WEBVTT - From the Vault - Hepatitis B: Hepatiti, Take 2 (Ep 89) 0:00:02.279 --> 0:00:06.360 My name is su Wang. I am a physician. I'm 0:00:06.360 --> 0:00:10.280 an MD MPH. I'm the medical director for the Center 0:00:10.320 --> 0:00:14.280 for Asian Health and Viral Hepatitis Programs at the Cooperman 0:00:14.640 --> 0:00:19.799 Barnabas Medical Center in New Jersey. And I'm also just 0:00:19.880 --> 0:00:24.000 coming off a two year presidency for the World Hepatitis Alliance, 0:00:24.040 --> 0:00:29.360 which is a nonprofit organization that represents patients living with 0:00:29.440 --> 0:00:32.880 viral hepatitis. And our goal is to harness the power 0:00:32.920 --> 0:00:37.279 of people living with viral hepatitis to achieve global elimination 0:00:37.360 --> 0:00:42.520 of viral hepatitis. I was diagnosed with hepatitis B in college. 0:00:43.159 --> 0:00:46.040 In my first year of college, I went to donate blood, 0:00:46.200 --> 0:00:51.120 right to do a good thing, donate blood, and shortly 0:00:51.159 --> 0:00:54.200 after I got a big, fat envelope sent to my 0:00:54.320 --> 0:00:58.960 dorm and it said, don't be worried. You don't have HIV, 0:00:59.440 --> 0:01:03.120 but you do have hepatitis B. And I was a 0:01:03.120 --> 0:01:05.919 pre med student, but honestly I didn't know anything about 0:01:05.920 --> 0:01:09.800 hep BEE. I called my sister, confided in her about 0:01:09.800 --> 0:01:12.240 this new diagnosis, and she said, oh, didn't you know 0:01:12.480 --> 0:01:15.400 Mom also has hep BE. And then I just I 0:01:15.440 --> 0:01:17.639 just remember thinking, Oh, who do I need to tell 0:01:18.440 --> 0:01:20.840 and when I went back home, I did go see 0:01:20.840 --> 0:01:23.920 a doctor and talked to her about it, and I 0:01:23.959 --> 0:01:26.200 think she did blood work and basically said I was 0:01:26.200 --> 0:01:28.319 a carrier and there was nothing to worry about. So 0:01:28.600 --> 0:01:31.440 I honestly pushed it to the back burner. Didn't want 0:01:31.440 --> 0:01:34.080 to think about it, so it didn't come up again 0:01:34.160 --> 0:01:38.240 until med school. I filled in all my med school 0:01:38.520 --> 0:01:41.640 forms and a lot of our employment forms and our 0:01:41.720 --> 0:01:45.039 screenings for working at a hospital. You do have to 0:01:45.400 --> 0:01:49.640 indicate you know what your heppy vaccination and statuses. And 0:01:49.840 --> 0:01:53.440 I had indicated that I was a carrier and didn't 0:01:53.760 --> 0:01:55.560 hear anything about it. I didn't think anything of it. 0:01:55.600 --> 0:01:56.880 And it's not untill now. 0:01:56.920 --> 0:01:59.840 That I've heard numerous people who are in med school 0:02:00.000 --> 0:02:02.560 found out to have happy and actually they lose their 0:02:02.560 --> 0:02:05.760 acceptances to med school or they faced quite a bit 0:02:05.800 --> 0:02:08.480 of what I would consider discrimination over their status. 0:02:09.040 --> 0:02:09.160 Uh. 0:02:09.320 --> 0:02:11.760 And it's happened to residents, it's happened to nurses, it's 0:02:11.760 --> 0:02:15.200 happened to deal students. So it is an issue of 0:02:15.320 --> 0:02:18.440 stigma and discrimination. But I was fortunate it didn't happen 0:02:18.440 --> 0:02:20.560 to me, and kind of was in the back of 0:02:20.560 --> 0:02:22.600 my mind, and I remember kind of when we learned 0:02:22.600 --> 0:02:25.200 about hepatitis is kind of listening a little bit more attentively. 