Hepatitis B, relatively rare in the United States, is a "silent killer" of people of Asian descent, who are 20 to 30 times more likely to be infected than other ethnic groups. While comprising just 3.6 percent of the U.S. population, Asians account for half the nation's patients with hepatitis B, which can lead to cirrhosis of the liver, liver cancer and death. From 5 percent to 15 percent of people in U.S. Asian communities are infected, depending on the locale. A recent University of California-Irvine study of 828 Vietnamese people in Orange County age 18 and older found that 13 percent had hepatitis B and 69 percent had been exposed to it.

Laws in 31 states now require that children be vaccinated for the disease when they enter middle school, but some people are asking why federal and local authorities are not spending more money to warn older children and young adults -- particularly in Asian communities -- about the need for testing and vaccination.

Doctors and activists in Orange County's Little Saigon -- the world's largest community of expatriate Vietnamese -- say they hear the subject discussed on Vietnamese-language TV and radio. But community activist Diep Tran said she knows of no government outreach program. "The community is aware of hepatitis B and liver cancer, but they don't know the extent of how the disease spreads, how you contract it or what the treatment is," she said. Vietnamese men have the highest rate of liver cancer in the world, much of it caused by hepatitis B, said Steven McPhee, a UC-San Francisco professor of medicine and principal investigator at the Vietnamese Health Promotion Project.

Hepatitis B is spread by oral or sexual contact and is endemic in much of Asia. Many are exposed during birth. It is also passed from child to child because of childhood scrapes, skin diseases or kids sharing toothbrushes. Hepatitis B is 100 times more easily transmitted than HIV, said Dr. Gary Euler, an epidemiologist for the National Immunization Project at CDC. Euler said the latest estimates are that two-thirds of children of Asian origin ages 2-18 have been vaccinated.

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