Podcast Summary
Awareness of potential risks and stigma as a mother: Dr. Sue Wong, despite living with hepatitis B for decades, was not significantly impacted by stigma. However, becoming a mother made her aware of the risks and lifelong challenges faced by those with the virus. Now, she advocates for eliminating stigma and ensuring access to testing and treatment.
Despite being diagnosed with hepatitis B as a college student and carrying the virus for decades, Dr. Sue Wong's personal and professional life were not significantly impacted by the stigma and discrimination often associated with the disease. However, when she became a mother, she became acutely aware of the potential risk of passing the virus to her children and the lifelong challenges faced by those living with hepatitis B. As a physician and advocate, she now works to eliminate the stigma surrounding viral hepatitis and ensure access to testing and treatment for all. The experiences of discrimination faced by those with hepatitis B in education and employment highlight the importance of raising awareness and reducing stigma to ensure equal opportunities for all.
A physician's personal journey to understanding Hep B and patient care: Healthcare professionals and patients must collaborate, considering both medical outcomes and emotional experiences, to provide effective and holistic care for Hep B patients.
Healthcare professionals and patients must work together to address the complexities of diseases like hepatitis B (Hep B) and improve overall patient care and quality of life. Dr. Wong, a physician who served the Chinese community in Chinatown, learned firsthand about the prevalence of Hep B and the challenges patients faced in accessing care. She advocated for increased screening and treatment, but it wasn't until she shared her own experience of living with Hep B that she truly understood the emotional impact of the disease. This personal connection led her to see the importance of considering patients' experiences beyond just medical outcomes. By combining scientific knowledge with patient stories, we can create more effective and holistic approaches to healthcare and work towards eliminating the suffering caused by Hep B.
Patient autonomy in healthcare decisions: Respect patient choices, listen to their wishes, and avoid imposing societal or gender-based expectations when recommending treatments for hepatitis b or other health concerns.
During our discussion on hepatitis b, we delved into the importance of patient autonomy and the potential challenges patients face in making informed decisions about their own health. While discussing endometriosis in a previous episode, we touched upon the issue of physicians not fully considering patients' wishes when recommending treatments. This issue can also apply to decisions regarding hysterectomies or other reproductive procedures. We emphasized the significance of healthcare professionals listening to their patients and respecting their choices, rather than imposing societal or gender-based expectations. Moving on to the topic at hand, hepatitis b is the second hepatitis virus we've covered, belonging to the Hepadniviridae family, which specifically affects the liver. We also mentioned hepatitis d in relation to hepatitis b due to their interplay. Hepatitis b is a significant global health concern, with various transmission routes and potential complications. Understanding the biology, transmission, symptoms, and prevention methods of hepatitis b is crucial for maintaining liver health and reducing its spread. Stay tuned as we explore this topic further.
Hepatitis B: A Partially Double-Stranded DNA Virus with High Infectivity: Hepatitis B is a partially double-stranded DNA virus that can cause chronic infection and cancer. It's highly infectious, with up to 90% of babies born to mothers with chronic Hepatitis B becoming infected if not treated, compared to only 6% for Hepatitis C.
Hepatitis B is a partially double-stranded DNA virus that causes chronic infection in a significant portion of those infected, particularly in infants born to mothers with chronic hepatitis B. This virus, which primarily infects the liver cells or hepatocytes, is transmitted through blood and sexual contact, and can persist in the environment for several days. Hepatitis B is unique among human viruses in its use of a reverse transcriptase to replicate its genome, allowing it to integrate into our DNA and potentially cause chronic infection and cancer. Vertical transmission of Hepatitis B occurs at much higher rates than Hepatitis C, with estimates ranging from 40 to 90% of babies born to mothers with chronic Hepatitis B becoming infected if not treated, compared to only 6% of people with Hepatitis C transmitting the virus to their offspring. The high infectivity of Hepatitis B is likely a major contributor to this difference. Other viruses with partially double-stranded DNA genomes exist, specifically in animals, and this feature is a unifying characteristic of hepatoviruses.
