providers to overlook the need for testing for apis. transmission 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 contrary to 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. mortality risks without appropriate management and screening, one in four hepatitis b infected individuals (25%) will die 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 chronically infected individuals 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 people with chronic hepatitis b infection, 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 and pacific islanders. 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 individuals early enough for treatment. statistics global statistics 350-400 million people worldwide have chronic hbv infection (compare with 40 million living with hiv) without appropriate treatment or monitoring, 1 in 4 people with chronic hbv will die of liver cancer, cirrhosis or liver failure. hbv takes a million lives a year in the world. hbv is second only to tobacco in causing the most cancer deaths worldwide. 80% of primary liver cancer (hepatocellular carcinoma) is caused by chronic hbv infection. hbv is preventable with a vaccine available for over 25 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 us 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: trends in 5-year survival by year of diagnosis in the us site1974-761983-851992-99 breast cancer75%78%87% colon cancer51%58%62% prostate cancer67%75%98% liver cancer4%6%7% there are more hbsag-positive (chronically infected with hbv) api women than women of other ethnicities: incidence of chronic hbv in the us by ethnicity maternal race/ethnicity 2002 births estimated maternal hbsag prevalence estimated births to hbsag(+) women non-hispanic2,298,1560.132,988 african american593,6910.52,968 asian pacific islander (foreign born)175,2648.915,598 asian pacific islander (us born)35,6431.4499 hispanic35,6431.4499 other42,3300.5212 total4,021,72623,054 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. china statistics 1/3 of the world's chronic hbv patients live in china. 130 million chinese (1 in 10) have chronic hbv. 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. hbv kills 500,000 mainland chinese each year (50% of global deaths). comparing hbv with hiv/aids in mainland china: hbv hiv/aids 130 million with chronic hbv650,000 with hiv 10% of population< 0.05% of population 500,000 die of liver cancer and/or liver failure each year44,000 died of aids in 2003 rates of hepatitis b infection chronic hbv infection rates in us 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%) us born api: 1.4% chronic hbv infection rates in caucasian, hispanic, or african american: 0.1%, 0.1%, 0.5%