What is one of the top 5 causes of death by cancer?

2. What is one of the top 5 causes of death by cancer? Liver cancer

3. How many people worldwide have been infected with HBV? Nearly 2 BILLION people

4. How many people are living with chronic HBV worldwide? 350 – 400 million people Compare to the 40 million people worldwide that are living with HIV

5. What percentage of Asians in the US have chronic HBV? 10% of Asian Americans Which is about 0.3% of the US population

6. How many people worldwide die each year from HBV-related complications? 600,000

7. True or FalseHepatitis B is hereditary. Nahttttttttt

8. How is HBV transmitted?List 3 major transmission methods • VERTICAL TRANSMISSION – mother to child at birth • BLOOD – reusing contaminated medical devices, sharing IV needles or razors, open wound contact • SEX– unprotected sex with someone that has HBV

9. True or FalseHBV can be transmitted from person to person by mosquitoes. Actually, we duno  There are no documented cases of this happening. However, it is known that different strains of mosquitoes are able to carry and transmit different viruses.

10. Can a non-symptomatic person with HBV still transmit it to someone else? Hell yeah they can. An infected individual’s blood will still have the virus even if no symptoms are present. It’s important to remember that for the most part, symptoms do not show until it’s too late.

11. The patient is pregnant and has chronic HBV. Can transmission of HBV to the child be prevented by getting a C-section at birth? NO. A C-section will NOT prevent vertical transmission of HBV! Also, a C-section is unnecessary as long as the child gets the birth dose of HBIg (HBV immunoglobulin) and finishes the HBV vaccination series

12. While tabling, someone asks you, “I want to protect myself from both Hepatitis A and B. What can I do?” “You should be vaccinated for Hepatitis A and B (if surface antigen test is negative). The Hepatitis A vaccine is a 2-shot series. The Hepatitis B vaccine is a 3-shot series. There is also a combination Hepatitis A and B vaccine on the market called Twinrix; the shot schedule for Twinrix is the same as that for the HBV vaccine.” Then give em a fancy Twinrix pen.

13. Why does the WHO call the HBV vaccine the 1st “anti-cancer” vaccine? HBV causes 80% of all liver cancer – preventing and eliminating HBV infection can essentially eliminate 80% of all liver cancer.

14. I received my 1st HBV shot a year ago, but never completed the series. What should I do? You should complete the 2nd and 3rd shots asap You do not need to repeat the 1st dose. The recommended schedule for the HBV vaccine is only a series of MINIMUM time requirements between each shot. (1st shot -1 month – 2nd shot – 5 months – 3rd shot) Why? The 3rd does is essentially like a booster shot; after the 1st 2 doses, 80% of people have already developed immunity to HBV.

15. True or FalseCurrent CDC guidelines recommend getting your blood tested ten years after being vaccinated, and then getting a booster shot. False! The CDC currently has no recommendations for HBV booster shots

16. Does the HBV vaccine series work for everyone? NOT 100%! Some individuals need to be vaccinated multiple times for any sort of immunity to develop. About 5% of people are immunologically non-responsive to the vaccine. It is recommended that these individuals avoid high-risk activities, such as sharing IV needles or engaging in unprotected sex, etc. * * * * * Drunk driving doesn’t count as a high-risk activity in this case, but you should probably avoid that anyway 

17. What should I do to find out if I have HBV? Ask your physician for the hepatitis B surface antigen (HBsAg) blood test. This is the ONLY blood test that can positively identify whether or not you’re infected.

18. At a recent physical my doctor said that my liver function blood tests are normal, and I feel completely healthy. Does this mean I am HBV-free? Why or why not? Not necessarily. The HBsAg test is the only blood test that can definitively determine whether or not you are an HBV carrier. Also, not all HBV carriers show abnormal liver enzyme levels. In many carriers, these levels stay normal until they reach the end stages of liver damage or liver cancer.

19. DailyDouble!

20. Explain these test results: 1) HBsAg- / anti-HBs+ / HBcAb+ 2) HBsAg- / anti-HBs+ / HBcAb- • The core antibody test (HBcAB) is +, indicating that immunity was developed during a prior infection. The surface antibody test (anti-HBs) is also +, so the person is protected from chronic HBV infection. • The core antibody test is negative but the surface antibody is positive, indicating that immunity was developed by getting the HBV vaccine.