0:02:26.080 --> 0:02:29.880 And when I got to residency after med school, I 0:02:29.880 --> 0:02:32.360 became really good friends with somebody. A friend of mine 0:02:32.400 --> 0:02:36.400 went into infectious disease, and I had confided in her 0:02:36.440 --> 0:02:39.520 that I had happatitis B and she told me, oh, 0:02:39.520 --> 0:02:41.280 make sure you see a doctor for it. I hadn't 0:02:41.280 --> 0:02:44.359 seen a doctor in years at that point. So I 0:02:44.400 --> 0:02:47.840 went in to see somebody and they did my viral 0:02:47.880 --> 0:02:50.480 load and I did the ultrasound and everything was fine. 0:02:50.639 --> 0:02:53.600 It was very low. I didn't need medication. And at 0:02:53.600 --> 0:02:56.320 that point, I remember I was engaged, I think, and 0:02:56.360 --> 0:02:59.280 so my friend had said, oh, make sure your fiance 0:02:59.400 --> 0:03:03.040 also gets to and he ended up getting tested and 0:03:03.080 --> 0:03:05.079 needing to get vaccinated, and you know, so that was 0:03:05.160 --> 0:03:07.400 kind of the extent of how it impacted my life. 0:03:07.440 --> 0:03:09.560 And I had told him about it, and I was, 0:03:09.720 --> 0:03:11.680 you know, I was happy that he was. He didn't 0:03:11.680 --> 0:03:13.680 make a big deal out of it, and these are 0:03:13.680 --> 0:03:15.520 all points now looking back, I realized, you know, I 0:03:15.600 --> 0:03:17.880 was fortunate, and so many people around the world are 0:03:17.919 --> 0:03:21.200 not so fortunate to have, you know, a career that's 0:03:21.240 --> 0:03:25.000 not affected by it, or a relationship that's not affected 0:03:25.000 --> 0:03:26.400 by it. You know, there are a lot of people 0:03:26.440 --> 0:03:28.560 who you know, lose their partners, they end up, they 0:03:28.639 --> 0:03:32.520 may get divorced, they may get disowned by family or 0:03:32.680 --> 0:03:34.480 unable to pursue the career they went to. 0:03:35.840 --> 0:03:36.480 So I didn't have. 0:03:36.440 --> 0:03:41.000 Any of that, and I got married and we got pregnant. 0:03:41.200 --> 0:03:44.320 I've had four kids, and with each one of those kids, 0:03:44.400 --> 0:03:47.360 especially the first one, it did hit me that, oh, 0:03:47.440 --> 0:03:49.200 I know, there's a chance that I could pass this 0:03:49.240 --> 0:03:52.640 affection on to my children, and that definitely weighed heavily 0:03:52.680 --> 0:03:55.120 on me. Although I knew the research that because my 0:03:55.680 --> 0:03:58.680 viral load was low, there would be very low chants 0:03:59.000 --> 0:04:02.960 of the developing hep BE. But that's where I really 0:04:02.960 --> 0:04:04.560 all of a sudden felt like, oh my gosh, you know, 0:04:04.640 --> 0:04:08.120 this could really impact me personally. And I'm happy to 0:04:08.160 --> 0:04:10.040 say that all for my kids are heap BE free 0:04:10.520 --> 0:04:12.280 and that they don't have to live with this chronic 0:04:12.320 --> 0:04:15.080 disease and worry about risk of lover cancer and other 0:04:15.120 --> 0:04:17.080 things that other kids have to go through even now 0:04:17.120 --> 0:04:19.880 in this day and age. And so as a physician, 0:04:19.920 --> 0:04:23.000 I didn't particularly have an inkling that I was going 0:04:23.080 --> 0:04:26.040 to do hepatitis work at all, And it wasn't until 0:04:26.120 --> 0:04:28.919 I moved to New York City after I finished my 0:04:28.960 --> 0:04:32.280 residency and I took a job with a community health 0:04:32.279 --> 0:04:36.600 center in Chinatown. So I began serving the largely Chinese 0:04:36.640 --> 0:04:40.120 community in Chinatown and learned so much more about HEPBE 0:04:40.200 --> 0:04:42.200 than I ever knew. That it's, you know, one of 0:04:42.200 --> 0:04:46.480 the most common infectious diseases around the world. Up to 0:04:46.600 --> 0:04:48.600 like one in ten of our patients had heppy was 0:04:48.640 --> 0:04:52.560 as common as hypertension. And whereas I had seen specialists, 0:04:52.640 --> 0:04:55.360 you know, during residency, a lot of our patients could 0:04:55.360 --> 0:04:58.320 not afford to see a specialist and they weren't necessarily 0:04:58.400 --> 0:05:01.360 easily accessible. So many of us at the community health 0:05:01.360 --> 0:05:05.960 center learned to treat hep BEE along with hypertension, diabetes, 0:05:06.000 --> 0:05:09.520 and other chronic diseases. So during that time, I really saw, 0:05:09.920 --> 0:05:11.799 you know, a lot of the difficulties that people face 0:05:11.920 --> 0:05:15.120 and getting care, and so I began really advocating and 0:05:15.160 --> 0:05:18.160 creating programs that would help people living with hepatitis be 0:05:18.680 --> 0:05:21.960 to increase screening in the communities, linkage to care, all 0:05:21.960 --> 0:05:24.719 these things that can happen in a very complex medical system. 