It's Sunday, right after a church sermon. The smell of frankincense was still lingering in the air when the priest pulled me to the side and asked for my advice about a 21-year-old Ethiopian woman who had been losing weight drastically over the last few weeks. She was complaining of severe right upper side abdominal pain, nausea, loss of appetite, and had yellowish hue in her eyes and skin (jaundice). In the same town, an Ethiopian nursing student had been by the bedside of her severely ill 59-year-old father. This man raised ten children with great family values and had provided the best education available in Ethiopia. However, he was slowly succumbing to a liver disease he rarely suspected.

Both case narratives are based on true stories, and underscore the devastating impact of hepatitis B on the Ethiopian community. Approximately 2 billion people worldwide have chronic hepatitis B. In Ethiopia, it is estimated that 7.3 million (11%) people are chronic hepatitis B carriers. There is no specific data I could obtain on hepatitis B infection amongst Ethiopians in America, nevertheless this disease poses a major health problem in the United States. According to the Center for Disease Control and Prevention (CDC), nearly 1.5 million people in the United States have chronic hepatitis B. About 25 to 40% of those who are carriers of hepatitis B develop liver disease such as cirrhosis (scarred liver) and a specific type of liver cancer known as hepatocellular carcinoma - the case in point of the 59-year-old father. A smaller proportionof 1% develops deadly acute hepatitis, as did the 21-year-old young woman.

How is hepatitis B transmitted? The mode of hepatitis B transmission is very similar to that of HIV. The virus is concentrated in the greatest amounts of blood, vaginal secretion, and semen. Sex without condoms among heterosexuals and vertical (mother-to-fetus)transmission comprise the two leading modes of infection. Hepatitis B can also be contracted through needle sharing, ear piercing, tattooing, sharing razors and toothbrush as well as use of contaminated surgical equipments, including ones used for female circumcision in Ethiopia. Hepatitis B is different from hepatitis A - an acute self-limited infection secondary to unsanitary food handling and contaminated water. Hepatitis C causes chronic liver disease and is more likely to be transmitted through contaminated blood (IV drug needle, blood transfusion) and less likely through sexual intercourse. Currently, there is no vaccine for hepatitis C.

Health practitioners generally screen for hepatitis B infection with the clinical history, hepatitis B surface antigen (HBsAg), which is a marker of infection, and two antibodies: IgM anti-HBc, marker for acute infection and IgG anti-HBc, marker for chronic infection. In my practice, I usually check for immunity against hepatitis B rendered by vaccination by measuring the level of antibodies against the hepatitis B surface antigen (anti-HBS) one to six months after vaccination, for adults, and three to nine months, for infants. This is because a small percentage (10%) of those vaccinated do not develop immunity after vaccination and may require repeat vaccination. In stark contrast to HIV, there is a highly effective vaccination that can prevent hepatitis B transmission.

Currently, CDC mandates that all infants, health care professionals, and high-risk populations receive three recommended hepatitis B immunizations. The designation of 'high risk' includes those at risk of sexual exposure to the virus, IV drug users, renal dialysis patients and hemophiliacs. CDC also recommends that all pregnant women be screened for hepatitis B surface antigen (HBsAg) as part of their prenatal care. Each year, approximately 150,000 infants are born to women who have immigrated to the United States from areas of the world where hepatitis B virus infection is highly endemic, which includes Ethiopia. If an expecting mother tests positive, her newborn will automatically receive HBIG post-exposure passive immunization in the nursery to prevent risk of infection.

In summary, hepatitis B is a deadly but preventable disease of the liver, an organ with many vital functions including detoxification of the body of deadly toxins, inhibition of uncontrolled bleeding after surgeries or accidents as well as provision of key ingredients for digestion of fats and elimination of waste. I especially recommend that young people who are sexually active get screened and/or vaccinated with the hepatitis B vaccine, which is effective, safe and available at most health centers. Only then, we can prevent unnecessary loss of life to hepatitis B.