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The Paid Leave Podcast
Paid Leave is a hot topic in our country right now. The United States is the only industrialized nation in the world without a national paid leave policy, and Connecticut is one of only 13 states and the District of Columbia to have a state program in place. Other cities and states are working to join the paid leave movement. The Paid Leave Podcast examines the state of Connecticut's paid leave program and the impact it has on various groups and diverse communities. Radio veteran Nancy Barrow interviews the people who fought to make paid leave a reality in Connecticut, and those who will ultimately benefit from the program. The states with paid leave include Connecticut, Rhode Island, California, New Jersey, New York, Washington, Massachusetts, Oregon, Maryland, Delaware, Minnesota, Colorado, Vermont, New Hampshire, Illinois, Minnesota and the district of Washington, D.C.
The Paid Leave Podcast
Breaking Down Hepatitis with a Yale Medical Expert
In this episode of The Paid Leave Podcast, I speak with a liver specialist from the Yale School of Medicine. World Hepatitis Day is observed each year on July 28th to raise awareness of viral hepatitis. The theme for 2025 is: "Hepatitis, Let’s Break it Down." It calls for urgent action to dismantle the financial, social and systemic barriers including stigma that stand in the way of hepatitis elimination and liver cancer prevention. I spoke with Yale's Dr. Bubu Banini, who is an assistant professor of medicine at the Yale School of Medicine, and works at the Yale Liver Center and volunteers on a regular basis with the American Liver Foundation. Dr. Banini goes on to explain the importance of the liver and the various types of viral hepatitis (A, B, C, D, E, G). She highlights the social barriers and is hoping to negate the stigma associated with liver diseases. Dr. Banini also discusses the effectiveness of vaccinations and treatments for chronic viral hepatitis, such as hepatitis C, and the importance of mental health support for patients. Dr. Banini emphasizes the benefits of the Connecticut Paid Leave program for caregivers and patients dealing with chronic liver diseases.
For more information about the American Liver Foundation please go to their website at: Liver - American Liver Foundation
For more information about the Yale Liver center: Yale Liver Center < Liver Center
To get in touch with Dr. Bubu Banini please go to: Bubu Banini, MD, PhD < Yale School of Medicine
For more information or to apply for benefits please go to: CT Paid Leave
https://ctpaidleave.org/s/?language=en_US
https://www.facebook.com/CTPaidLeave
https://www.instagram.com/ctpaidleave/
https://twitter.com/CTPaidLeave
https://www.youtube.com/results?search_query=ct+paid+leave
Hello Connecticut, give you information you should know about Connecticut Paid Leave and maybe just a little World Hepatitis Day is observed each year on July 28, to raise awareness of viral hepatitis an inflammation of the liver. The theme for 2025 is "Hepatitis. Let's break it down." It calls for urgent action to dismantle the financial, the social and systemic barriers, including stigma, that stand in the way of hepatitis elimination and liver cancer prevention. Millions of Americans from all walks of life are living with viral hepatitis, and most don't know they even have the virus. More than half of the people living with hepatitis don't know they have it and are unknowingly transmitting the virus to others. Here to talk more about hepatitis, is Dr Bubu Banini. Dr Bubu Banini is an assistant professor at the Yale School of Medicine, where she also serves as the Translational Research Director of the metabolic health and weight management program. She also serves as the Associate Director of the clinical and translational core of the Yale liver Center. Dr Banini has board certifications in gastroenterology, transplant hepatology and obesity medicine. Her clinical and research interests are in chronic liver diseases, specifically metabolic dysfunction associated sciatic liver disease. Dr Banini recently co chaired the fatty liver disease working group established by the Connecticut State General Assembly to provide recommendations to the state on how to increase awareness and to improve care for people living with liver disease. She serves on various boards and committees, including study sections of the National Institutes of Health committees bit more. Connecticut Paid Leave brings peace of mind to your for the American Association for the Study of Liver Diseases and the American Gastroenterology Association and on the National Medical Visionary Advisory Board for the American Liver home, family and workplace. Welcome to The Paid Leave Foundation. Welcome to The Paid Leave podcast Dr. Banini. Podcast!
Dr. Banini:Thank you so very much. Nancy, it's a pleasure to be here today.
Nancy Barrow:Since we're here to talk about World Hepatitis Day, yes. What is hepatitis?
