. hepatitis B has
been a hidden epidemic in Philadelphia, negatively impacting
the lives of thousands often without their knowledge.

an increase in acute hepatitis B infection, driven largely by the
opioid epidemic and injection drug use behaviors.
Since 2012, the Hepatitis B Foundation, and its community
coalition Hep B United, has provided free community-based
hepatitis B education, and testing and linkage to care for highrisk communities. So far, we have screened 2,906 individuals
and found an overall hepatitis B prevalence of 7.86%, which is
among the highest prevalence rates found by community-based
programs in the U.S. Additionally, 43% were found to be susceptible and in need of vaccination. Interestingly, 60% of those
tested stated that they have a primary medical provider and had
seen a doctor within the past 12 months - yet had never been
tested for hepatitis B virus. We also found that there is very low
awareness of hepatitis B among high-risk communities, and that
hepatitis B-related stigma and myths about transmission and
treatment serve as barriers to testing.

Philadelphia has a socioeconomically and culturally diverse
population of approximately 1.6 million people. The city is
home to many communities with elevated risk for infection with
the hepatitis B virus, which causes chronic liver infection and a
The World Health Organization is calling for the elimination
significantly increased risk of developing cirrhosis and liver cancer. of viral hepatitis by 20302, and in the U.S., we are working
Locally impacted communities include Asian, Pacific Islander, and towards that goal through a national plan led by federal, acaAfrican foreign-born communities, as well as LGBTQ+, homeless, demic, clinic, and community partners. We have the tools to
and drug user communities. Pennsylvania has the fourth highest eliminate hepatitis B in the U.S. - a preventive vaccine, a robust
burden of newly reported chronic hepatitis B infection in the program to prevent mother to child transmission, and antiviral
nation1, and Philadelphia accounts for 74% of these cases. In therapies that can control the virus and prevent liver cancer.
2016, Philadelphia had an annual HBV rate of 38.4/100,000 The United States Preventive Services Task Force (USPSTF)
people1. While the Philadelphia Department of Public Health and the CDC have clear guidelines for testing and vaccinating
(PDPH) has been made aware of 25,132 Philadelphians living high-risk individuals. However, we are not seeing the increases
with chronic hepatitis B infection, it is estimated that up to 65% in diagnosis or decreases in chronic hepatitis B infection that
of infected people remain undiagnosed, so there are thousands we should. In Philadelphia, with a high prevalence of hepatitis
more Philadelphians who need to be diagnosed and linked with B infection and low diagnosis rates, there is much work to be
appropriate medical care. Additionally, Philadelphia is now seeing done to eliminate hepatitis B.

24 Philadelphia Medicine : Fall/Winter 2019

Philadelphia Medicine Fall/Winter 2019

Table of Contents for the Digital Edition of Philadelphia Medicine Fall/Winter 2019