Editor’s Note: TakePart’s Paula Carvajal recently sat down with Stanford Professor of Medicine Emeritus Emmet Keeffe to discuss chronic Hepatitis B (HBV) and the World Health Organization’s attempts to eradicate the silent killer. Dr. Keeffe was the Chief of Hepatology at the Stanford University School of Medicine from 2000 to 2007, and published research on the diagnosis and treatment of chronic Hepatitis earlier this year.

TakePart: In general terms, what is hepatitis B?

Professor Emmet Keeffe: Hepatitis can be acute or chronic. Chronic hepatitis B is a condition in which the hepatitis B virus chronically affects the liver and causes brash amounts of damage over many decades. Chronic hepatitis can be followed by a development of cirrhosis or liver cancer.

TP: Why is it considered the “silent killer”?

EK: Hepatitis B is typically silent as there are no symptoms. It’s picked up because of either abnormal liver tests or routine screenings, like at the time of a blood transfusions, or because of known risk factors such as Asian ethnicity or multiple sexual contacts or intravenous drug use or as risk factors such as that.

TP: Why do people in Asia have such a high risk of infection?

EK: Because it is passed from mother to child at the time of birth. Historically Asians have been infected. There is a high infection rate in Asians, of Asian origins or Asian Americans. It has been in that population for many decades, for a really long time.

TP: Are more testing facilities and education on the topic being provided to those areas?

EK: Yes. That is taking place around the world. In the US as well.

TP: What are some common myths about how hepatitis B is spread?

EK: I think one of the main myths among many of the populations is that it is a mild condition for which an individual doesn’t need to be
particularly concerned. This proves true for other medical conditions, like high blood pressure, which may not be symptomatic. Therefore, there is not any sense of advocacy for treatment or ongoing medical care. Some people have the infection for many, many years
without any symptoms at all.

TP: How many people go untested for the virus?

EK: The infection rate in the US is estimated to be somewhere between 1.2 and 2 million individuals who are infected. I think typically only a third of those have been diagnosed because the other two thirds haven’t been tested.

TP: What keeps people from getting tested?

EK: Lack of knowledge about the possibility they might be infected, not knowing risk factors, physicians not knowing which patients in their routine practice should be tested.

The infection rate in the US is estimated to be somewhere between 1.2 and 2 million individuals who are infected. I think typically only a third of those have been diagnosed because the other two thirds haven’t been tested.

TP: Children infected from birth tend to get chronic HBV because they have gone untested. Is it because their immune system tends to be weaker?

EK: Yes. When children are born, they have immature immune systems. They don’t recognize the virus as foreign; therefore, they have a chronic infection that is not cleared by the body’s immune system. The chronicity rate is very high; it’s in the order of 70 - 90 percent. If an adult acquires hepatitis B, the chronic rate is only two to five percent. So 95 - 98 percent of adults clear the virus because they have an immune system that attacks the virus and doesn’t allow it to become chronic.

TP: Is there a cure?

EK: So far there is no cure for hepatitis B. There are seven licensed therapies by the FDA, all of which can control the activity of the virus, the viral replication, but they do not eradicate or cure the virus.

TP: Is there a pandemic threat of hepatitis B?

EK: Not really. Hepatitis B is relatively stable around the world. It will be decreasing in future generations because most countries have adopted vaccine programs. There are strategies, for example, to vaccinate all newborns and to vaccinate people that are older, who were not vaccinated at birth. Hopefully this can be eradicated by universal vaccination around the world. That process is already underway. There’s the World Health Organization that is trying to get the whole world vaccinated.

TP: Has the vaccine proven to be safe?

EK: Yes. That has been proven over many, many years. There is a small minority of people who are always concerned about vaccinations in the induction of neurologic conditions, but they have never been supported by sound, scientific evidence.

TP: How close is the WHO is reaching its goal to vaccinate 90 percent of the population?

EK: I don’t know precisely, but they are behind. They are not on the schedule they had hoped.

TP: Do you know any of the roadblocks they’ve come against in being able to provide the vaccines?

EK: The roadblocks have been cost and delivery. For example, the largest population that is infected is China, which is of course a
huge country. China is a relatively poor country. To get the vaccines at an affordable price and then to get them out to every small village is a tremendous logistic challenge.

TP: What is the cost of the vaccine?

EK: It does vary in different parts of the world. For example, in China, the Chinese government has led to the development of their own vaccine production factories. They will be able produce the vaccines at a fraction of the cost of what we would pay for it in the United States. So the cost varies around the world.

photo credit: cambodia4kidsorg’s Flickr photostream (creative commons)