China has the highest incidence of the disease, with an estimated 170 million people with c hronic infections. Ten percent of those infected, or about 17 million people, show symptoms of the disease -- ranging from jaundice and fatigue to scarring of the liver (cirrhosis) or liver cancer. With only about 4 percent of those affected reportedly receiving treatment, each year about 300,000 Chinese die from hepatitis B. In India, the prevalence of hepatitis B is between 4-6 percent. For hepatitis C, it is about 1-2 percent. Fifty percent of patients who present to liver clinics already suffer from chronic hepatitis B or hepatitis C infections and of those, about half suffer from advanced disease, where few therapeutic treatment options exist. In certain parts of India, particularly among the poor, in rural areas and in aboriginal groups, infection rates are considerably higher and awareness of the disease and of health care in general is low. Also, while some 150 countries have added hepatitis B vaccine to their immunization schedules for infants, India has not yet done so. Therefore prevalence rates in the country remain almost static. Finally, while a great emphasis has been placed in India on HIV/AIDS prevention and awareness, HIV prevalence is about 0.3 percent, or just about a tenth of the prevalence of the hepatitis B virus in t he country. Yet, awareness of HIV is significantly greater at the community level.
There are about 1.2 million people in Japan, or 1 percent of the population, infected with hepatitis B. In 2005, the mortality rate for liver cancer, mainly caused by hepatitis virus, was nearly 27 percent. The main infection route for the virus is sexual transmission. There is an urgent need for early detection. However due to stigma and a lack of education in Japan, people tend not to take tests early enough and remain untreated.
Current efforts to address health disparities in addressing hepatitis B/C in Asia are focused on developing a portfolio of demonstration projects that raise the profile of hepatitis B in countries like India, China and Japan, that inform policy and national programs, that build capacity for institutions as well as the potential for community responses and that, in many cases, focus on the hardest hit populations -- children, blood donors, the poor - for treatment. Children are recognized as an important entry point to families and for building community awareness. In Japan, the effort aims to increase awareness and testing, while reducing the stigma of the disease, requires coordination with a second growing health problem related to another sexually transmitted disease, HIV/AIDS.
And while mass-vaccination programs have helped stem the tide of new cases, vaccinations are of no value for those already infected. What’s more, in many rural areas, much work is still required to expand vaccination rates and stem the problem of mother-to-child transmission of the disease. Finally, stigma associated with hepatitis B must be overcome along with the varying approaches to medical practice and treatment surrounding the disease.
The Bristol-Myers Squibb Foundation has been working for some time in Asia to support a variety of disease education and vaccination efforts, as well as prevention of mother-to-child transmissions -- the most common means of transmission. More work is required and is expected to focus on building health care capacity in partnership with local NGOs, governments and the medical community, as well as developing other support services at the community level.