A new law in California requires health care facilities to offer adult clients free screenings for hepatitis B and hepatitis C, both of which cause inflammation of the liver and can lead to cancer, the need for a liver transplant and death. The law also requires that care and treatment be provided for those who test positive. 

Governor Gavin Newsom signed the bill, AB 789, into law in October. California is the first state to mandate the hepatitis tests be offered.

“AB 789 is an important, lifesaving legislation that would help end the silent epidemic of liver disease and liver cancer deaths in California caused by untreated hepatitis B and C,” Samuel So, MD, a Stanford University School of Medicine professor and director of the Asian Liver Center, told The Bay Area Reporter.

“Hepatitis B disproportionately impacts our Asian-American communities,” added bill cosponsor Assemblyman David Chiu (D–San Francisco). “By signing this bill, California is equipping patients with the information they need and working to address disparate health outcomes in communities of color. Expanding access to hepatitis B and C screenings will save lives in California.”

In California, about 90% of people with chronic hep B are members of the Asian American and Pacific Islander communities, reported KQED in a segment on the new law. African Americans have the second highest rate of chronic infection in the state.

Currently, there is no cure for hepatitis B virus (HBV), an effective vaccine is available. The Basics section titled “What Is Hepatitis B?” offers more information:

The virus is easily spread via hep B–positive blood, semen or other body fluid. Pregnant women who have hepatitis B can also transmit the virus to their babies, usually during birth. People who have not been infected with HBV can be vaccinated against the virus to prevent infection.

There are two phases of hepatitis B infection: acute and chronic. Acute refers to a new infection that is less than six months old; an HBV infection that lasts more than six months is chronic. Acute hepatitis B will resolve on its own without serious complications in the majority of newly infected teens and adults. When this occurs, people are no longer contagious and are immune to further HBV infections. However, in people whose infection does not resolve, HBV may be transmitted to others. Chronic hep B can cause fibrosis (mild to moderate liver scarring), cirrhosis (serious liver scarring), liver cancer, liver failure and death.

The risk that a hepatitis B infection will become chronic varies according to the age at the time of infection. In the United States, approximately 90% of infants and 25% to 50% of children under age 5 will remain chronically infected with HBV. In adults, roughly 95% recover completely.

Because of routine HBV vaccination, the number of new hepatitis B infections in the United States has declined from about 260,000 a year in the 1980s to nearly 21,000 in 2016, with the greatest decline occurring in children and adolescents.

Unlike hepatitis B, there is no vaccine for hepatitis C, although effective cures are now common. According to Hep’s Basics section about hepatitis C, the virus is transmitted when the blood of an infected person passes into the blood of an uninfected person. Hepatitis C virus (HCV) is most easily spread through direct blood-to-blood contact, such as:

  • Sharing needles and other equipment (paraphernalia) used to inject drugs. Injection drug users who share needles, syringes and paraphernalia associated with injecting are at the highest risk for HCV.

  • Blood transfusions and organ transplants before July 1992. Widespread screening of the blood supply in the United States began in 1992.

  • Sexual contact with someone who has HCV. The risk of becoming infected with hepatitis C through unprotected sexual intercourse is low, but it is still possible. HCV sexual transmission risk is higher among those who are HIV positive and in men who have sex with men. Sex with multiple partners, having a sexually transmitted disease and rough sex may increase the risk of transmitting HCV sexually.

  • Having an HCV-positive mother. Women who are infected with hepatitis C have a 6% chance of passing the virus along to their babies during pregnancy or delivery. The risk increases significantly if the woman has HIV, hepatitis B or a high HCV viral load (the amount of HCV in a measurement of blood). The hepatitis C transmission risk is doubled or tripled in women with HIV. It is unlikely that hep C can be transmitted through breastfeeding or breast milk.

Hepatitis C treatment has improved immensely in the past decade. Today, the infection is curable, and the treatment is easier, shorter and safer than ever, often entailing daily tablets for 12 to 24 weeks. You can learn about it, including the various Food and Drug Administration–approved medications in our Hepatitis C Treatment section.

In related news, last month an advisory panel at the Centers for Disease Control and Prevention recommended that all adults younger than 60 be vaccinated against hepatitis B. However, hep B vaccinations became a standard recommendation for children beginning in 1991, which means that most adults born in the United States and younger than 30 years old are already vaccinated.