Dr. Banini:Yes so when we say hepatitis, it really is a term that refers to inflammation of the liver. And in that word, it doesn't really tell you what is causing the inflammation. So essentially, you know, layman's terms is just hepatitis means inflammation. And so we are able to further characterize what the inflammation is related to by saying viral hepatitis, or alcohol, as you should say, hepatitis. So the World Hepatitis Day, as you mentioned, is coming up on the 28th of July, and that the focus of that is on viral hepatitis. This is in recognition of the fact that there are various viruses that can lead to inflammation of the liver, hepatitis, as I mentioned, and over time, some forms of those hepatitis infections can cause long term damage that can cause chronic liver disease, that can then put the individual at risk for end stage liver disease and cancer. So these can really be very serious.
Nancy Barrow:How do they usually get diagnosed? And it is ike a simple blood test that let's you know you have heapatitis or is there more testing that needs to get done?
Dr. Banini:Yeah, that's a good question. That's a great question. A lot of times, the patient may present with what we call jaundice, so yellowing of their eyes and skin, and that really is a signal that there's something severely wrong with the liver. And as you mentioned, typically, the diagnosis is blood based. And so the different types of hepatitis that one can get our viral hepatitis A, or have a, for short, we can also have viral hepatitis B, hepatitis C, hepatitis D and hepatitis E, as well as the newest form of viral hepatitis, which is hepatitis G. You know, viral hepatitis G was identified in 1995 so about 30 years ago, and so we do not know much about it in comparison with other hepatitis that have been around for for much longer. And so some people refer to viral hepatitis G as human Peggy virus one. So HP, HPG, v1, that is another name for that.
Nancy Barrow:Interesting. So what are the differences with A, B, C, D and E? And how do they affect you differently?
Dr. Banini:So viral hepatitis A typically causes acute hepatitis. It is a highly contagious, usually short term form of viral hepatitis infection, and that can spread quickly from person to person when they consume contaminated foods or drinks. Oh, wow. It can cause severe inflammation to the liver, and it is typically prevented by vaccination. So a lot of times, individuals may get a vaccine which combines viral hepatitis A and B, and with that series of vaccinations, it protects them from contracting the infection when they are exposed. So despite that, unfortunately, some individuals still succumb to viral hepatitis A in the setting of not having been vaccinated. So usually we. Have about 100 deaths a year in the US related to viral hepatitis. You We also mentioned the other types of viral hepatitis, B and C are the most common forms of chronic viral hepatitis that we encounter. There is a large percentage of patients who will clear the infection shortly after they contract it. However, a percentage of individuals who contracted go on to develop a chronic infection from hepatitis B or C. We also have viral hepatitis D, which a lot of times we see it piggybacking on viral hepatitis B, so those who have viral hepatitis B have a more higher risk of also contracting hepatitis D, and that can also lead to severe liver injury, especially in the setting of having both viral hepatitis B and D and then E. I mentioned as well. That can also be found in contaminated foods, so typically a shed through the stool of infected individuals, and we see that causing disease, and typically in young children and in pregnant individuals. I touch briefly on hepatitis G as well, and then Human Immunodeficiency Virus or HIV can also cause severe liver disease, and we see that sometimes occurring together with chronic viral hepatitis C. So an individual may have co infection, which means there's both HIV and chronic hepatitis C affecting the liver.
Nancy Barrow:Are they all contagious?
Dr. Banini:So they are so contagious in terms of the fact that, yes, they can be spread from one person to the other through different ways. As I mentioned, the subtypes of viral hepatitis A and E can be found spread through contaminated foods, contaminated drinks, viral hepatitis B and C typically spread through coming into contact with infected body fluids. So that could be using the same household items that exposes one person's blood to the other, or through sexual contact or using needles, for instance, that are infected, whether it is through IV drug use, or sometimes in healthcare workers, where they happen to have a needle prick from a patient who may have had chronic viral hepatitis B or C that can be spread to them through that means.
Nancy Barrow:Boy, that's that's a little bit scary. What are some of the treatments for the different forms of hepatitis? Are there treatments that that work, and can they be cured?
Dr. Banini:Yes, yes. So absolutely. The good news is that we do have treatments, especially for the chronic viral hepatitis subtypes, so chronic viral hepatitis C can be cured with almost close to 100% cure rate. And that really was not the case, you know, a couple of decades ago, or actually even less than that time, in a matter of few months, they would have close 100% cure, if they are consistent with taking it as prescribed. So that is really a great success that we're able to offer that.
Nancy Barrow:Yeah and how about a and b and and and D. Are they more difficult to treat?
Dr. Banini:Yeah so, viral hepatitis A, typically, we are able to support patients through the acute infection supportive care, being able to, you know, give them things like Tylenol and fluids and helping with whether other symptoms that they contract. And a lot of times, they're able to get through that acute viral hepatitis A infection. Again, the goal is to prevent getting it in the first place. So if
Nancy Barrow:How do you prevent it? That's, that's a great segueway, like, how do you prevent it, though?
