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Community survey unveils alarming statistics on Hepatitis B: Nearly 50,000 undiagnosed “Hidden Hepatitis B Patients” in Hong Kong Half of Hepatitis B patients underestimate disease severity and neglect medical follow-up

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HONG KONG SAR – 12 December 2023 – Chronic Hepatitis B (HBV) significantly increases the risk of acute liver failure, cirrhosis, and liver cancer. To effectively manage the disease, patients require regular monitoring and timely treatment. However, a recent community hepatitis B screening and disease awareness survey conducted by Asiahep Hong Kong has revealed alarming findings. The survey aimed to provide insights into the current state of hepatitis B in the city, and the results highlight a concerning reality. Approximately 50,000 individuals in Hong Kong remain undiagnosed as “hidden hepatitis B patients.” Furthermore, the survey found that 43% of hepatitis B carriers have not sought any medical advice, and less than half of the hepatitis B patients (46%) undergo appropriate medical follow-up. These findings underscore the urgent need for increased awareness, education, and proactive healthcare interventions to address this pressing public health issue.

Asiahep Hong Kong has collaborated with six prominent social welfare organizations, social enterprises, and student group including the esteemed City Lions Club of Hong Kong, The Hong Kong Society for Rehabilitation, Sik Sik Yuen, The Jade Club, and the medical student societies of CUHK and HKU to launch the territory-wide
Asiahep Hong Kong has collaborated with six prominent social welfare organizations, social enterprises, and student group including the esteemed City Lions Club of Hong Kong, The Hong Kong Society for Rehabilitation, Sik Sik Yuen, The Jade Club, and the medical student societies of CUHK and HKU to launch the territory-wide “Combating Hepatitis B in Hong Kong 2023” campaign.

Combatting Hepatitis B: An Urgent Call to Action

Viral hepatitis remains a pressing global public health concern. In alignment with the Hong Kong Special Administrative Region Government’s commitment to the World Health Organization’s mission of eliminating viral hepatitis as a public health threat by 2030, Asiahep Hong Kong has collaborated with six prominent social welfare organizations, social enterprises, and student groups. These include the esteemed City Lions Club of Hong Kong, The Hong Kong Society for Rehabilitation, Sik Sik Yuen, The Jade Club, the medical society of the Chinese University of Hong Kong, and the medical society of the Hong Kong University Students’ Union. With unwavering support from Gilead Sciences, they have launched the groundbreaking “Combating Hepatitis B in Hong Kong 2023” campaign, which took place from June to October this year.

Mr Andy Wing-chuen LAM, President of the City Lions Club of Hong Kong, expressed his dedication to serving the community by stating, ” City Lions Club of Hong Kong has always been committed to serving society and organizing activities that benefit people from all walks of life in Hong Kong. We are thrilled to collaborate with Asiahep Hong Kong on this significant initiative. Together with the student organizations from two esteemed medical schools in Hong Kong, we have deployed medical consultants and volunteers to The Hong Kong Society for Rehabilitation, Sik Sik Yuen and The Jade Club. Our aim is to provide free hepatitis B screening services to their members, benefiting over 700 citizens. Going forward, the City Lions Club of Hong Kong will continue to forge partnerships with various organizations, working hand in hand to combat hepatitis B.”

Key survey findings from “Combating Hepatitis B in Hong Kong 2023” campaign

A total of 768 Hong Kong residents aged 18 and above participated in the “Combating Hepatitis B in Hong Kong 2023”. The main survey results are as follows:

1. Over 50,000 unidentified hepatitis B carriers uncovered in Hong Kong

Out of the 768 participants involved in this campaign, a total of 41 individuals were identified as hepatitis B patients, indicating an infection rate of approximately 5.3% (41 out of 768). These findings are consistent with the data released by the Department of Health. Remarkably, six individuals were solely diagnosed with hepatitis B through this screening campaign, underscoring the importance of such initiative. Considering the adult population in Hong Kong, it is estimated that there are still approximately 50,000 undiagnosed individuals who are “hidden hepatitis B carriers”.