0:05:25.400 --> 0:05:28.120 We tried to create a program to kind of streamline 0:05:28.240 --> 0:05:30.200 all of that. As I was getting more and more 0:05:30.240 --> 0:05:33.080 immersed in, you know, really providing the care that needs 0:05:33.120 --> 0:05:36.159 to happen, I really had the hat on, like, you know, 0:05:36.279 --> 0:05:38.760 the physician hat, like this is what needs to be done, 0:05:39.279 --> 0:05:41.800 these are the interventions, this is the science behind it. 0:05:42.279 --> 0:05:44.760 I did not wear the patient hat at all in 0:05:44.839 --> 0:05:46.920 terms of what it meant for me, and I kind 0:05:46.920 --> 0:05:49.599 of didn't feel like that that was my role, and 0:05:49.640 --> 0:05:52.120 it wasn't until somebody did an interview. Actually, I did 0:05:52.160 --> 0:05:54.920 an interview for CDC, and it was the first time, 0:05:55.040 --> 0:05:56.920 like on camera that I had I said, you know, 0:05:57.000 --> 0:06:00.240 I'm actually living with hepatitis B myself. And at that 0:06:00.240 --> 0:06:02.960 point I had already occasionally mentioned it to patients. So 0:06:03.040 --> 0:06:04.920 if I was counseling a patient who had been newly 0:06:04.960 --> 0:06:06.919 diagnosed with HEPPY and I could see they were really 0:06:06.920 --> 0:06:11.280 distraught or felt really overwhelmed, I would share with them 0:06:11.320 --> 0:06:13.159 that I also was living with hep BEE. I was 0:06:13.279 --> 0:06:15.120 just like them. I had to go for blood tests 0:06:15.279 --> 0:06:17.360 and I think that really helped them see that it's 0:06:17.440 --> 0:06:21.039 possible to live a happy, healthy life and it's not 0:06:21.080 --> 0:06:23.880 a death sentence. So I was using that more often, 0:06:23.880 --> 0:06:26.960 but I'd never spoken about it publicly, so it took 0:06:26.960 --> 0:06:29.080 me a while. And what I've seen as a physician, 0:06:29.120 --> 0:06:31.440 which I think as physicians we don't quite get, is 0:06:31.560 --> 0:06:35.400 just how powerful that personal experience is. And I have 0:06:35.720 --> 0:06:39.240 only learned this through other people. Somebody asked me to 0:06:39.240 --> 0:06:41.600 get involved with the World Hepatitis Alliance, which is led 0:06:41.600 --> 0:06:44.440 by patients, and through that on the board. The board 0:06:44.520 --> 0:06:48.280 is all patients who represent each of the WHO regions. 0:06:48.880 --> 0:06:51.400 And I heard specifically from a good friend of mine 0:06:51.440 --> 0:06:53.080 who was now a good friend of my d lee, 0:06:53.080 --> 0:06:56.279 who represented the Whippo region, the Western Pacific region. He 0:06:56.360 --> 0:06:59.240 told me all these stories of people who really had 0:06:59.320 --> 0:07:03.040 happy drastically empire their life in ways that us in 0:07:03.080 --> 0:07:04.000 medicine don't measure. 0:07:04.080 --> 0:07:04.240 Right. 0:07:04.279 --> 0:07:08.039 We measure the outcomes. We look at our morbidity, mortality, 0:07:08.480 --> 0:07:14.160 life expectancy right soorrhosis, lever cancer. We don't look at 0:07:14.520 --> 0:07:18.000 outcomes in terms of somebody's quality of life. You know, 0:07:18.000 --> 0:07:22.520 when I hear these stories of how people have suffered 0:07:22.840 --> 0:07:24.800 with the burden of the disease, even if they are 0:07:25.200 --> 0:07:26.920 I mean, as a doctor, if you were to look 0:07:26.960 --> 0:07:29.160 at them, they would look healthy. You would tell them. 0:07:29.200 --> 0:07:31.720 