21. Explain these test results:HBsAG+ / anti-HBs+ Patient has the antibodies for HBV, but is still infected. He/She should follow the same monitoring recommendations for those with chronic HBV. FYI: this is a rare occurrence Don’t forget! This person can still transmit HBV along to someone else.

22.  Couldn’t think of a question

23. True or FalseEveryone with chronic HBVneeds treatment. FALSE! Treatment is costly and harsh on the body. If no symptoms occur, regular monitoring (ALT, AFP, ultrasound) is the best course.

24. What are your recommendations for monitoring of people with chronic HBV? With appropriate monitoring, it is completely possible to lead a normal and healthy life. There are a few tests you should do regularly to screen your liver for early signs of damage or cancer. Every 6 months: - alanine transferase (ALT) test: screens for liver damage. - alpha-fetoprotein (AFP) test: screens for liver cancer Also, get an ultrasound of the liver once a year to scan for tumors. The combination of all 3 of these tests is essential, as either one by itself is not 100% effective in detecting liver damage or cancer. We also recommend getting the hepatitis A vaccine to prevent any further damage to your liver. Also avoid drinking alcohol.

25. How many FDA-approved treatments (not vaccines) for HBV exist today? There are currently only 5 FDA-approved medications for HBV. None of these medications can completely eliminate the virus from your body, but they can help control the viral load. There have been no other proven treatments found to get rid of the virus. 3 Oral Antiviral meds – Adefovir, Entecavir, Lamivudine 2 Infection meds – alpha-Interferon, Pegylated interferon shots

26. Patient: HBsAG + / anti-HBs +How long should this patient takethe 3 oral medications? (Adefovir, Entecavir, Lamivudine) Long-term / For life

27. I have chronic hepatitis B. I also have cirrhosis, and my family has a history of liver cancer. What changes, if any, would you make to the normal recommendations for monitoring my disease? Increase the frequency of AFP screening (for liver cancer) to once every 3-4 months, and increase the frequency of ultrasounds to once every 6 months.

28. What are the differences between Hepatitis A, B, and C? Hepatitis A is a food-borne virus, Hepatitis B and C are blood-borne. The main mode of transmission for Hepatitis A is food and water, for Hepatitis B is mother to child, and for Hepatitis C is blood transfusion. Hepatitis A is acute infection only; Hepatitis B and C are usually chronic infections. Hepatitis A and B have vaccines. Hepatitis C does not.

29. Why are HBV rates so much higher in Asians than in any other ethnic group? HBV is endemic to Asia in the same way that HIV is endemic to Africa. Main mode of transmission for Asians is vertical transmission. Non-Asian HBV transmission occurs later in life, usually through IV drug use or unprotected sex. Since HBV is passed generation to generation in Asians, education and awareness are especially crucial.

30. DailyDouble!

31. China carries the biggest burden of HBV in the world. How many people in China are living with chronic HBV? 130 million people

32. True or FalseA majority of liver cancer is caused by alcohol abuse. FALSE! 80% of liver cancer is due to chronic HBV. and yes this question is too easy for a 400 point question

33. I completed all three shots of my hepatitis B vaccine series, but I still do not have immunity. What are some possible reasons for this? What do you recommend that I do? • 1. The vaccine was not stored properly (an environment that is too hot or cold can render the vaccine ineffective) • 2. The vaccine was administered incorrectly • You are immunologically nonresponsive to the vaccine – this is the case in about 5% of all people. • You can try the vaccine series again, perhaps using a different brand of vaccine. Get the blood test afterwards to confirm whether or not the vaccine worked. If the vaccine doesn’t work after multiple tries, you are likely in the 5% of those unresponsive to the vaccine. In this case, avoid engaging in high-risk activities like sharing needles, having multiple sexual partners, etc.

34. Final Jeopardy

35. Is it true that the HBV vaccine is equally effective if administered in the arm or the butt? Explain. NOPE The vaccine does not work if injected in fat, so it must be given in muscular tissue such as the arm or thigh. It also does not work subcutaneously.