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Immigration See other Immigration Articles Title: Hepatitis Risk for East Asians in New York (It's a risk for everyone!) Among east Asian immigrants in New York City, one person in seven carries the hepatitis B virus, a new study has found. The condition puts them at far greater risk than other Americans for deadly diseases like liver cancer and cirrhosis. Most of the people tested had no idea that they were infected, a fact that frustrates doctors who know that with proper screening and treatment, the disease can be controlled, if not cured. But three-quarters of the people in the study had no health insurance, and even those who did had trouble getting coverage for screening. The study, led by researchers at New York University School of Medicine, found that 15 percent of east Asians in New York — as many as 100,000 people — are chronic hepatitis carriers, with the rate highest among immigrants from China. That infection rate is 35 times the rate found in the general population. Hepatitis B, like hepatitis C, is generally contracted through the blood, and is not transmitted through casual contact with infected people. Because Hepatitis B is endemic in many Asian countries, growth in the number of Asian immigrants in New York and across the country has made the disease a broad, expensive, emerging health problem. In the 2000 census, there were 800,000 Asians in the city, with roughly half from China. Since the development a generation ago of a vaccine that is given to nearly all children born in the United States and to many adults who are considered at risk, hepatitis B has become rare in this country. While doctors have long worried about the disease in immigrant groups, little has been done to raise awareness of the danger. "The health care costs are enormous," said Dr. Henry J. Pollack, the lead author of the study, which is to be published late this week in the Centers for Disease Control and Prevention's journal, Morbidity and Mortality Weekly Report. People can carry the hepatitis B virus for decades without showing any signs of illness, until it causes life-threatening diseases like cancer or cirrhosis. The New York State cancer registry shows rates of liver cancer among Asian-Americans 6 to 10 times as high as for whites, Dr. Pollack said, a difference that is mostly attributable to hepatitis B. Hepatitis B is prevalent in many poor countries, and there are an estimated 350 million cases worldwide. It is most common in China, but scientists do not understand why. In Asia, the disease most commonly passes from mothers who do not know they have it to their children in the womb. Dr. Thomas Tsang, another principal investigator in the study, said the results confirmed that Asian-Americans face a major health problem that is not captured by national statistics. The Centers for Disease Control and Prevention has estimated that just 0.3 percent of all Americans have chronic hepatitis B, but experts say that may undercount people from Asia. "In this past week alone, from those people we screened, I have seen 7 to 10 people who needed to be started on medication because they had abnormal liver tests," said Dr. Tsang, who is chief medical officer of the Charles B. Wang Community Health Center in New York City. Representative Mike Honda, Democrat of California and chairman of the Congressional Asian Pacific American Caucus, said California faced a problem similar to New York's, one that was going largely unrecognized. Early detection and suppression of the virus can interrupt the cycle of mother-to-child transmission. An adult immune system can usually fight off a new hepatitis B infection. But, Dr. Pollack said, "If you get it when you're an infant, your chance of getting chronic hepatitis B is greater than 90 percent." In the last decade, doctors have been able to use an array of new drugs to treat chronic infection, but they do not cure the disease. Rather, they often suppress the virus so that it causes little or no harm. The medication must be taken for life. The researchers found that people from Fujian province — the biggest source of Chinese immigration to the United States in recent years — had the highest rate of infection, which corresponds to findings by the Chinese government. The researchers screened 1,836 Asian-born adults last year at 12 sites in heavily Asian neighborhoods in Queens, Brooklyn and Manhattan. More screenings have been conducted this year, but those results have not yet been analyzed. Some 61 percent of the subjects, who volunteered for the screening, were born in China, and 30 percent were born in Korea. Among those who said they had never been tested, who were just over half the subjects, 15 percent, tested positive. Lawrence K. Altman contributed reporting for this article.
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