Graduate Students Fight Hepatitis B in Boston


On February 7, Leslie Hsu, a master's student in the Department of Health and Social Behavior, and other Boston-area graduate students, will be at Boston's South Cove Community Health Center helping to stop the needless death of children from hepatitis B. There is no cure for those afflicted with this disease, but there is a safe and reliable vaccine to prevent its transmission. Screening tests to determine a whether a person has been exposed to hepatitis B, as well as vaccinations, will be available at no cost to people without health insurance, courtesy of donations by Merck and Co. and Beth Israel Deaconness Medical Center.

This is the first phase of a plan to combat this deadly disease. Those doing the fighting include co-directors Hsu and HMS student Michael Tran, along with more than twenty other volunteers from HSPH, HMS, and Tufts and Boston Universities. Together, these students make up the HepB coalition: the Hepatitis B Education and Prevention Boston Initiative.

Hepatitis B, which causes liver failure and death, infects an estimated 250,000 Americans each year, killing nearly 5,000 annually. Like AIDS, the disease is spread by a virus, usually transmitted through bodily fluids. However, hepatitis B is a hundred times more contagious than AIDS. Hepatitis B can be transmitted not only through unprotected sex, contact with blood or bodily fluids, and from mother to child at birth, but also from sharing gum or food, or from sharing personal items like toothbrushes and razors. For a variety of reasons, the disease is especially prevalent in populations from Southeast Asia, China, the Pacific Islands, and areas of Africa and South America.

The South Cove Community Health Center serves Boston's Chinatown and neighboring communitiesareas with large Chinese and Southeast Asian populations. Between 1990 and 1995, the average hepatitis B incidence in Boston for Asians was nearly 200 per 100,000 people, compared with rates of 28 for African-Americans and less than 7 for whites.

Hsu is intimately familiar with the tragedy underlying these statistics. While she was in college, planning on a medical career, her brother was diagnosed with liver cancer, caused by hepatitis B. A month after he died, Hsu's mother was diagnosed with hepatitis B. She, too, became a victim of this preventable disease.

Researchers are working on a cure for hepatitis B, and some positive results have been achieved, yet prevention through vaccination and education are the safest and cheapest options for preventing suffering and death. It was precisely this thought that led Hsu to HSPH, rather than to medical school, following her college graduation. "I lost some of my faith in medicine," said Hsu. "My experiences with hepatitis B showed me how much more effective prevention could be than trying to treat somebody who is already ill. I chose to study in the Department of Health and Social Behavior because it allows me to focus on disease prevention and health promotion."

Phase two of the HepB plan is to get all of the participants to return to the clinic for the second and third shots necessary for the vaccine to be effective. The second vaccination is given after a month, and the third after six months. "Some of the ways that previous vaccination efforts had failed was by not getting people to return for the follow-up vaccinations," said Hsu. "We're using incentives to get people to come back. Not just the promise of freedom from hepatitis B, but we're also going to be giving away some things donated by the community. So far we've got donations from the Chinatown McDonald's, Ben and Jerry's Ice Cream, Sir Speedy, Kinko's copying, and the Sony Cheri Theatre, and we're hoping to obtain the cooperation of other sponsors."

Another mechanism for assuring follow-up is HepB's Big Sibling program. This program began as a way of fostering relationships between the student volunteers and youths in the neighborhood with a goal of encouraging the kids to come back for all three vaccinations and helping the kids and their families fill out the proper paperwork to receive medical care.

In preparation for the February 7 screening and vaccinations, HepB volunteers have begun a mass media campaign including the distribution of pamphlets and posters and the staffing of a toll-free telephone hotline. Hsu eagerly stressed that HepB could use more help, either in the form of donations for incentives or as volunteers to help staff the clinics or the telephone hotline. A training session for volunteers is scheduled for January 31. Those interested should contact Hsu at lhsu@hsph.harvard.edu, or volunteer coordinator Cassandra Keleher at ckellehe@student.med.harvard.edu.

Leslie Hsu, co-director of the HepB Initiative: Hepatitis B Education and Prevention Boston.

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