They're perfectly healthy, their liver enzymes are normal, their viral 0:07:31.760 --> 0:07:33.840 load is low. Like you know, I only need to 0:07:33.840 --> 0:07:35.240 see you once a year. You're fine. You know, in 0:07:35.280 --> 0:07:37.640 our mind we think it's we think it's nothing like 0:07:37.760 --> 0:07:39.880 if you were to then delve into how they feel 0:07:39.920 --> 0:07:42.320 about themselves, and most patients won't even tell me that. 0:07:42.400 --> 0:07:44.880 So I know that what I see, what I glimpse 0:07:44.960 --> 0:07:48.240 in my exam room is just such a small part 0:07:48.320 --> 0:07:50.840 of what it means for them to live with a disease. 0:07:50.880 --> 0:07:54.040 And so you know, it's beyond just like keeping them 0:07:54.120 --> 0:07:58.000 from getting sorosis and liver cancer. You know, us in medicine, 0:07:58.040 --> 0:08:01.360 if we're if our mission is to prove quality of 0:08:01.400 --> 0:08:04.840 life and decrease burden of disease on people's lives, we 0:08:04.920 --> 0:08:08.480 have to think outside just you know, our our biochemical tests. 0:08:09.920 --> 0:08:11.800 I think, you know, I've just learned that we can't 0:08:11.840 --> 0:08:14.480 afford to operate in our silos, right, the scientists cannot 0:08:14.520 --> 0:08:17.960 afford to operate in you know, their silos only like 0:08:18.000 --> 0:08:21.440 publishing to the scientific community and having meetings that are 0:08:21.440 --> 0:08:24.720 only for scientists and medical researchers. But we have to 0:08:24.720 --> 0:08:27.000 get out of the box. We have to combine. You know, 0:08:27.040 --> 0:08:30.120 the people living with the disease have to work in 0:08:30.200 --> 0:08:32.320 concert with the medical community if we're really going to 0:08:32.320 --> 0:08:35.760 make progress for elimination and for uh you know, really 0:08:35.760 --> 0:09:14.800 alleviating the suffering of be on people's lives. 0:09:23.440 --> 0:09:26.400 Thank you so much, doctor Wong for sharing your story. 0:09:26.920 --> 0:09:30.760 Thank you. Hi. I'm Aaron Welsh and. 0:09:30.720 --> 0:09:32.520 I'm Aaron Alman Updyke. 0:09:32.679 --> 0:09:35.920 And this is this podcast will Kill You. 0:09:36.040 --> 0:09:38.079 Welcome to another episode. 0:09:38.480 --> 0:09:44.120 Yes, welcome, Welcome. As you have probably gathered, we are 0:09:44.160 --> 0:09:49.040 going to be talking about another hepatitis virus, our second 0:09:49.040 --> 0:09:54.079 podcast history. Yes, this one hepatitis B. Yeah, we started 0:09:54.120 --> 0:09:58.360 with C. Now we're going to be what's next? Uh, well, 0:09:58.400 --> 0:10:01.520 I am going to mention D. I figured. 0:10:03.520 --> 0:10:04.560 I think next will be A. 0:10:05.240 --> 0:10:08.800 Yeah, next will definitely be A, and then we'll have 0:10:08.840 --> 0:10:10.679 to do E. And then maybe by the time that 0:10:10.720 --> 0:10:12.000 comes out, there'll be a few. 0:10:11.760 --> 0:10:14.960 More and we can cover all in one quite possible. 0:10:15.360 --> 0:10:19.040 Well, Aaron, what time is it? 0:10:19.040 --> 0:10:21.119 It's quarantiny time, Aaron. 0:10:21.280 --> 0:10:24.400 It is. And what are we drinking this week? 0:10:24.559 --> 0:10:26.359 We're drinking the beasting. 0:10:27.000 --> 0:10:31.880 We are appatitis B, hepatitis B. And what is in 0:10:31.960 --> 0:10:32.560 the beasting? 0:10:33.120 --> 0:10:37.440 Well, it's a lovely little bev a ginger mint syrup, 0:10:37.960 --> 0:10:42.560 some lemon juice, club soda. If you're drinking alcohol, you 0:10:42.600 --> 0:10:44.120 could certainly put some gin in it. 0:10:44.520 --> 0:10:48.160 That will be the little sting. But otherwise on its own, 0:10:48.800 --> 0:10:53.439 it is delicious, very refreshing. I just I love it, 0:10:55.080 --> 0:10:58.880 and we will post the full recipe for this quarantini 0:10:59.040 --> 0:11:01.960 as well as our non alcoholic Placey Brita on our 0:11:01.960 --> 0:11:05.199 website This podcast Willkill You dot com, as well as 0:11:05.240 --> 0:11:06.960 on all of our social media channels. 