Infectious Disease

Hepatitis B

The prevalence of chronic hepatitis B virus (HBV) infection varies by geographic region. Most of North America is a low-prevalence (< 2%) area. Certain high-prevalence pockets exist, especially areas with a high proportion of Asian immigrants, where rates of chronic HBV are as high as 5% to 15% (Carey 2009). Asian Americans and Pacific Islanders (AAPIs) account for over half of the 1.3 million chronic hepatitis B cases and for over half of the deaths resulting from chronic hepatitis B infection in United States. (Juon 2008) There is a higher prevalence of Hepatitis B among Chinese-Americans, and hence, a higher prevalence of Hepatitis B-associated liver cancer.

In most low-prevalence areas, HBV infection is acquired mainly during adolescence and mid-adulthood, whereas perinatal transmission is the main route in high-prevalence (≥ 8%) areas. Up to 40% of patients with chronic HBV infection develop liver complications. Age at acquisition affects the likelihood of chronicity and the development of liver complications. The risk of each is greatest with perinatal transmission; the disease is usually self-limiting when exposure to HBV occurs during adolescence or young adulthood. Viral load predicts progression to cirrhosis and hepatocellular carcinoma. Also, Yuen et al (2005) followed 3,233 Chinese patients with chronic HBV infection for approximately 4 years, and found that the risk of developing liver complications from chronic HBV infection increased as ALT concentration increased.

Several studies to measure the knowledge, attitudes, and behaviors of Hepatitis B (HBV) screening and vaccination in the Chinese American population have shown that knowledge level of HBV risk factors and screening and vaccination rates are low (Ma 2008; Thompson 2002; Nguyen 2007). Therefore, intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing and vaccination (Coronado 2007).

Tuberculosis (TB)

There were 646 deaths from TB in 2005, a 1.7% decline from 657 deaths in 2004. As a group, Asian and Pacific Islanders have the highest prevalence of tuberculosis. The rate of TB in Asians is 25.6 cases per 100,000 persons, which is over 10 times that of the White population in the US and more than twice over other populations. It is also important to note that since 1998, the percentage of U.S.-born patients with MDR (MultiDrug Resistant)TB has remained < 0.7%. However, of the total number of reported primary MDR TB cases, the proportion occurring in foreign-born persons increased from 25% (103 of 407) in 1993 to 80% (73 of 91) in 2006. (