Hepatitis refers to an inflammation of the liver. It can have a variety of causes, including viruses. One of these is the hepatitis B virus (HBV), which causes the liver infection hepatitis B.

In the United States, hepatitis B disproportionately affects the Asian community. In fact, the American Liver Foundation estimates that hepatitis B impacts 1 in 12 Asian Americans and Pacific Islanders.

While hepatitis B is a short-term (acute) illness in some people, in others it develops into chronic hepatitis B. Over time, this can cause cirrhosis, or scarring of your liver, and even liver cancer. However, it’s possible to prevent hepatitis B through vaccination.

Read on to learn about the high prevalence of hepatitis B in the Asian community, why this is happening, and what’s being done about it. You can also explore ways to prevent and treat hepatitis B.

Experts have studied the prevalence of hepatitis B in Asian communities both inside and outside the United States.

In the United States

When researchers at the Centers for Disease Control and Prevention (CDC) assessed the prevalence of hepatitis B in the United States between the years of 2015 and 2018, they found the following:

  • The prevalence of past or present hepatitis B was highest in Asian American adults (21.1 percent) compared to the total adult population (4.3 percent).
  • The prevalence of past or present hepatitis B was higher in American adults born outside the United States (11.9 percent) than those born in the United States (2.5 percent).
  • The prevalence of hepatitis B vaccination was highest in Asian American adults (31.4 percent) compared to the total adult population (25.2 percent).

According to additional data from the CDC, about 862,000 Americans are living with chronic hepatitis B. Asian Americans account for 58 percent of these individuals, despite making up only 6 percent of the total population.

The CDC also noted that an estimated nearly 70 percent of Asian Americans were born outside the United States. According to the Department of Health and Human Services (DHHS), most Asian Americans living with chronic hepatitis B contracted HBV before arriving in the United States.

Data from the DHHS also showed that compared to white Americans:

  • Asian Americans were twice as likely to develop chronic hepatitis B between the years of 2013 and 2016
  • Asian Americans were almost eight times more likely to die from hepatitis B

Outside the United States

According to the World Hepatitis Alliance, the prevalence of hepatitis B is highest, 6.2 percent, in the Western Pacific region. This area includes:

  • China
  • Japan
  • Southeast Asia
  • the Pacific Islands

The World Health Organization (WHO) estimated that, in the Western Pacific region, 57 percent of deaths from viral hepatitis are due to complications from chronic hepatitis B or C such as cirrhosis or liver cancer. In 2016, China, Japan, and Vietnam recorded the most deaths from chronic hepatitis.

There may be several reasons why the prevalence of hepatitis B is high in Asian communities, both within the United States, and outside of it.

Outside the United States

No one reason explains why hepatitis B is so prevalent in many parts of Asia. Instead, multiple factors contribute to its prevalence, such as:

  • Asymptomatic infections. Some people that contract HBV don’t have any symptoms. Because of this, a person may not know they have an HBV infection, and the virus can be unintentionally transmitted to others.
  • Transmission route. HBV can be transmitted during birth. This is one of the most common ways the virus is transmitted in Asian communities. The CDC says that about 9 in 10 infants that contract HBV will go on to develop chronic hepatitis B.
  • Access to health care. Access to hepatitis B testing, treatment, and vaccination may be limited in some areas. This can result in underdiagnosed and untreated hepatitis B, allowing HBV to spread.
  • Education. A lack of knowledge about hepatitis B risks, symptoms, and transmission routes can contribute to the spread of the virus.
  • Stigma. Some people may be afraid of the stigma carried by hepatitis B. For example, a 2020 research review conducted mainly in Asia found that up to 20 percent of respondents feared being denied healthcare and up to 30 percent feared losing their job due to hepatitis B.

In the United States

Over the past decade, Asian Americans have been the fastest-growing racial or ethnic group in the United States. A lot of this increase is due to immigration. Immigration also plays a role in the prevalence of hepatitis B in Asian American communities.

Of those living with hepatitis B born outside the United States, a 2018 research review estimated that 58 percent immigrated from areas of Asia with a high or moderate prevalence of hepatitis B.

For example, a 2019 retrospective study of 7,272 Asian immigrants in New York City found that 13 percent tested positive for HBV. Researchers noted that many of these individuals were at an increased risk for liver cancer.

Other factors mentioned earlier are important as well. For example, access to adequate testing and treatment can still be a problem for Asian Americans in the United States.

A 2012 study examined treatment in 612 people with chronic hepatitis B. Of those studied, 99 percent were Asian American. Researchers found that only half of those that were eligible for antiviral treatment actually received it.

A 2013 survey study assessed hepatitis B testing and treatment in historically marginalized groups in the United States. Of 53,896 respondents, researchers found that:

  • only 39 percent reported being tested for hepatitis B
  • of the 1,235 individuals that had tested positive for hepatitis B, only 33.3 percent reported receiving treatment

Within the United States, knowledge about the risk of hepatitis B and how HBV is transmitted can still be low. A 2015 survey study assessed knowledge and awareness about HBV in 258 Asian American college students. It found that:

  • out of 14 questions, students answered a median of 8 correctly
  • over half of students knew that hepatitis B can lead to cirrhosis or liver cancer
  • 78 percent of students believed that hepatitis B was a hereditary condition
  • half of the students didn’t know that HBV could be contracted during delivery or through sex
  • between 13 and 26 percent believed HBV could be transmitted through the air or by sharing eating utensils

You may be wondering what doctors and public health experts are doing to address this disparity. Let’s take a look at some of the strategies they’re taking.