Hepatitis B transmission during childbirth: Newborns are most at risk for chronic Hepatitis B infection due to transmission during childbirth, and prevention efforts are crucial to reduce the risk of fibrosis and liver cancer.
Hepatitis B transmission does not occur transplacentally, but rather during childbirth, whether vaginal or cesarean section. The incubation period of the infection can range from 30 days to 6 months, and while some people may experience symptoms such as jaundice, nausea, vomiting, and abdominal pain during an acute infection, many do not show any symptoms at all. Chronic infection, which is defined as the persistence of the Hepatitis B surface antigen for a period of at least 6 months, is most common in infants infected at birth and carries a significant risk of progression to fibrosis and liver cancer. The likelihood of a chronic infection establishing varies inversely with age at exposure, making it crucial to prioritize prevention efforts for newborns. The transmission dynamics and health implications of hepatitis B make it a significant public health concern.
Infants have a higher risk of chronic hepatitis B infection and liver cancer: Infants have a longer immune tolerant phase, increasing their risk of chronic hepatitis B infection and ultimately liver cancer, while adults have a lower risk but face more severe consequences if infected
Infants have a higher risk of developing a chronic hepatitis B infection compared to adults, with 90% of infected infants likely to develop chronic infection compared to 2-5% for adults. Although the risk is lower for adults, the consequences of a chronic hepatitis B infection are more severe, with up to 15-40% of those with chronic infection developing liver cancer. The reason for this difference is not fully understood but is believed to be related to the different phases of the chronic infection. In the immune tolerant phase, the virus integrates into the genome and causes minimal damage. In the immune active phase, the body recognizes the virus, mounts an immune response, and causes inflammation and damage to the liver. The longer someone is in this phase, the greater their risk of cancer. Infants tend to have a longer immune tolerant phase, making them more likely to develop chronic infection and ultimately liver cancer.
Immune response to hepatitis B infection: Some people clear Hepatitis B and gain immunity, while others establish a tolerant relationship, increasing chronic infection risk. Cross-genotypic immunity applies, but chronic carriers can get Hepatitis D. No cure, but treatments manage symptoms and reduce inflammation.
The immune response to hepatitis B infection varies greatly between individuals. While some people are able to clear the virus and develop lifelong immunity, others, particularly those infected during pregnancy or those with chronic infection, may establish a tolerant relationship with the virus, leading to a higher risk of chronic infection. Immunity to hepatitis B is believed to be cross-genotypic, meaning that protection against one genotype also applies to other genotypes. However, individuals with chronic hepatitis B infection can become infected with hepatitis D, a unique virus that requires the presence of hepatitis B to replicate. While there is a vaccine for hepatitis B, there are currently no cures for the virus, and treatments such as pegylated interferon and antivirals are used to manage symptoms and reduce inflammation. The severity of hepatitis B infection and the need for treatment can depend on the individual's phase of infection.
The hepatitis B virus has ancient origins and likely infected various animals including dinosaurs and early humans.: The hepatitis B virus, part of the hepadnaviridae family, likely originated around 820,000 years ago and spread to humans around 12,000 to 16,000 years ago.
The origins and evolution of the hepatitis B virus have been a topic of ongoing research and debate, with new hypotheses and discoveries continually shaping our understanding of this ancient and widespread virus. The hepatitis B virus is part of the hepadnaviridae family, which is much larger and older than previously thought, with estimates suggesting it originated around 820,000 years ago. The virus likely infected various animals, including dinosaurs and early humans. The most recent common ancestor of the hepatitis B virus is now believed to have emerged around 12,000 to 16,000 years ago in Eurasia, and it spread from there to Africa, Europe, and the Americas before the Neolithic Revolution. The virus's transmission characteristics suggest that it may have spread before humans began settling in larger groups and farming. Despite ongoing research, the origins and evolution of the hepatitis B virus remain a complex and fascinating area of study.
Ancient origins and evolution of hepatitis B virus: The hepatitis B virus has a long history in human populations, leading to multiple genotypes and changing prevalence. Its origins are unclear, but it may have been recognized in ancient medical texts as jaundice, with hepatitis A possibly more common in outbreaks due to fecal-oral transmission.
