Asian American Pacific Islanders (AAPI) are disproportionately affected by hepatitis, particularly chronic hepatitis B virus (HBV) infection. This infection is a blood-borne pathogen that is transmitted from either infected mother to child during pregnancy or at birth, percutaneously, or sexually. While blood transfusion is another mode of infection, screening donors by HBV nucleic acid testing has reduced risk to only 1 in 1 million transfusions.
It is estimated that there are about 20,000 new cases of HBV infection each year in the United States. This leads to chronic infection in about 5% of adults and up to 10-60% in infants not given HBV immune globulin and vaccinated at birth. Routine vaccination for HBV in infants has reduced the incidence of disease and will lead to many fewer cases in the future.
The prevalence of chronic HBV infection is significantly higher among AAPI populations compared to other racial and ethnic groups in the United States. It is estimated that over 50% of the global population of individuals with chronic HBV infection resides in the Asia-Pacific region, which includes many countries with large AAPI populations.
To address these disparities, various initiatives have been implemented to promote hepatitis B awareness, screening, and vaccination within AAPI communities. These efforts include community outreach programs, culturally sensitive educational materials, and partnerships between healthcare providers and community organizations.
Multiple tests are available for the diagnosis of acute and chronic hepatitis B virus (HBV) infection as well as for evaluating immune status. Selecting the most appropriate serologic and antigenic markers along with properly interpreting results can be complex and confusing, especially for the non-specialist. Laboratory guidance and interventions to assist with optimal test selection and interpretations can reduce unnecessary or incomplete testing as well as reduce the risk of diagnostic errors. The module, Screening and Diagnosis of Hepatitis B Virus (HBV) Infection , authored by Ron B. Schifman, MD, FCAP is available to assist with optimizing test ordering and reporting practices involving markers used for initial evaluation of HBV infection based on specific clinical indications. This module will not address hepatitis B testing for managing and treating patients with known HBV infections.
Overall, pathologists play a critical role in the diagnosis, management, and prevention of hepatitis. The pathologist's expertise and the CAP's resources can have a positive impact on public health efforts, especially those affecting AAPI communities. For more recommendations on screening and testing for chronic HBV, view the CDC's recent report.