0:11:07.520 --> 0:11:10.120 On our website This Podcast will Kill You dot Com, 0:11:10.600 --> 0:11:13.520 you will find any and every of the things that 0:11:13.559 --> 0:11:16.120 you ever wanted to know about the podcast. You can 0:11:16.160 --> 0:11:19.320 find Bloodmobile, who does all of our music, and the 0:11:19.360 --> 0:11:23.200 link to their Spotify. You can find merch all of 0:11:23.240 --> 0:11:27.240 our merch. You can find transcripts for all of our episodes. 0:11:27.480 --> 0:11:32.040 You can find a bookshop dot org affiliate account, and 0:11:32.520 --> 0:11:35.079 a good Reads list. You can find all You're doing 0:11:35.120 --> 0:11:36.800 great things for all of our episodes. 0:11:36.840 --> 0:11:37.080 Thanks. 0:11:37.120 --> 0:11:41.360 I need the encouragement, and you can find our Patreon. 0:11:41.640 --> 0:11:45.679 Wow, that was impressive. Thank you. 0:11:45.840 --> 0:11:46.160 Thanks. 0:11:46.400 --> 0:11:48.400 I'm always relieved when I don't have to do it. 0:11:49.040 --> 0:11:51.959 I always get really nervous and then I just power through. 0:11:52.400 --> 0:11:54.360 I like it. It's like you get in the zone 0:11:54.400 --> 0:12:01.040 and then you're there. Well before we get into the episode, 0:12:01.480 --> 0:12:04.880 I wanted to mention one thing because Endometriosis, which is 0:12:05.160 --> 0:12:08.600 the last episode we released, is still on my mind. 0:12:08.720 --> 0:12:11.960 Even though I've been reading a lot about happatitis B, 0:12:12.160 --> 0:12:15.120 I still have these like little thoughts of endo that 0:12:15.160 --> 0:12:19.160 pop in, and I realized that there was like one 0:12:19.200 --> 0:12:23.120 more thing that I wanted to say. Also, like Endometriosis, 0:12:23.160 --> 0:12:27.200 we've recorded it, it's not yet released, and so maybe 0:12:27.240 --> 0:12:29.520 people will have already said this by the time this 0:12:29.600 --> 0:12:31.400 comes out. It's sort of a weird time travel thing 0:12:31.440 --> 0:12:35.320 we're doing here. Yeah, But in the Endometriosis episode, we 0:12:35.440 --> 0:12:40.680 talked about how often complete or partial hysterectomy is recommended 0:12:41.120 --> 0:12:46.000 as like a cure for endometriosis, which it isn't, and 0:12:46.440 --> 0:12:49.600 which that can also add another dimension of pain and 0:12:49.679 --> 0:12:53.880 anguish to an already difficult disease. But I also think 0:12:53.920 --> 0:12:57.280 that another aspect to that that we didn't really touch on, 0:12:57.520 --> 0:13:00.160 and I think is important to mention, is that there 0:13:00.200 --> 0:13:03.359 can also be a reluctance on the part of physicians 0:13:03.360 --> 0:13:07.559 to perform hysterectomies or even just tubal ligations, like getting 0:13:07.559 --> 0:13:11.000 your tubes tied for whatever reason, even if that reason 0:13:11.120 --> 0:13:13.600 is I don't want to have any children or any 0:13:13.640 --> 0:13:16.960 more children, a lot of people are just told, oh, 0:13:17.000 --> 0:13:19.079 you're just too young. You might change your mind and 0:13:19.120 --> 0:13:21.319 want to have kids in the future. And so really 0:13:21.360 --> 0:13:24.040 that's sort of another way in which many times physicians 0:13:24.080 --> 0:13:27.720 don't fulfill the very basic requirement of listening to their patient, 0:13:27.800 --> 0:13:30.760 and how the social and gender role of someone can 0:13:30.800 --> 0:13:34.880 be held as more important than what they want than 0:13:34.920 --> 0:13:35.480 their wishes. 0:13:35.960 --> 0:13:36.480 Yeah. 0:13:36.840 --> 0:13:39.120 Anyway, that just kept like circulating in my head and 0:13:39.120 --> 0:13:40.840 I was like, oh, gosh, I need to say it. 0:13:42.480 --> 0:13:45.080 So yeah, okay, got it out. 0:13:45.440 --> 0:13:48.440 Yeah, that's an incredibly important point. 