Jade Ribbon Campaign

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The Jade Ribbon Campaign logo.

The Jade Ribbon Campaign (JRC) was launched by the Asian Liver Center 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.

1 Outreach Efforts
2 Why should Asians and Pacific Islanders be aware of hepatitis B?
3 Why is hepatitis B often not diagnosed?
4 How is hepatitis B transmitted?
5 Common misconceptions
6 How is hepatitis B life-threatening?
7 Statistics
8 References
9 See also
10 External links

[edit] Outreach Efforts

Press conference with San Francisco mayor Gavin Newsom

Since the campaign's founding, the Asian Liver Center (ALC) have been spearheading the Jade Ribbon Campaign through public service annoucements 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.

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.

A National Asian Interest Fraternity, Pi Alpha Phi, has taken the agendas of the Jade Ribbon Campaign as its national Philanthropy event. Holding yearly events and awareness campaigns, the issue of HBV is starting to spread amongst young Asian-Americans on American campuses as well.

[edit] 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 infecton and develop liver cancer.

[edit] 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.

[edit] 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 eariler. 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.

[edit] 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.

[edit] 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.

[edit] Statistics

[edit] 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.

[edit] 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:

**Trends in 5-Year Survival by Year of Diagnosis in the U.S.**
Site	1974-76	1983-85	1992-99
Breast cancer	75%	78%	87%
Colon cancer	51%	58%	62%
Prostate cancer	67%	75%	98%
Liver cancer	4%	6%	7%

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

**Incidence of Chronic HBV in the U.S. by Ethnicity**
Maternal Race/Ethnicity	2002 Births	Estimated Maternal HBsAg Prevalence	Estimated Births to HBsAg(+) Women
Non-Hispanic	2,298,156	0.13	2,988
African American	593,691	0.5	2,968
Asian Pacific Islander (foreign born)	175,264	8.9	15,598
Asian Pacific Islander (U.S. born)	35,643	1.4	499
Hispanic	35,643	1.4	499
Other	42,330	0.5	212
Total	4,021,726		23,054

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 househoulds; 20% live with 5 or more people
Many API seek medical treatments from Traditional Chinese Medicine (TCM) practictioners.
- No rountine blood tests and medical check-ups.
- Under-reporting of both acute and chronic HBV infection.

[edit] China Statistics

1/3 of the world’s chronic HBV patients live in China.^[2]
130 million Chinese (1 in 10) have chronic HBV.^[4]
In one day, 3 times more people die of HBV than the entire SARS outbreak.
In two years, less than 10 people have died from avian flu in China.^[2]
HBV kills 500,000 mainland Chinese each year (50% of global deaths).^[4]
Comparing HBV with HIV/AIDS in mainland China:

HBV^[4]	HIV/AIDS^[5]
130 million with chronic HBV	650,000 with HIV
10% of population	< 0.05% of population
500,000 die of liver cancer and/or liver failure each year	44,000 died of AIDS in 2003

[edit] 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%