Public health officials in San Francisco, and leaders from its large Asian community, are mounting an aggressive campaign to eradicate hepatitis B from the city. They say demographics are largely responsible for San Francisco having the highest concentration of hepatitis B in the U.S, as well as the highest rates of liver cancer, which is usually caused by the virus.
Greg Zhang, 46, is recovering from recent surgery to remove a tumor from his liver...a result of his life-long infection with hepatitis B.
Zhang's surgeon is Dr. Samuel So, director of the Stanford University Asian Liver Center.
"Hepatitis B is the silent killer because most people who are chronically infected may not be aware of the infection," he said. "In fact you know two out of three of them don't even know they're infected because usually they feel perfectly healthy."
The hepatitis B virus is found in blood and bodily fluids. Many people can live with the virus and never get sick, but 25 percent of those infected eventually develop severe liver damage or cancer. The virus can be transmitted by unsafe sex and unsterile needles, but most people who suffer from the disease become infected at birth from their mothers.
Zhang, and his younger brother Haiyang, were born in China, one of several Asian countries where the disease is endemic. Haiyang died of advanced liver cancer shortly after he was diagnosed.
The American Liver Foundation says one in 10 Asian Americans have the virus, a disease that's 100 times more likely to strike Asian Americans than other ethnic groups. And in San Francisco, a full one-third of the population is of Asian descent.
The city's Hep B Free Campaign offers free testing, vaccinations, and treatment. There's no known cure for hepatitis B, although the virus can be kept in check with anti-viral medicines. Those infected need to have yearly ultrasounds and blood tests to screen for early stages of liver cancer.
Newborns need a vaccination within the first day of life to prevent transmission of the virus from their mothers, and babies need two more doses within the first six months for full immunity.
Public awareness is another part of the campaign. A controversial advertisement on television and billboards shows 10 Asian beauty pageant contestants and asks which one deserves to die.
Hepatitis B carries a stigma. And that is something California Assembly member Fiona Ma of San Francisco is working hard to change. She is Hepatitis B-positive.
"My cousin, who was born in China, actually got very upset and said, 'Please don't talk about it. People will think you are sick and they are not going to vote for you.' And my message was, 'I am a public figure and this is my responsibility,'" she said.
But Stanford's Dr. So - whose mother-in-law died from liver cancer - says changing attitudes is just a start. He says other diseases get more public attention and therefore more money.
"This is really tragic on a global scale, there's really major neglect about hepatitis B. About one in 20 people in the world are chronically infected. One in 20. Ten times more than people in the world infected with HIV," Dr. So said.
For now, the battle against hepatitis B is concentrated in communities with large Asian populations. Other cities, including Philadelphia, Washington and Los Angeles, are making plans to use the San Francisco program as a model.