Dr. Banini:Key I think is having access or getting that vaccine, if you are able to, I mentioned that we have vaccinations that are available for very. Viral hepatitis A and viral hepatitis B, hepatitis C does not have a vaccine, but we do have it for hepatitis A and B and so typically, with the series of vaccinations. So for viral hepatitis A is two vaccinations done at, you know, baseline and then after six months. And for hepatitis B, is three vaccinations, then at baseline, at one month, and then at six months. And that really gives you protection from from contracting it. If one has not had the vaccination for protection, then you really want to be careful in terms of what you're eating, what you're drinking, and that's in the case of viral hepatitis A, because, like I mentioned, it can be contracted through exposure to dirty foods and drinks, and for viral hepatitis B and C, making sure that you really are vigilant with contacts, in terms of sexual contacts, in terms of in the healthcare field, being careful not to expose yourself to contaminated needles that may cause that. Another way through which people can contract chronic viral hepatitis B and C is through tattoos. So now, now, methods for tattoos are a lot more sanitary than several years ago, where people would sort of have tattoos done by their friends and their garage or and unfortunately, sometimes the needles that I use for those tattoos are not properly standardized, and so if that needle was used in an individual who had chronic viral hepatitis and then used on the next person, there was the chance that it could get transmitted to them. And then something else that I wanted to mention is the opioid epidemic. Unfortunately, we've heard about that ravaging our communities in the past several years, and that was another way through which chronic viral hepatitis could be transmitted from one person using a needle to inject opioids and then the next person using the same needle. So there was a period of time where we were seeing an uptick, especially in chronic viral hepatitis C related to the opioid epidemic, and thankfully, over the last year, so it seems to be going down. So that that really is something for people to be aware of.
Nancy Barrow:Do some forms of hepatitis cause liver failure or liver cancer?
Dr. Banini:Yes, really, any kind of acute viral hepatitis infection can increase the risk of liver failure, and this occurs when the infection is so severe that it really overwhelms the body and starts to shut down. The liver is function. And as I mentioned, we work with a number of other specialists as because we know that the liver is very interconnected with other organs. And so really, in true sense of the word failure, liver failure means the liver really cannot sustain its multiple functions. I mentioned that there are over 500 different functions that the liver can do. And so in that setting, then we start to look into the possibility of the individual getting a liver transplant, because that sometimes is the only way through which the person can be saved. So that happens typically in the setting of acute viral hepatitis infection. I do want to note that sometimes when individuals have chronic viral hepatitis infection, they can be a reactivation of flare of that chronic viral hepatitis so we see that sometimes in those who have chronic viral hepatitis B, that the disease has been under fairly good control for several years, and then you may have a flare, which then puts them into acute liver injury, and that can lead to failure. And then, in terms of chronic viral hepatitis infection, any kind of hepatitis. And going back to the beginning of the program, I mentioned that hepatitis really refers to inflammation of the liver. And so any thing that continuously makes the liver inflamed, this doesn't go away. It keeps on causing inflammation. And day in, day out, continuously, can put the liver at risk for scarring. And in the medical terms, we refer to scarring of fibrosis, and it is an attempt by the liver to regenerate and recover from that chronic insult that it keeps seeing, and as it keeps on trying to regenerate, it gets more cells, and some of them really put the liver at risk for having that scar tissue, and also put the liver at risk for becoming cancerous. So we do see individuals with chronic liver disease developing cancer when persons have the most advanced form of scarring. So typically when you develop scarring, it starts mild, and then they it can advance. And advanced scarring, which we call fibrosis, stage four or cirrhosis, increases the risk for liver cancer. And so we are very vigilant in those individuals that have advanced scarring or advanced fibrosis, we need to image their liver every six months so that, God forbid, they ever get liver cancer. We can't catch the cancer early, because sooner we catch the liver cancer, the more options available to offer the patient, as opposed to when the liver cancer is caught too late, at that time, we don't have good options for cure.
Nancy Barrow:Well, this year's theme is hepatitis. Let's break it down, and it calls for action to dismantle the financial, social and systemic barriers, including stigma. Let's talk about this. Why is there such a stigma attached to hepatitis?
