The objective of the Jade Ribbon Campaign is twofold: (1) to eradicate HBV worldwide; and (2) to reduce the incidence and mortality associated with liver cancer.
Considered to be the essence of heaven and earth, Jade is believed in many Asian cultures to bring good luck and longevity while deflecting negativity. Folded like the Chinese character "人" (ren) meaning "person" or "people", the Jade Ribbon symbolizes the spirit of the campaign in bringing the Asian and global community together to combat this silent epidemic.
Outreach efforts
Since the campaign's founding, the Asian Liver Center (ALC) has been spearheading the Jade Ribbon Campaign through public service announcements in various media such as newspapers, magazines, TV, radio, billboard, and buses targeting communities with large API populations. The ALC also holds numerous seminars for health professionals and the public, cultural fairs, conferences, and HBV screening/vaccination events.[3]
3 For Life
One of the ALC's largest achievements was the founding of 3 for Life in September 2004, a pilot program in collaboration with the San Francisco Department of Public Health that provided low-cost hepatitis A and B vaccinations and free hepatitis B testing to the San Francisco community every first and third Saturday of the month for a year. The program tested and vaccinated over 1,200 people—50% of which were found to be unprotected against HBV and 10% to be positive for HBV. Upon the completion of 3 for Life in September 2005, the ALC currently is working on plans to launch a similar screening/vaccination program to service the large API population in Los Angeles.[4]
LIVERight
The Answer to Cancer (A2C) run was founded by Adrian Elkins, a 20-year-old student at Southern Oregon University who was diagnosed with liver cancer in 2002. Had he known during his childhood that his ethnicity and chronic hepatitis B infection increased his chance of developing liver cancer by 100%, he would have been regularly monitored for liver damage. He had no idea that hepatitis B – a disease he contracted at birth in Calcutta, India – causes 80% of the world's liver cancer cases. Adrian battled his disease for ten months, working tirelessly to organize an event to raise money for liver cancer research. Adrian saw the first-ever A2C run take place on August 8, 2003. Thanks to the generous support of friends, families and numerous companies, the 2003 Answer to Cancer Race was able to raise more than $20,000 for three charities and reach out to more than 240 participants. Adrian died only eight days after this first race.[citation needed]
Adrian Elkins inspired the Asian Liver Center to start LIVERight on the go!, a 5K Run/Walk to raise awareness about hepatitis B and liver cancer in the Asian Pacific Islander community.[citation needed]
On April 30, 2005 in San Francisco's Golden Gate Park, the Asian Liver Center and the Answer to Cancer Foundation hosted LIVERight, the first 5K run/walk to raise awareness about hepatitis B and liver cancer.[citation needed]
On November 11, 2006, the 2nd annual LIVERight was held at Stanford's Sand Hill Fields. The community event had 700 registered participants, 100 volunteers, and raised over $135,000.
The 3rd Annual LIVERight 5k Run/Walk took place on May 10, 2008. It had over 600 registered runners and raised over $100,000 to fight hepatitis B and liver cancer.
The 4th Annual LIVERight 5k Run/Walk was held on Saturday, May 2, 2009 at Golden Gate Park in San Francisco, California. The over 400 runners raised over $100,000 to fight liver cancer and hepatitis B.
The goal of LIVERight was not only to raise money to support ALC's outreach efforts, but more importantly to educate and increase awareness of this pressing public health issue. Educational displays, informational booths and course signs were unique and significant components to the event. The education allowed participants to learn more about hepatitis B prevention and treatment, as well as hear the real stories about the lives lost and won to liver cancer.[5]
Jade Ribbon Campaign reusable bag
99 Ranch Market and the Asian Liver Center at Stanford University joined together to create the Jade Ribbon reusable shopping bag—an environmentally-friendly way to raise awareness about an urgent health concern for Asians. The eco-friendly reusable shopping bag, along with educational materials on hepatitis B, was made available from July 24 to August 31 in 2009 with every donation of two dollars or more to the Jade Ribbon Campaign to support hepatitis B education and outreach.[6]
Team HBV collegiate chapters
Team HBV is the official chapter of the Asian Liver Center at Stanford University and is currently the only student-run, non-profit, collegiate organization in the United States that addresses the high incidence of hepatitis B and liver cancer in the Asian and Pacific Islander community.[7]
The mission of Team HBV is to advance the goals of the ALC at college campuses across the United States to help fight hepatitis B and liver cancer worldwide.