Vaccination

Hepatitis B is a vaccine-preventable disease. Because of this, vaccination plays a vital role in decreasing the prevalence of hepatitis B in the Asian community.

Many people contract HBV during infancy. To prevent this, the hepatitis B vaccine is recommended for all infants in the United States.

Asian American adults actually have the highest prevalence (31.4 percent) of hepatitis B vaccination in the United States, according to the CDC. For comparison, the prevalence of hepatitis B vaccination in all American adults is 25.2 percent.

Increasing the vaccination rate of infants in countries with high hepatitis B prevalence is also vital. To do this, many countries have implemented hepatitis B vaccination programs or policies.

One example of this is getting infants vaccinated against HBV quickly after birth. This can involve putting a universal vaccination policy in place for infants.

Some areas have also offered subsidies to pregnant people if they deliver in a hospital rather than at home. This increases the likelihood that healthcare professionals can give the first dose of the hepatitis B vaccine shortly after birth.

Outreach

Community outreach is a vital part of lowering hepatitis B prevalence in the Asian community. Some of the benefits of these programs include:

  • Education. Education about hepatitis B might help stop the spread of HBV. Community outreach programs can inform people about the health risks associated with hepatitis B, how HBV is transmitted, the availability of a safe and effective hepatitis B vaccine, when and where to seek testing, and potential treatment options if you’re diagnosed with hepatitis B.
  • Connections. Some outreach programs include storytelling from people living with hepatitis B. Not only can these stories raise awareness, but they also can put a human face to hepatitis B and help lower stigma.
  • Access to testing and treatment. Most programs are invested in advocating for better access to testing and treatment for hepatitis B, particularly in the most heavily impacted communities.

Some examples of outreach programs in the United States related to hepatitis B are:

You can take these steps to help prevent hepatitis B.

Vaccination

A safe and effective vaccine is available to protect against HBV. Most people who receive the hepatitis B vaccine have immunity for life.

The vaccine is usually given in a series of two or three shots. Adults receive two or three shots depending on the vaccine. Children and adolescents receive two. It’s recommended for all infants and for unvaccinated children and adolescents under the age of 19. The CDC also recommends it for certain unvaccinated adults.

If you’d like to receive the hepatitis B vaccine, talk to a healthcare professional. They can give you more information.

Testing

Blood tests can help you know whether you currently have or have previously had hepatitis B. If you currently have hepatitis B, you can seek treatment and also take steps to prevent HBV from being transmitted to others.

It’s important to talk to a healthcare professional about HBV testing if any of the following are true:

  • You were born in a country with a moderate to high rate of hepatitis B.
  • You’re not vaccinated against hepatitis B and have at least one parent that was born in a country with a moderate to high rate of hepatitis B.
  • You’re currently living with someone who has hepatitis B.
  • Your sexual partner is living with hepatitis B.

If you’d like to seek testing for hepatitis B, the CDC has a search tool that can help you find a testing location near you.

Reduce exposure risk

In addition to vaccination and testing, you can also prevent hepatitis B by taking steps to reduce your risk of exposure to blood or other bodily fluids that may contain HBV. Some examples include:

  • always using a condom or other barrier method during sex
  • not sharing or reusing needles or injection drug equipment
  • not sharing personal care items, such as toothbrushes and razors

The recommended treatment for hepatitis B depends on the type of hepatitis B that you have — acute or chronic.

There are no medications to treat acute hepatitis B. Instead, a medical professional will recommend supportive measures, such as:

  • resting
  • drinking plenty of fluids
  • getting adequate nutrition
  • avoiding alcohol until you recover

Antiviral medications are available for chronic hepatitis B, although they’re not recommended for everyone. Your doctor will let you know if you’re a good match for antiviral medications.

They’ll also continue to monitor your liver function and may recommend these best practices for people living with hepatitis B:

If you were recently diagnosed with hepatitis B and are seeking care, the Hepatitis B Foundation has a physician directory that can help you find a liver specialist near you.

If you think that you’ve been exposed to HBV, contact a medical professional. This is important even if you’re not completely sure you were exposed.

It’s possible to prevent hepatitis B if you receive the hepatitis B vaccine or hepatitis B immune globulin (HBIG) within 24 hours of exposure. HBIG is a shot that contains antibodies against HBV.

Additionally, make an appointment with a medical professional if you’re experiencing symptoms of hepatitis B, such as:

Your doctor can perform tests to determine whether you have hepatitis B. If you’re diagnosed with hepatitis B, they will talk with you about available treatment options and ways that you can help manage your liver health.

Hepatitis B disproportionately impacts the Asian community both inside and outside the United States. Chronic hepatitis B can lead to serious complications like liver damage or liver cancer.

In many cases, a person contracts the virus at birth or in early childhood. Hepatitis B doesn’t always cause symptoms, so the virus can be transmitted to others without knowing.

Other reasons for this disparity include low access to care, lack of knowledge related to hepatitis B, and stigma attached to the virus. A variety of outreach programs around the world are working hard to address these things.

Vaccination can prevent hepatitis B. It’s also important to get tested for hepatitis B, particularly if you or your parents arrived in the United States from an area in which hepatitis B is very prevalent.

If you believe you’ve been exposed to HBV or are experiencing symptoms of hepatitis B, be sure to make an appointment with a healthcare professional.