Jade Ribbon Campaign

The Jade Ribbon Campaign (JRC) was launched by the Asian Liver Center (ALC) at Stanford University in May 2001 during Asian Pacific American Heritage Month to help spread awareness internationally about hepatitis B (HBV) and liver cancer in Asian and Pacific Islander (API) communities.

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.

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Outreach Efforts

Since the campaign's founding, the Asian Liver Center (ALC) have 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. Moreover, the ALC also holds numerous seminars for health professionals and the public, cultural fairs, conferences, and HBV screening/vaccination events.

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.

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.

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.

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.

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 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.

Team HBV

Team HBV is the official chapter of the Asian Liver Center 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.

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. Berkeley's chapter, however, has a unique history as it operated as a student-facilitated class in the Program for Democratic Education at Cal (DeCal) since Spring 2005 prior to becoming a Team HBV chapter.

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 U.S. 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.

Why should Asians and Pacific Islanders be aware of hepatitis B?

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 U.S. 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 U.S. 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^[1][2]. Although most hepatitis B carriers have no symptoms, they can still transmit the infection and develop liver cancer.

Why is hepatitis B often not diagnosed?

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. Carriers may exhibit normal blood tests for liver function and be granted a clean bill of health. The diagnosis cannot be made unless your doctor orders 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 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 U.S. vaccination programs has led many individuals and health-care providers to overlook the need for testing for APIs.

How is hepatitis B transmitted?

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

• 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.

How is hepatitis B life-threatening?

Without appropriate management and screening, one in four hepatitis B carriers (25%) dies 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 carriers 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 chronic hepatitis B carriers, 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. 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 carriers early enough for treatment.

Statistics

Global Statistics

• 350-400 million people worldwide have chronic HBV infection (compare with 40 million living with HIV)^[1][2]
• Without appropriate treatment or monitoring, 1 in 4 person with chronic HBV will die of liver cancer, cirrhosis or liver failure.
• HBV takes a million lives a year in the world.^[1][2]
• HBV is second only to tobacco in causing the most cancer deaths worldwide.^[2]
• 80% of primary liver cancer (hepatocellular carcinoma) is caused by chronic HBV infection.
• HBV is preventable with a vaccine available for over 20 years.

United States Statistics

• HBV is the biggest health disparity between Asian American and White Americans.
• 10% of Asian Americans are chronically infected versus less than 0.3% of the general population.
• 1.4 million people are chronically infected in U.S. and more than half are Asian.
• Liver cancer incidence is 6 - 13 times higher for Asians.
• Liver cancer mortality remains higher than other cancers despite advances in research and medical technology:

• There are more HBsAg-positive (chronically infected with HBV) API women than women of other ethnicities: ^[3]

• API population has increased 4x since 1980 (14.4 million in 2002)
• Foreign born API: 2.5 million in 1980 and 8.3 million in 2002
  • 75% came from countries with chronic HBV rates of 8-15%
• APIs tend to live in large households; 20% live with 5 or more people
• Many API seek medical treatments from Traditional Chinese Medicine (TCM) practitioners.
  • No routine blood tests and medical check-ups.
  • 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.^[4]

China Statistics

• 1/3 of the world’s chronic HBV patients live in China.^[2]
• 130 million Chinese (1 in 10) have chronic HBV.^[5]
• 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.^[2]
• HBV kills 500,000 mainland Chinese each year (50% of global deaths).^[5]
• Comparing HBV with HIV/AIDS in mainland China:

Rates of Hepatitis B Infection

• Chronic HBV infection rates in U.S. and Western Europe (lowest): 0.1-0.5%
• Chronic HBV infection rates in Asia, Pacific and sub-Saharan Africa: 10% (5-20%)
• Chronic HBV infection rates in API Americans: 7% (approximately 840,000)
  • Foreign born API: 9% (range 5-15%)
  • U.S. born API: 1.4%
• Chronic HBV infection rates in Caucasian, Hispanic, or African American: 0.1%, 0.1%, 0.5%

References

See also

• Hepatitis B
• Liver cancer
• Hepatocellular carcinoma (HCC)
• San Francisco Hep B Free
• Hepatitis B in China