Dr. Banini:I think it is due to a number of factors. So when we think about chronic viral hepatitis, hepatitis B, hepatitis C, a number of ways that people contracted, as I mentioned, is through contact with others body fluids that have already been infected. So whether it's through IV needle use, IV drug use, or through sexual contact, and I think there is a stigma in that setting, that when someone sees that they have hepatitis then everybody, everybody may be looking at them as having engaged in one of those practices, whether it's through drug use or having had unprotected sex with someone who had the disease. And so there's stigma in that way. There's also stigma in other forms of chronic liver disease, for instance, alcohol related liver disease. So in that setting, typically, we find that alcohol liver disease affects those who use moderate to high amounts of alcohol, and so the individual may not be willing to share that they have alcohol dependence, because of the stigma that comes from society in sort of looking at that person and judging them as having engaged in those habits. And so in recognition of that stigma, actually the the N I triple A, which is the national association that looks at alcohol abuse disorders has recommended using terminology that is non stigmatizing, so that instead of saying alcoholic, we are encouraged to Say alcohol associated, so that people are getting away from using alcoholic liver disease to saying alcohol associated liver disease, instead of seeing alcohol addiction or someone has engaged in alcoholism, we would say alcohol use disorder again, To take away that stigma of putting almost the blame on the person and recognizing that is a disorder that resulted in that, just as any other disorder can really result in disease.
Nancy Barrow:Connecticut Paid Leave helps offer up to 12 weeks of income replacement while you take time away from work to tend to your own serious health condition or that of a loved one. So you can take time away from work and get income replacement to diagnose or treat hepatitis and if it's a chronic health condition, like you had mentioned, you can take those 12 weeks year after year if there are flare ups. How does a program like Connecticut paid leave help your patients and their caregivers?
Dr. Banini:Yeah. I mean, it is very challenging at times to take care of someone who has a chronic liver disease when the disease is in advanced stages or when it's very severe and individuals need to get a liver transplant. For instance, it would require the primary caregiver to take time off to care for their loved ones, because really they need almost 20 or seven care and attention in that setting. So that Connecticut paid leave would give patients and also their caregivers the peace of mind that they can take the time off that is necessary to care for their loved ones, but still be able to pay their bills even while they do that.
Nancy Barrow:Yeah, I know I stress during that time is not good for you either. So, so I think connected leave is sort of like a stress reliever in the fact that you don't have to worry about paying your bills.
Dr. Banini:Absolutely that really, I mean, with everything that's going through, taking away that stress that comes with financial strain is a big help.
Nancy Barrow:Do you encourage people to seek mental health care when they have a diagnosis of hepatitis?
Dr. Banini:Yes, I think it can be very mentally and psychologically challenging. Not everybody, necessarily may need mental health support, but there are some individuals, especially those that may have had the disease for several years and ended up having complications from those conditions. Might be my benefit from speaking to a mental health provider to get the support that is necessary. I encourage my patients that as much as they are providers that are trained to care for their body. They are also providers are trained to care for their mind, and so patients should all their caregivers should not have hesitation about asking for support for for their mind, because we know that the mind really works very closely with the body, and supporting both of those components is essential.
Nancy Barrow:What would you like to see happen duringWorld Hepatitis Day on July 28th?
Dr. Banini:I think this is a great avenue for people to learn about hepatitis, learn about viral hepatitis, learn about other types of chronic liver diseases and build awareness. We know that more than half of people who have chronic liver disease, including hepatitis, do not know, and that's why the transmission rate can also be high, because without knowing, they don't take the necessary precaution to prevent transmitting it to other people. And so I think this is really a great avenue for education for all parties involved, to try and move forward knowledge about the liver, and also try and move forward knowledge about how to care for those with chronic liver disease, I do want to put a plug in that, as much as we are celebrating World Hepatitis Day on July 28 the state of Connecticut also in recognition especially of the fact that metabolic dysfunction associated liver disease is causing a high prevalence of chronic liver disease in Connecticut and other parts of the US came up, put together a working group for which I was fortunate to co chair last year and earlier this year, and we put forward a set of 20 recommendations to the state as to how we can increase awareness of chronic liver disease. And Connecticut is going to have its first Connecticut liver health day next April. April 19, 2026, so I'm excited about that. So I think these really are avenues to increase awareness about chronic liver disease.
Nancy Barrow:I want to thank my incredible guest and brilliant guest, Dr Bubu Banini from the Yale School of Medicine, for joining me on the paid leave podcast. Thank you so much for taking time out of your very busy schedule to join us. I know you're really busy!
Dr. Banini:Thank you so very much. Nancy, it's been a pleasure!
Nancy Barrow:For more information or to apply for benefits, please go to ctpaidleave.org. This has been another edition of The Paid Leave Podcast. Please like and subscribe, so you'll be notified about new podcasts that become available. Connecticut Paid Leave is a public act with a personal purpose. I'm Nancy Barrow, and thanks for listening.