0:13:49.200 --> 0:13:53.800 Okay, should we move on to the actual topic of 0:13:53.840 --> 0:13:54.600 today's episode. 0:13:54.679 --> 0:13:58.920 Today's topic hepatitis B. Let's take a quick break and 0:13:58.960 --> 0:14:34.920 then get into the biology. So, like you mentioned erin, 0:14:35.320 --> 0:14:39.760 this is our second hepatitis virus, and I know for 0:14:39.840 --> 0:14:43.480 sure that during our hepatitis C episode we talked at 0:14:43.560 --> 0:14:50.080 least a little bit about how all the hepatiti all 0:14:50.120 --> 0:14:53.760 the hepatitis viruses are named, not for anything that links 0:14:53.800 --> 0:14:57.240 the particular viruses together, aside from the fact that they 0:14:57.280 --> 0:15:02.720 all predominantly affect the liver. So there are five predominant 0:15:02.760 --> 0:15:06.280 viruses which we kind of already named at the beginning, A, B, C, D, 0:15:06.400 --> 0:15:11.160 and E. And today we're focusing on hepatitis B, and 0:15:11.240 --> 0:15:14.640 I will mention hepatitis D and you'll understand why in 0:15:14.680 --> 0:15:19.080 a minute if you don't already know the little interplay 0:15:19.120 --> 0:15:24.680 between hepatitis D and B. All right, hepatitis B. It's 0:15:24.720 --> 0:15:30.760 in the family Hepadnavii day, which essentially just means viruses 0:15:30.800 --> 0:15:35.280 that affect the liver, like no surprise, straightforward. One thing 0:15:35.320 --> 0:15:38.000 that's there's a lot of interesting things about the virology 0:15:38.080 --> 0:15:40.360 of hepatitis B, and I'm probably not even going to 0:15:40.440 --> 0:15:45.080 do them justice, but here we try. Hepatitis B virus 0:15:45.160 --> 0:15:49.720 is a partially double stranded DNA virus, which is weird. 0:15:50.720 --> 0:15:53.360 So it has a genome that it's like in a 0:15:53.400 --> 0:15:57.280 little circle, and part of it is double stranded and 0:15:57.320 --> 0:15:59.960 part of it is single stranded, which is very bizarre. 0:16:00.720 --> 0:16:01.840 Do you have a question already? 0:16:01.920 --> 0:16:05.360 Erin I can see, I mean yes, but I'm waiting, 0:16:05.960 --> 0:16:06.640 being patient. 0:16:06.760 --> 0:16:11.200 Okay, we'll see if I have any answers. Hepatitis B 0:16:11.320 --> 0:16:14.960 virus has a lot of different genotypes that vary very 0:16:15.040 --> 0:16:19.960 widely in their overall geographic distribution. However, as we mentioned 0:16:20.040 --> 0:16:22.480 up top, and as we'll talk a lot about towards 0:16:22.480 --> 0:16:25.840 the end of this episode, this is a globally distributed, 0:16:26.320 --> 0:16:28.280 incredibly prevalent. 0:16:27.960 --> 0:16:32.560 Virus, like incredibly incredibly prevalent. 0:16:33.040 --> 0:16:35.400 And it's still, as far as I can tell a 0:16:35.400 --> 0:16:38.880 little bit up for debate whether these different genotypes really 0:16:38.960 --> 0:16:41.800 vary in their tendency to cause chronic infection or in 0:16:41.880 --> 0:16:44.800 their overall disease course. A lot of sources I read 0:16:44.880 --> 0:16:48.040 said that yes, different genotypes kind of have different tendencies 0:16:48.160 --> 0:16:53.120 or characteristics, and some said it's up for debate, so okay. 0:16:53.720 --> 0:16:56.760 But being a virus, this is of course a pathogen 0:16:56.760 --> 0:16:59.880 that has to find its way into our cells, and 0:17:00.040 --> 0:17:03.640 being a virus that infects the liver, it's unsurprising that 0:17:03.720 --> 0:17:07.000 the primary cell type that it infects is our hepatocites, 0:17:07.119 --> 0:17:11.600 our actual liver cells, not the blood vessels in our liver, 0:17:12.040 --> 0:17:15.560 not any of the other things around there, but generally 0:17:15.680 --> 0:17:17.600 our liver cells. 