Adopted by the Asian Liver Center in Fall 2006, the first official Team HBV chapters were founded in Cornell, Duke, and University of California, Berkeley. There are now Team HBV Collegiate Chapters at Duke, Cornell, UC Berkeley, Stanford, Brown, UC Davis, Harvard, Wesleyan, the University of Pennsylvania, Rice, Wesleyan, and UC San Diego, and international chapters at Jiaotong University in China, Central University for Nationalities, Tsinghua University, and Minzu University of China.
The Inaugural Team HBV Collegiate Conference, organized by the Asian Liver Center, brings together individuals representing Team HBV chapters worldwide, Jade Ribbon Campaign advocates, and hepatitis B and liver cancer experts. The conference provides a professional forum for Team HBV chapters to share insights, best practices, and strategies to advance hepatitis B outreach, education, and communication. The first Team HBV Collegiate Conference took place November 2009 at Stanford University.
San Francisco Hep B Free
San Francisco Hep B Free is a citywide campaign to turn San Francisco into the first hepatitis B free city in the nation. This unprecedented 2-year-long campaign beginning April 2007 will screen, vaccinate and treat all San Francisco Asian and Pacific Islander (API) residents of hepatitis B (HBV) by providing convenient, free or low-cost testing opportunities at partnering health facilities and events.
The SF Hep B Free campaign puts San Francisco at the forefront of America in fighting chronic hepatitis. It will be the largest, most intensive healthcare campaign for Asian and Pacific Islanders in the US This initiative has received national attention and is being looked to as a model by the California legislature. Mayor Gavin Newsom, Assemblywoman Fiona Ma and Supervisor Ed Jew are leading the effort with more than 50 healthcare and Asian Pacific Islander organizations. The SF Board of Supervisors and SF Health Commission have passed unanimous resolutions supporting SF Hep B Free.
Cal Hep B Free
Cal Hep B Free is a student-led, not-for-profit health promotion pilot program launched on September 15, 2008 at the University of California, Berkeley. Supported by numerous student organizations on campus and endorsed by Vice Chancellor of Student Affairs Harry Le Grande, City of Berkeley Public Health Division, and California Assemblywoman Fiona Ma, the major student-initiated campaign effort brings together university students, faculty, and administration at UC Berkeley in an effort to screen, vaccinate, and treat high-risk ethnic groups, particularly individuals of Asian and Pacific Islander (API), Middle Eastern, Eastern European, Russian, and African descent for hepatitis B (HBV). The Cal Hep B Free campaign will allow UC Berkeley to join San Francisco Hep B Free, the largest healthcare campaign in the US to target APIs in the US, at the forefront of America in fighting chronic hepatitis B.
The slogan for Cal Hep B Free is: B SMART, B TESTED, B FREE! and outlines the specific objectives of the campaign:
B SMART: Dispel misconceptions and create campus awareness about the health risks of HBV and the importance of screening for HBV.
B TESTED: Promote routine hepatitis B screenings and assist and direct students, faculty, and staff to campus and other local sites where they may obtain free or low-cost screenings.
B FREE: Design and implement a unique, coalition-partnership model that involves campus and local entities to maximize awareness and sustainability. Knowledge is power and can prevent what you don't know from killing you!
Erik's DeliCafe Partnership
JoinJade campaign at Stanford University partnered with three Erik’s DeliCafe locations to promote hepatitis B and liver health awareness in Santa Clara County, where an estimated 31,273 people are living with chronic hepatitis B. The collaboration aimed to promote testing, as diagnosis and regular monitoring significantly reduce a chronic carrier’s chance of developing liver cancer.[8]
Franchise owners Mayank and Ambika Agrawal distributed awareness inserts to 5,000 customers between July 15-July 28, 2019, in recognition of World Hepatitis Day. The owners also helped sponsor scholarships for students to attend the Annual Youth Leadership Conference on Asian and Pacific Islander Health.[8]
International efforts
Qinghai Project
Home to a large population of ethnic minorities of low socioeconomic status, the Qinghai province is a remote, often neglected, rural region of China with a high prevalence of chronic hepatitis B. Since many children 5 years of age and older in Qinghai were not vaccinated against the hepatitis B virus at birth, a private-public partnership was formed between the Ping and Amy Chao Foundation, the ZeShan Foundation, the Asian Liver Center at Stanford University, the China Center for Disease Control and Prevention, the Chinese Foundation for Hepatitis Prevention and Control, and the Qinghai government. Using the existing provincial China CDC structure, this private-public partnership in Qinghai resulted in a unique two-part school-based immunization program to educate and provide free Hep B vaccination for all children in kindergarten and grade school within the region.[9][10]
Between 2006 and 2008, this program demonstrated the feasibility and successful implementation of:
A province-wide catch-up vaccination program that reached 600,000 children in 2,200 schools, and
A hepatitis B education program incorporated into the school curriculum.