Dr Kelvin Long-yan LAM, President of the Asiahep Hong Kong and a specialist in gastroenterology and hepatology, provided valuable insights into hepatitis B, stating, “Hepatitis B is often referred to as an invisible killer due to its ability to remain asymptomatic in the early stages of infection. It is only when the hepatitis B virus triggers persistent liver inflammation for more than 6 months that it progresses into chronic hepatitis B. Chronic hepatitis B is a lifelong infection and can pose a significant risk of acute liver failure. Furthermore, in the long term, approximately 15-40% of individuals with chronic hepatitis B may experience disease progression, including liver cirrhosis or liver cancer.”

2. 43% of patients fail to follow up after receiving a diagnosis, and less than half (46%) of individuals with hepatitis B undergo regular check-ups

During the campaign, a significant number of participants (35 individuals) who were already aware of their hepatitis B infection took part. Surprisingly, it was found that a staggering 43% of these individuals did not seek further medical advice upon learning about their diagnosis. Additionally, less than half (46%) of the hepatitis B patients consistently undergo the recommended routine testing.

Dr Michael Kin-kong LI, Vice President of the Asiahep Hong Kong, expressed deep concern about this situation. Dr. LI explained, “The condition of hepatitis B can undergo rapid changes, necessitating regular monitoring of liver enzymes (ALT), alpha-fetoprotein (AFP), and hepatitis B viral load (HBV-DNA) to assess the virus’s activity and overall liver health. If any abnormalities are detected in these tests, such as an increase in viral load or the presence of liver fibrosis, cirrhosis, or decompensated liver function, it is crucial to promptly prescribe antiviral medications to the patients. By reducing the hepatitis B viral load in the body, we can effectively control the progression of the disease and mitigate the risk of developing liver cirrhosis or even liver cancer.”

Furthermore, it is advisable for specific patients to undergo assessments to evaluate their renal function and osteoporosis. Dr. LI elaborated, “A minority of hepatitis B patients have encountered renal impairment and reduced bone density following prolonged usage of certain antiviral medications. To mitigate the advancement of more severe complications, doctors typically switch these patients to alternative medications that exert a lesser impact on kidney and bone health. This approach not only helps in managing the hepatitis B viral load in their bodies, but also contributes significantly to the partial restoration of renal function and the amelioration of decreased bone density.”

Summary and Recommendations

Dr Kelvin Long-yan LAM, President of the Asiahep Hong Kong, emphasized that a significant number of Hong Kong citizens born before 1988 have not received the hepatitis B vaccine, making them highly susceptible to hepatitis B infection. The District Health Centres (DHC) / DHC Expresses (DHCE) play a crucial role in disease prevention, screening, and managing chronic illnesses. Therefore, it is strongly recommended that the government actively utilize the network of District Health Centers/Stations to implement a comprehensive hepatitis B screening program across the entire region. Additionally, it is crucial to provide regular physical examinations for hepatitis B patients, aiming to achieve the goal of combating hepatitis B citywide as early as possible.

The Asiahep Hong Kong, based on the screening and survey results, would like to propose the following recommendations to the government and relevant organizations:

1) Provide free hepatitis B testing services through DHC / DHCE for individuals born before 1988 to identify “hidden” hepatitis B patients at an early stage;

2) Emphasize the importance of regular check-ups for hepatitis B patients and establish public-private collaborations to provide regular physical examinations for them. These examinations should include semi-annual blood tests to assess liver function, alpha-fetoprotein levels, hepatitis B viral load, and ultrasound examinations of the liver. This approach aims to reduce the likelihood of hepatitis B patients developing severe liver diseases;

3) Patients undergoing hepatitis B treatment should also undergo regular health assessments, including monitoring of overlooked indicators such as renal function and bone density. These assessments help to identify potential side effects of medications and allow for discussions with physicians regarding the most suitable treatment plans.

Dr Kelvin Long-yan LAM emphatically highlighted the criticality of early detection among hepatitis B patients, as a lack of awareness until the disease advances to liver cancer can lead to substantial delays in receiving timely treatment. Consequently, he urges individuals to promptly undergo hepatitis B testing, assuming responsibility for their own and their family’s well-being, and effectively interrupting the transmission of hepatitis B. By joining forces, Hong Kong can collectively combat and ultimately eliminate hepatitis B within the foreseeable future.

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