0:17:17.640 --> 0:17:19.600 The things that make up the meat. 0:17:19.840 --> 0:17:24.080 Of the liver exactly, also called the paranama of the liver, 0:17:25.160 --> 0:17:26.160 the fancy word for. 0:17:26.160 --> 0:17:26.840 The meat. 0:17:29.400 --> 0:17:33.879 So hepatitis B is transmitted in very similar ways to 0:17:33.920 --> 0:17:39.080 hepatitis C, as you may remember from several seasons ago now, 0:17:39.160 --> 0:17:44.360 but with a few important caveats. So, hepatitis B can 0:17:44.400 --> 0:17:47.560 be a blood born virus, So anything that involves the 0:17:47.600 --> 0:17:51.920 sharing of blood, whether that's contaminated needles in the healthcare 0:17:51.920 --> 0:17:56.320 setting or in intravenous drug use settings, it can be 0:17:56.359 --> 0:17:59.720 transmitted via blood transfusions, and of course is something that 0:17:59.720 --> 0:18:01.640 we see screen for to try and reduce the. 0:18:01.640 --> 0:18:02.119 Risk of that. 0:18:03.440 --> 0:18:08.200 But hepatitis B is also much more easily transmitted sexually 0:18:08.240 --> 0:18:13.119 compared to hepatitis C. It's present in so many bodily fluids. 0:18:13.680 --> 0:18:14.640 Why is that? 0:18:15.400 --> 0:18:20.080 It's a really good question. I imagine it is largely 0:18:20.119 --> 0:18:25.000 because hepatitis B is very very infectious. As an example, 0:18:26.000 --> 0:18:30.160 according to WHO, it's fifty to one hundred times more 0:18:30.240 --> 0:18:33.159 infectious than HIV WHOA. 0:18:33.440 --> 0:18:37.160 So I know, do we know the reasons for that 0:18:37.480 --> 0:18:39.320 increased infectivity. 0:18:39.720 --> 0:18:43.800 Oh, that's a very good question. I do not, Okay, yeah, 0:18:43.840 --> 0:18:46.479 And I don't also have numbers on like the actual 0:18:46.560 --> 0:18:49.920 infectious dose. I couldn't find a solid answer on that either. 0:18:51.000 --> 0:18:53.600 I do know that it can persist in the environment 0:18:53.880 --> 0:18:56.119 for at least several days. So I think it's a 0:18:56.160 --> 0:18:59.440 pretty hardy virus, so that might be part of it. 0:18:59.560 --> 0:19:06.000 Yeah, Okay, So going back real quick, partially double stranded, 0:19:06.080 --> 0:19:09.399 what's the implication of that in like a virology sense? 0:19:09.440 --> 0:19:12.760 So it's really interesting. Hepatitis B is one of the 0:19:12.840 --> 0:19:16.800 few viruses that's not an RNA virus but uses a 0:19:17.040 --> 0:19:21.040 reverse transcriptase in order to replicate its genome. So HIV 0:19:21.560 --> 0:19:25.560 is an RNA virus that relies on an enzyme reverse 0:19:25.600 --> 0:19:29.840 transcriptase to make a form of DNA in order to 0:19:29.880 --> 0:19:34.399 then replicate, and B also does even though it's a 0:19:34.520 --> 0:19:35.480 DNA virus. 0:19:36.280 --> 0:19:39.080 That is so bizarre, and so I definitely came across 0:19:39.080 --> 0:19:42.440 some of that in the evolution behabers because it kind 0:19:42.440 --> 0:19:44.679 of throws a wrench in things as to like the 0:19:44.800 --> 0:19:48.680 mutation rates, the scale of the molecular clock, blah blah blahh. 0:19:48.400 --> 0:19:50.440 Yeah, and it also, as I'll kind of talk a 0:19:50.480 --> 0:19:53.480 little bit more about later, it allows it to integrate 0:19:53.560 --> 0:19:56.719 into our genome in a way that then sets us 0:19:56.800 --> 0:20:01.920 up for both chronic infection and also potentially cancer right 0:20:01.960 --> 0:20:03.399 and cancer causing mutations. 0:20:03.600 --> 0:20:11.879 Aha, spoilers do other viruses have this partially double stranded 0:20:12.000 --> 0:20:14.520 DNA thing as well. 0:20:14.680 --> 0:20:17.080 I don't know of any other human viruses, but I 0:20:17.119 --> 0:20:19.840 know that there are other animal hepatnaviruses that do. 0:20:19.880 --> 0:20:24.119 Right, Okay, those so that's like the unifying future of hepatnaviruses. 0:20:24.160 --> 0:20:30.600 Okay, yeah, yeah, wow cool? Okay, So hepatitis B is 0:20:30.680 --> 0:20:34.840 also transmitted back to that part of it vertically at 0:20:34.920 --> 0:20:36.280 much higher rates. 