Impact: The success of this large scale province-wide demonstration program led the Chinese government to announce the adoption of a new policy beginning in 2009 to provide free catch-up hepatitis B vaccination for all children in China under the age of 15 who have not been vaccinated.
Prevalence and risks for Asians and Pacific Islanders
While 0.3% of the United States population has chronic hepatitis B infection, APIs make up more than half of the 1.3-1.5 million known hepatitis B carriers. Depending on the country of origin, 5-15% of foreign born APIs in the US are hepatitis B carriers. In some Pacific Rim countries, as many as 10-20% of the population are hepatitis B carriers.
Despite the availability of the hepatitis B vaccine, vaccination rates outside the US are low and hepatitis B remains a global health problem. Therefore, many children worldwide remain unvaccinated and many adults may be chronic carriers. The World Health Organization (WHO) estimates that there are 350-400 million people with chronic hepatitis B and many are not even aware of their condition.[11][12] Although most hepatitis B carriers have no symptoms, they can still transmit the infection and develop liver cancer.
Reasons for lack of diagnosis
The danger of hepatitis B lies in its silent transmission and progression. Many chronic hepatitis B carriers are asymptomatic (have no symptoms) and feel perfectly healthy. Chronically infected individuals may exhibit normal blood tests for liver function and be granted a clean bill of health. The diagnosis cannot be made without a specific blood test for the presence of the hepatitis B surface antigen (HBsAg), a marker for chronic infection. Since the detection of hepatitis B is so easily missed, even by doctors, it is also up to the patient to specifically request the HBsAg test. Early detection not only benefits the person tested, but prevents infection from being passed silently from one child to another, and from one generation to another.
In addition, misconceptions about the endemic nature of hepatitis B in the API population and the efficacy of US vaccination programs has led many individuals and health-care providers to overlook the need for testing for APIs.
Transmission
Most APIs are infected by HBV at birth by their carrier mothers (perinatal infection). Individuals who are infected at birth can develop liver cancer at age 35 or earlier. Also, individuals infected at birth will carry the virus for life, regardless of future vaccination. Transmission is also common during early childhood through direct contact with blood of infected individuals, occurring from contact between open wounds, sharing contaminated toothbrushes or razors, or through contaminated medical/dental tools. Hepatitis B can also be transmitted by blood transfusions, sharing or reusing needles for injection or tattoos, and unprotected sex.
Common misconceptions
Contrary to common misconceptions
Hepatitis B is not transmitted through food/water.
Hepatitis B is not transmitted through casual contact, such as hugging or shaking hands.
Hepatitis B is not transmitted through kissing, sneezing, or coughing.
Hepatitis B is not transmitted through breastfeeding.
Vaccination does not help individuals who are already infected with hepatitis B.
Mortality risks
Without appropriate management and screening, one in four hepatitis B infected individuals (25%) will die from liver cancer or cirrhosis (liver damage leading to scarring and eventually death from liver failure). Some develop cancer as early as 30 years of age. Every year, approximately one million people worldwide die from the disease because they are not diagnosed before the point where current treatment can be effective. Because so many chronically infected individuals feel perfectly healthy even with early liver cancer, the disease can progress without the carrier even knowing. When symptoms do appear, it is often only at the late stages of the disease. All people with chronic hepatitis B infection, whether they feel healthy or sick, are at risk for developing liver cancer or cirrhosis. Finding the cancer when it is small by regular screening remains the best chance of surviving liver cancer.
Hepatitis B is one of the largest health threats for Asians and Pacific Islanders. All individuals of Asian descent should request the hepatitis B surface antigen test (HBsAg) to identify infection. Also, individuals should request the hepatitis B surface antibody test (HBsAb) to identify immunity. 5%-10% of those vaccinated do not develop the antibodies and are not protected. The only way to prevent deaths from liver cancer is to identify chronic HBV individuals early enough for treatment.