The hepatitis B virus has ancient origins and has been present in human populations for thousands of years. It can be transmitted in various ways, including at birth, through sexual contact, blood, and violent interactions. The virus's long presence in human populations has led to the emergence of multiple genotypes or lineages, some of which have gone extinct or shifted in prevalence. The understanding of the origins and evolutionary history of the virus can provide insights into current epidemiological patterns and potential future developments. The virus was likely recognized and described in ancient medical texts under the term jaundice, but it's difficult to determine which specific hepatitis virus was causing outbreaks described in history. The hepatitis A virus, which is transmitted fecal-orally, may have been more commonly responsible for outbreaks in crowded or unsanitary conditions. However, hepatitis B and other viruses transmitted through blood or bodily fluids could also have caused outbreaks, especially with the increased use of needles in the mid-19th century.
Link between yellow fever vaccine and hepatitis outbreak goes unnoticed for decades: Despite the link between yellow fever vaccine and hepatitis outbreak being identified during WW2, the technology to test blood supply for hepatitis B wasn't available, leaving people with a difficult choice between risking infection or death from blood loss.
The link between the yellow fever vaccine and the resulting hepatitis outbreak was not recognized for decades due to the common occurrence of hepatitis in overcrowded unsanitary areas. This made it difficult to identify the vaccine itself as the cause. During World War 2, after receiving the yellow fever vaccine, which contained human serum, over 50,000 US army personnel came down with hepatitis, with estimates suggesting over 330,000 infections in total. A British doctor named F.O. McCallum hypothesized that the hepatitis was transmitted through blood products and proposed the distinction between hepatitis A and B. This recognition led to further research into the clinical differences between the two forms of hepatitis and the importance of identifying different routes of transmission. However, despite this knowledge, the technology to test the blood supply for hepatitis B was not yet available, leaving people with a difficult choice between receiving potentially contaminated blood or risking death from blood loss. Progress in identifying the hepatitis B agent stalled in the 1950s and 1960s due to the infancy of the field of virology and the lack of advanced technology for genetic testing.
Identifying the elusive hepatitis B virus: Despite ethical concerns, researchers worked to understand and prevent the spread of hepatitis through unconventional methods. The discovery of the hepatitis B virus came from an unlikely team.
The identification of the hepatitis B virus was a challenging and complex process due to the virus's difficult lab characteristics and the lack of clear understanding of its nature. During this time, unethical experiments, such as the Willowbrook State School hepatitis studies, were conducted in an attempt to understand and prevent the spread of hepatitis. These studies, while reducing the incidence of hepatitis, raised significant ethical concerns and led to stricter regulations in medical research and consent. Despite the efforts of many researchers, the identification of the hepatitis B virus remained elusive, with the team that ultimately made the discovery being unlikely candidates.
Unexpected discoveries in science: Important findings can emerge from unexpected places and collaboration is crucial for scientific progress
Scientific discoveries often don't follow a neat, linear path. The discovery of Hepatitis B is a great example, as it was not made by researchers specifically looking for it, but rather by a team searching for blood plasma protein polymorphisms. This anecdote illustrates that important findings can emerge from unexpected places and that the scientific process is not always as orderly as we may think. Meanwhile, Dr. Baruch Bloomberg's work focused on understanding how genetics, human behavior, and the environment contribute to disease. He was particularly interested in polymorphisms, which led him to investigate new blood plasma protein polymorphisms that could be associated with disease susceptibility. Using an unconventional approach, Bloomberg and his team identified a new protein, which they named the agg protein. Although it wasn't a strong marker for disease susceptibility, it showed that their technique could be effective in discovering new serum proteins. Later, Bloomberg collaborated with Dr. Harvey Alter, who would later be instrumental in identifying the Hepatitis C virus. This partnership demonstrates that scientific progress often relies on collaboration and the exploration of various research areas.
Discovering the Hepatitis B Virus: Baruch Blumberg and Daniel M. Alter discovered the hepatitis B virus in the 1960s, initially met with skepticism, but their findings sparked global interest and led to a crucial step in understanding and preventing the spread of this disease.