0:20:36.760 --> 0:20:36.920 This. 0:20:37.640 --> 0:20:39.679 Let me tell you some numbers. The estimates that I 0:20:39.720 --> 0:20:44.920 read ranged from forty to ninety percent of babies born 0:20:45.000 --> 0:20:48.159 to people living with hepatitis B with chronic hepatitis B 0:20:48.880 --> 0:20:52.960 will become infected with hepatitis if they are not treated. 0:20:53.440 --> 0:20:54.000 Wow. 0:20:54.160 --> 0:20:58.040 And this is in comparison to only six percent of 0:20:58.160 --> 0:21:02.199 people with hepatitis C will then transmit hepatitis C to 0:21:02.280 --> 0:21:03.000 their offspring. 0:21:03.800 --> 0:21:06.359 What is the reason for that difference? 0:21:06.720 --> 0:21:11.520 Again, I think it's largely just how infectious hepatitis B is. Okay, 0:21:11.840 --> 0:21:14.560 But here's something that I think is very interesting and 0:21:15.080 --> 0:21:20.080 important about this vertical transmission of hepatitis B. First of all, 0:21:20.160 --> 0:21:22.639 a lot of times when we talk about vertical transmissions, 0:21:22.680 --> 0:21:27.520 so from parent to offspring, it's wind viruses or bacteria 0:21:27.760 --> 0:21:32.239 can cross the placenta and infective fetus during pregnancy. That 0:21:32.359 --> 0:21:35.800 is not what happens in hepatitis B. The transmission is 0:21:35.840 --> 0:21:40.800 not transplacental. In the vast, vast majority of cases, it's 0:21:40.960 --> 0:21:45.760 happening during the process of childbirth, and it's not happening 0:21:46.080 --> 0:21:50.639 during breastfeeding. It's not happening during pregnancy crossing the placenta. 0:21:50.720 --> 0:21:56.560 It's happening specifically during the period of childbirth, whether that 0:21:56.680 --> 0:22:02.399 birth happens vaginally or VC section. What there is some 0:22:02.600 --> 0:22:05.520 papers that suggest that C section delivery is a slightly 0:22:05.760 --> 0:22:10.680 lower risk, but it's not conclusive. And if you've ever 0:22:10.720 --> 0:22:13.720 seen a delivery of either kind, it kind of makes 0:22:13.760 --> 0:22:17.200 sense because neither one is really less bloody than the other, 0:22:17.640 --> 0:22:20.760 and so many bodily fluids are being exchanged no matter 0:22:20.840 --> 0:22:22.440 what exit root a baby takes. 0:22:22.840 --> 0:22:25.920 It's so it's just like the blood and bodily fluids. 0:22:25.560 --> 0:22:29.560 Blood bodily fluids. It's thought that cervical secretions. So if 0:22:29.560 --> 0:22:32.240 a baby comes out vaginally, and that's why maybe there's 0:22:32.240 --> 0:22:34.840 some thought that it's a slightly higher risk, but the 0:22:34.920 --> 0:22:40.920 data hasn't really borne that out necessarily. What that's very interesting, 0:22:41.040 --> 0:22:43.360 I know, because I didn't really realize that I kind 0:22:43.400 --> 0:22:46.520 of thought that it was something that could be transmitted transpolacentally. 0:22:47.000 --> 0:22:51.000 Yet it's not, and that is really important when we 0:22:51.040 --> 0:22:55.360 talk about how to treat and prevent hepatitis B infection. 0:22:55.560 --> 0:22:56.600 So let me. 0:22:56.800 --> 0:23:02.440 Keep going, shall I? You shall The incubation period of infection, 0:23:02.560 --> 0:23:05.200 the time from when someone gets infected to when they 0:23:05.240 --> 0:23:10.639 show symptoms, can really range anywhere from thirty days to 0:23:10.880 --> 0:23:15.600 up to six months. And I think that this incubation period, 0:23:16.240 --> 0:23:20.439 even noting it incubation period, is interesting because hepatitis B 0:23:21.600 --> 0:23:26.560 is a virus that can be entirely asymptomatic, and chronic 0:23:26.680 --> 0:23:30.960 infection is generally defined as the persistence of a specific 0:23:31.000 --> 0:23:35.679 anigen being able to detect hepatitis b's surface antigen for 0:23:35.920 --> 0:23:39.720 a period of at least six months. So it's interesting 0:23:39.760 --> 0:23:42.320