Statistics
Global statistics
350-400 million people worldwide have chronic HBV infection (compare with 40 million living with HIV)[11][13]
Under-reporting of both acute and chronic HBV infection.
Federal ACIP guidelines recommending that universal infant vaccination against HBV at birth, regardless of the mother's HBV status were implemented in November 1991.[17]
China statistics
1/3 of the world's chronic HBV patients live in China.[18]
130 million Chinese (1 in 10) have chronic HBV.[19]
In one day, 3 times more people die of HBV than the entire SARS outbreak.
In two years, fewer than 10 people have died from avian flu in China.[20][21]
HBV kills 500,000 mainland Chinese each year (50% of global deaths).[19]
Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pain, and diarrhea. Hepatitis is acute if it resolves within six months, and chronic if it lasts longer than six months. Acute hepatitis can resolve on its own, progress to chronic hepatitis, or (rarely) result in acute liver failure. Chronic hepatitis may progress to scarring of the liver (cirrhosis), liver failure, and liver cancer.
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection period, people often have mild or no symptoms. Early symptoms can include fever, dark urine, abdominal pain, and yellow tinged skin. The virus persists in the liver, becoming chronic, in about 70% of those initially infected. Early on, chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis. In some cases, those with cirrhosis will develop serious complications such as liver failure, liver cancer, or dilated blood vessels in the esophagus and stomach.
Hepatitis D is a type of viral hepatitis caused by the hepatitis delta virus (HDV). HDV is one of five known hepatitis viruses: A, B, C, D, and E. HDV is considered to be a satellite because it can propagate only in the presence of the hepatitis B virus (HBV). Transmission of HDV can occur either via simultaneous infection with HBV (coinfection) or superimposed on chronic hepatitis B or hepatitis B carrier state (superinfection).
In immunology, seroconversion is the development of specific antibodies in the blood serum as a result of infection or immunization, including vaccination. During infection or immunization, antigens enter the blood, and the immune system begins to produce antibodies in response. Before seroconversion, the antigen itself may or may not be detectable, but the antibody is absent. During seroconversion, the antibody is present but not yet detectable. After seroconversion, the antibody is detectable by standard techniques and remains detectable unless the individual seroreverts, in a phenomenon called seroreversion, or loss of antibody detectability, which can occur due to weakening of the immune system or decreasing antibody concentrations over time. Seroconversion refers the production of specific antibodies against specific antigens, meaning that a single infection could cause multiple waves of seroconversion against different antigens. Similarly, a single antigen could cause multiple waves of seroconversion with different classes of antibodies. For example, most antigens prompt seroconversion for the IgM class of antibodies first, and subsequently the IgG class.
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute form as a recent infection with relatively rapid onset, or in chronic form, typically progressing from a long-lasting asymptomatic condition up to a decompensated hepatic disease and hepatocellular carcinoma (HCC).
Hepatitis B is endemic in China. Of the 350 million individuals worldwide infected with the hepatitis B virus (HBV), one-third reside in China. As of 2006 China has immunized 11.1 million children in its poorest provinces as part of several programs initiated by the Chinese government and as part of the Global Alliance for Vaccines and Immunization (GAVI). However, the effects of these programs have yet to reach levels of immunization that would limit the spread of hepatitis B effectively.
Liver cancer, also known as hepatic cancer, primary hepatic cancer, or primary hepatic malignancy, is cancer that starts in the liver. Liver cancer can be primary in which the cancer starts in the liver, or it can be liver metastasis, or secondary, in which the cancer spreads from elsewhere in the body to the liver. Liver metastasis is the more common of the two liver cancers. Instances of liver cancer are increasing globally.
Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.
San Francisco Hep B Free is a citywide campaign to turn San Francisco into the first hepatitis B free city in the United States. This unprecedented campaign began in 2007, with the objective to screen, vaccinate, and treat all San Francisco Asian and Pacific Islander (API) residents for hepatitis B by providing convenient, free or low-cost testing opportunities at partnering health facilities and events.