The discovery of the hepatitis B virus by Baruch Blumberg and Daniel M. Alter in the 1960s was a groundbreaking moment in medical history, despite initial skepticism and rejection from the scientific community. Blumberg, intrigued by why some people developed an immune response after a blood transfusion, discovered a new protein they named the "Australia antigen." Although initially thought to be a human protein, it was later found to be the hepatitis B virus. They identified its prevalence in certain populations and noticed that it seemed to be transmitted through blood transfusions. Despite facing criticism due to their lack of background in hepatitis research, they published a paper in 1967 that sparked global interest in the possibility of finding the long-sought-after hepatitis B virus. With post-transfusion hepatitis rates reaching as high as 30%, the discovery of the hepatitis B virus was a crucial step in understanding and preventing the spread of this disease. However, confirmation from other researchers was still necessary to solidify their findings.
Discovery of Hepatitis B Virus and its Impact: The discovery of Hepatitis B Virus led to the development of a vaccine, reducing its spread, but also caused discrimination against carriers. Continued research aims to understand transmission and improve testing, vaccines, and reducing stigma.
The discovery of the hepatitis B virus in the late 1960s revolutionized the medical field by enabling the testing of the virus in blood products and the identification of carriers. However, this advancement also led to widespread discrimination and ostracization against those infected. The development of a hepatitis B vaccine in the 1980s, led by Maurice Hilleman and Baruch S. Blumberg, who were awarded the Nobel Prize for their work, significantly reduced the spread of the virus. Since then, research has continued on understanding transmission dynamics, developing better tests and vaccines, and recognizing the global burden of the virus. Despite these advancements, hepatitis B remains prevalent and transmission continues today. It's important to remember the history of stigma and discrimination faced by those infected and to continue efforts to reduce the negative impact on their quality of life.
Hepatitis B Disproportionately Affects Certain Regions with High Incidence and Prevalence: Despite a highly effective vaccine, 4% of the global population, mostly children, live with chronic hepatitis B. Only 10-11% of those infected know their status, and just 22% of diagnosed individuals receive treatment.
Despite approximately 4% of the world's population, or around 300 million people, living with chronic hepatitis B infection, the condition disproportionately affects certain regions, with the Western Pacific and African regions having the highest incidence and prevalence. Shockingly, only 10-11% of those infected know their status, and only 22% of diagnosed individuals are on treatment. Moreover, almost 4% of the global population infected with chronic hepatitis B, which is entirely preventable with a highly effective vaccine, are children under the age of 5. The vaccine, which is part of the universal vaccine program in over 180 countries, is 98-100% effective for 17-30 years and can prevent infection in babies if given within 12-24 hours of birth, along with IVIG. Despite these statistics, there seems to be a lack of awareness and discussion around hepatitis B, likely due to the unequal distribution of the burden.
Lack of testing and treatment for hepatitis B during pregnancy contributes significantly to the disease's high infection rates: Only 1% of pregnant people are getting tested and treated for hepatitis B, leading to a massive global problem with high infection rates. Stigma and discrimination faced by those living with the disease will be discussed in an upcoming bonus episode.
Despite having the tools to test, treat, and prevent the spread of hepatitis B, only 1% of pregnant people are getting tested and treated. This lack of access contributes significantly to the disease's high infection rates, making it a massive global problem. In an upcoming bonus episode, we will dive deeper into the stigma and discrimination faced by those living with hepatitis B and discuss efforts to address these issues. We had the privilege of speaking with Dr. Sherry Cohen, the senior vice president of the Hepatitis B Foundation, about her work and insights into the public health field. Be sure to mark your calendars for the bonus episode, coming out next Tuesday, February 1st. For more information, check out the book "Hepatitis B, The Hunt for a Killer Virus" by Dr. Brooke Blomberg and other sources we'll post on our website, thispodcastwillkillyou.com. We'd like to thank Dr. Wong for sharing her experiences and expertise, Bloodmobile for providing the music, and Exactly Right for their support. And, of course, a huge thank you to our listeners for tuning in. Stay tuned for more episodes, and remember to wash your hands!
