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Are Doctors Screening Their Patients for Hepatitis B?

hepatitisBy Curtis T. Miyamoto, MD

I recently met with Chari Cohen, MPH DrPh(c), Director of Public Health, and Kuan-Lung Daniel Chen, MPH, CPH, Program Manager, of the Hepatitis B Foundation about the challenges they are facing working in the area of detection and treatment of the hepatitis B virus. Like many nonprofit organizations, they are having some huge challenges. This particular foundation, however, is unique and special for our area.  You may already know that the hepatitis B virus was discovered in Philadelphia — at the Fox Chase Cancer Center — by Dr. Baruch Blumberg, who created the first vaccine.

The Hepatitis B Foundation, founded in Bucks County, is the only national, nonprofit organization focused on hepatitis B.  It concentrates on hepatitis B research, disease awareness, immunizations and treatment initiatives.

They have a large Philadelphia public health awareness and education campaign, free screening initiative and assist patients with finding care providers. There is also a Hep B United Philadelphia Coalition with over 75 coalition partners and a partnership with the CDC.

Hepatitis B is the most common serious liver infection in the world; 50 to 100 times more infectious than HIV; and affects 1.4 to 2 million Americans. Chronic infections have a one in four chance to develop hepatocellular carcinoma or liver failure and is preventable and treatable.

Asians, especially those new to the United States, are among the highest risk groups for developing hepatitis B. They are the second fastest growing population in Philadelphia behind Hispanics. Nearly one in 10 foreign-born Asian and Pacific Islander Americans have a chronic hepatitis B virus infection. But they are not the only group at risk.

The CDC has specific guidelines for testing. All persons born in regions of high and intermediate HBV endemicity, IV drug users, men with male sexual partners, immunosuppressed patients, people with elevated liver function tests, blood product donors, hemodialysis patients, pregnant women, infants born to HBsAg positive mothers, people living with infected patients, people who engage in needle sharing, individuals with sexual contact with hepatitis B surface antigen positivity and HIV-positive individuals should be tested and treated appropriately. And all US-born citizens not vaccinated as an infant should be tested.

This is an extensive list of individuals who are risk and, therefore, many more individuals should be tested than are currently being tested.  In spite of this, many patients at risk in the Philadelphia region are not being screened for hepatitis B. This means that patients who are chronically infected are not being diagnosed and patients who have been exposed are not being vaccinated, putting them at greater risk. Under the Patient Protection and Affordable Care Act, hepatitis B vaccination is covered. The obvious question is — why aren’t all patients at risk being screened?

The hepatitis B foundation has tirelessly tried to get the word out to both the physician community as well as the patients at risk to increase the amount of screening and improve access to vaccination and treatment. Although there has been some improvement, many patients are still being missed. Of course, funding is also an issue for these efforts. This is a problem for almost every nonprofit organization. In spite of the problems with the economy, there should always be funds for such life-saving and truly altruistic and life saving foundations such as the Hepatitis B foundation, American Cancer Society, etc.

In this particular case, the Hepatitis B Foundation is a local oragnization that is deserving of special attention by our healthcare professionals. The least we can do is to improve our efforts to screen all patients at risk and therefore save lives and encourage the many volunteers in this organization. The Philadelphia County Medical Society strongly supports improved hepatitis B screening, vaccination and treatment, and supports the Hepatitis B foundation.


Curtis T. Miyamoto, MD is president of the Philadelphia County Medical Society.


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