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Figure. Fujian in focus.
Within the Fujian Province of China, the following regions
send the most immigrants from China into the United States: Fuzhou, Changle, and Fuqing.
From reference 1.

On the southeast coast of China’s mainland lies the mountainous Fujian Province. Although it is one of China’s smaller provinces, Fujian is one of the largest sources of immigration from China into the United States (Figure).1

Qing Yeh, MD, was born in the Fujian Province and now runs a private internal medicine practice in New York City’s Chinatown. In this bustling ethnic neighborhood, Dr. Yeh serves a large Fujianese-American patient population. Dr. Yeh noted that because 90% of his patients are Chinese, most are immigrants and often carriers of the hepatitis B virus (HBV). His observation also is supported by a recent epidemiologic survey, which found that 23.46% of individuals from the Fujian Province in China are hepatitis B surface antigen–positive.2

Dr. Yeh attributes the high rate of chronic hepatitis B (CHB) infections in this region to a lack of proper prenatal care. “Vertical transmission is still an issue because a lot of immigrants to New York City are mostly farmers from remote areas in the Fujian province.”

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Qing Yeh, MD

According to Dr. Yeh, low education and literacy levels are other factors that may prevent Fujianese individuals with CHB from presenting for care. “They are farmers and they are not necessarily well-educated, and most of them only have elementary school education levels before they [leave Fujian],” he added.

In his experience, Asian-American patients will specifically come to Chinatown, New York City, to seek physicians who speak their language. “When patients come to America they have a language barrier and they are afraid to seek medical care, especially if they do not have legal status. They come to Chinatown because they feel more comfortable, especially because some doctors speak Fujianese, so communication-wise it is much easier,” said Dr. Yeh. The screening rate for CHB is very high in Dr. Yeh’s community; however, he noted that individuals who come from other parts of the country might not receive screening.

“There are still physicians out there who think CHB is not a common disease and they don’t treat it. Some of my patients have been in the United States for many years, went to high school here but never got screened, and the first time they maybe got pregnant [or] came in for a check-up, they find out that they are HBV-positive,” he explained.

In order to improve care and lower the incidence of CHB in the Fujianese-American population, Dr. Yeh believes that increased importance must be placed on screening, patient education, and awareness among the medical community.

“A lot of my patients got turned back from other states. Physicians don’t want to or don’t know how to treat these patients, so sometimes [the physician] will ask me to send a fax of what to order for medication,” said Dr. Yeh. He described one such physician in Seattle, Washington, who asked him to write an order. They did the patient workup in Seattle and then sent the results back to Dr. Yeh’s office in New York. “Now I’m going to write the prescription for [the physician] so my patient does not have to travel back and forth,” he added.

However, there are still many Fujianese- or other Chinese-American patients who rely on herbal remedies to cure or treat their CHB. “If individuals are afraid to go to a medical clinic or hospital, they will go to the newspaper. If you go to a Chinese newspaper, or even Vietnamese and Korean newspapers, there are a lot of herbal remedies that claim effectiveness and no side effects, cure everything, and they believe that,” Dr. Yeh said.

Despite the hurdles that Dr. Yeh faces when treating patients with CHB, he is proud of the progress made thus far. “Over the years in Chinatown, patient awareness of CHB has been much, much better compared with 10 years ago. I need less effort to educate patients on what HBV is, because they have basic knowledge.”

“The good news regarding CHB treatment is that the current antiviral regimen has been very effective in terms of viral suppression and liver function normalization, as well as liver histologic improvement. It has given our community providers and patients more confidence in CHB management,” added Dr. Yeh.

Although the prevalence of CHB remains high among Fujianese immigrants, Dr. Yeh is optimistic about the future. “Now we have younger immigrants coming here and they are more educated and more open to Western medicine, so it is much easier to screen them, and medical care is more accessible if they need it.”

References

  1. Liang Z, White MJ. In: Kyle D, Koslowski R, eds. Global Human Smuggling: Comparative Perspectives. Baltimore, MD: Johns Hopkins University Press; 2001:204-230.
  2. Lin S, Liu C, Shang H, et al. HBV serum markers of 49164 patients and their relationships to HBV genotype in Fujian province of China. J Clin Lab Anal. 2013;27(2):130-136.

B In the Know

  • In 2011, China had the highest total number of immigrants into the United States at 83,603*
  • Of the 27.9 million people who immigrated to the United States from 1974 to 2008, 63% were born in countries with high or intermediate CHB prevalence**
  • Between 1974 and 2008, about 1.3 million new cases of CHB were imported into the United States**
  • There were 57,600 cases of CHB per year between 2004 and 2008 (including an average of 53,800 imported cases per year and 3,800 cases of US-acquired infections)**
  • Of these aforementioned 57,600 cases, ~25% of people may develop fatal complications if proper medical management is not provided**
**Mitchell T, Armstrong GL, Hu DJ, et al. The increasing burden of imported chronic hepatitis B—United States, 1974-2008. PLoS One. 2011;6(12):1-6.