Hepatitis B Knowledge, Testing and Vaccination Levels in Chinese Immigrants to British Columbia, Canada
Hislop, T. Gregory, Teh, Chong, Low, Angeline, Li, Lin, et al., Canadian Journal of Public Health
Background: Little is known about hepatitis B (HBV) and liver cancer control in Chinese in Canada. Liver cancer, a significant health problem in Asia, is preventable and can be controlled through HBV blood testing, vaccination, and community education about HBV.
Objective: The overall goal was to increase HBV testing and vaccination in Chinese adult Canadians. The objective was to present findings on HBV testing, vaccination and knowledge in Chinese immigrants.
Methods: 504 randomly selected Chinese adult immigrants residing in Vancouver responded to the survey which examined HBV blood testing and vaccination practices, HBV knowledge levels and socio-demographic characteristics. Face-to-face interviews were conducted in Cantonese, Mandarin, or English.
Results: 57% of participants reported that they had received HBV blood testing, 38% had been vaccinated, and 6% were known HBV carriers. There were gender differences, with lower rates of testing and vaccination, and higher chronic carrier rates, among men. Over 80% knew that HBV can be spread by asymptomatic persons and can cause cirrhosis and liver cancer. However, confusion existed about the routes of HBV transmission.
Interpretation: A sizeable proportion of Chinese adult immigrants in Vancouver have not been tested or vaccinated for HBV. Knowledge level, especially about routes of HBV transmission, was low. This is a concern, given that chronic HBV infection is the most common cause of liver cancer in Asian North Americans. To improve knowledge, reduce risk of infection and the burden of chronic infection and its sequelae in immigrant populations, continuing educational efforts are needed.
MeSH terms: Hepatitis B; liver neoplasms; health knowledge, attitudes, practices; asian continental ancestry group; emigration and immigration
Asians, one of the fastest growing and most culturally diverse minority populations in Canada, has Chinese as the largest subgroup. In 2001, approximately 1,100,000 ethnic Chinese were living in Canada,1 the majority being foreign-born. Little is known about disease prevention behaviour and cancer control in the Chinese population.2
In many Asian countries, liver cancer, a preventable disease, is the most common cancer.1 s In North America, it occurs more frequently among Chinese than the general population,6,7 and among Asian-born as compared to North American-born Chinese.8 This excess risk is attributed to high rates of hepatitis B virus (HBV) infection combined with low levels of HBV vaccination.3-5 HBV infection is endemic in most Asian countries.9 Between 30% and 50% of Chinese immigrants to North America have serologic evidence of past HBV infection.10,11 In Canada, approximately 250,000 persons are estimated to be infected with HBV, 70% being immigrants from foreign countries.12
A significant proportion of HBV-infected persons become chronic carriers, potentially infectious to others and at considerable risk of liver cancer, chronic active hepatitis and cirrhosis.3,13,14 Chronic HBV infection is attributed to be the most common underlying cause of liver cancer in Asian North American populations.10 Chronic carriers may benefit from antiviral therapy and regular surveillance to detect early liver cancer,12 and should take precautions to avoid infecting others.15-18
There have been several recent reports on HBV-related knowledge and behaviour in Korean19 and Vietnamese20-22 immigrants, but not in Chinese immigrants. Potential strategies for controlling HBV infection among Asian populations in Canada include the routine testing of immigrants, vaccinating immigrants who have never been exposed to HBV, and educating communities about the routes of HBV transmission.14 Provincial guidelines recommend HBV testing in persons at high risk of HBV infection, including immigrants from regions with high HBV endemic rates, and those who are not immune.23
We are not aware of any national data addressing HBV knowledge and behaviour among Chinese Canadians. …