Hepatitis B is an infectious disease caused by the Hepatitis B virus (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
LIVERight is the first 5K run/walk to raise awareness about hepatitis B and liver cancer. The goal of LIVERight was not only to raise money for outreach efforts, but more importantly to educate and increase awareness of this pressing public health issue. Educational displays, informational booths and of course signs were unique and significant components to the event. The education allowed participants to learn more about hepatitis B prevention and treatment, as well as hear the real stories about the lives lost and won to liver cancer.
The 2009 Gujarat hepatitis B outbreak was a cluster of hepatitis B cases that appeared in Modasa, northern Gujarat, India in 2009. Over 125 people were infected and up to 49 people died. Several doctors were investigated and arrested after the outbreaks.
Hepatitis B virus (HBV) is a partially double-stranded DNA virus, a species of the genus Orthohepadnavirus and a member of the Hepadnaviridae family of viruses. This virus causes the disease hepatitis B.
cccDNA is a special DNA structure that arises during the propagation of some viruses in the cell nucleus and may remain permanently there. It is a double-stranded DNA that originates in a linear form that is ligated by means of DNA ligase to a covalently closed ring. In most cases, transcription of viral DNA can occur from the circular form only. The cccDNA of viruses is also known as episomal DNA or occasionally as a minichromosome.
The Asian Liver Center is a non-profit organization at Stanford University, United States, that researches the high incidence of hepatitis B and liver cancer in Asians and Asian Americans. The Asian Liver Center (ALC) was founded in 1996 to spearhead educational outreach and advocacy efforts in the areas of hepatitis B and liver cancer prevention and treatment, serves as a resource for both the general public and health practitioners, and implements clinical and research programs.
The transmission of hepadnaviruses between their natural hosts, humans, non-human primates, and birds, including intra-species host transmission and cross-species transmission, is a topic of study in virology.
Robert Palmer Beasley was an American physician, public health educator and epidemiologist whose work on hepatitis B involved extensive investigations in Taiwan. That work established that hepatitis B virus (HBV) is a primary cause of liver cancer and that hepatitis B virus is transmitted from mother to infant during childbirth. Beasley and his colleagues also proved that HBV mother-to-infant transmission is preventable by at-birth vaccination. Due to this work, the World Health Assembly designated HBV as the seventh global vaccine in 1992. He later became the author of HBV immunization policies for the World Health Organization.
The woolly monkey hepatitis B virus (WMHBV) is a viral species of the Orthohepadnavirus genus of the Hepadnaviridae family. Its natural host is the woolly monkey (Lagothrix), an inhabitant of South America categorized as a New World primate. WMHBV, like other hepatitis viruses, infects the hepatocytes, or liver cells, of its host organism. It can cause hepatitis, liver necrosis, cirrhosis, and hepatocellular carcinoma. Because nearly all species of Lagothrix are threatened or endangered, researching and developing a vaccine and/or treatment for WMHBV is important for the protection of the whole woolly monkey genus.
The epidemiology of hepatitis D occurs worldwide. Although the figures are disputed, a recent systematic review suggests that up to 60 million individuals could be infected. The major victims are the carriers of the hepatitis B surface antigen (HBsAg), who become superinfected by the HDV, and intravenous drug users who are the group at highest risk. The infection usually results in liver damage ; this is most often a chronic and severe hepatitis rapidly conducive to cirrhosis.
George Lau is a specialist in gastroenterology and hepatology, currently the founder and chairman of the Humanity and Health Medical Group in Hong Kong.
↑ Chang; Sue, E; Zola, J; So, SK (2009). "3 for Life: a model pilot program to prevent hepatitis B virus infection and liver cancer in Asian and Pacific Islander Americans". American Journal of Health Promotion. 23 (3): 176–81. doi:10.4278/ajhp.071025115. PMID19149422. S2CID25804585.
↑ Chen Jonathan J (2012-06-01). "A model program for hepatitis B vaccination and education of schoolchildren in rural China". International Journal of Public Health. 57 (3): 581–588. doi:10.1007/s00038-011-0289-x. PMID21845405. S2CID9637008.
↑ Estimated expected births to HBsAg-positive women: United States, 2002. Draft of 2005 ACIP HBV Guidelines.
↑ Chang; Lin, SY; Sue, E; Bergin, M; Su, J; So, SK (2007). "Building partnerships with traditional chinese medicine practitioners to increase hepatitis B awareness and prevention". Journal of Alternative and Complementary Medicine. 13 (10): 1125–7. doi:10.1089/acm.2007.0655. PMID18166125.
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