Infections from hepatitis A virus (HAV) and hepatitis B virus (HBV) are significant problems in Alaska Natives. Hepatitis A and B vaccines have been routine immunizations in Alaska Natives since 1984 and 1994, respectively. Hepatitis A vaccine is administered to all children over 1 year of age in the US and catch-up hepatitis A virus (HAV) vaccine programs are employed in several states for all children. Hepatitis B vaccine has been administered to all neonates and children in the US for the past decade and to high risk individuals. In addition, chronic hepatitis B and C infections are significant causes of morbidity and mortality from hepatocellular carcinoma (HCC) and cirrhosis in high risk populations in the US. Alaska Natives have one of the highest rates of chronic HBV infection of any ethnic group in the US and a high rate of morbidity and mortality from hepatitis C infection. Not all persons with chronic hepatitis B or C will develop cirrhosis or HCC and the risk factors for progression are not completely elucidated. Population studies are needed to study risk factors for progression of chronic HBV and HCV. The Liver Disease and Hepatitis Program (LDHP) of the Alaska Native Tribal Health Consortium (ANTHC) working collaboratively with the Arctic Investigations Program (AIP) of the Centers for Disease Control and Prevention (CDC) has cohorts of persons who received hepatitis A and B vaccine as infants, children and adults available to determine long-term protection. In addition, the LDHP has recruited large cohorts of Alaska Natives with chronic hepatitis B or C infection. Relevance The strategy and cost effectiveness of hepatitis A and B vaccination programs depends on the supposition that these vaccines will provide long-term protection against hepatitis A and B infection. Also of concern is that persons with chronic hepatitis B or C infection are at-risk to cirrhosis and other serious liver disease. Using several Alaska Native cohorts, studies are proposed to (a) determine the duration of protection against hepatitis A and B infection in persons immunized 15-30 years ago and (b) better understand the treatment and natural history of chronic hepatitis B or C infection.

National Institute of Health (NIH)
National Center for HIV, Viral Hepatitis, STDS and Tb Prevention (NCHHSTP)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZCD1-SMW (01))
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O'Neill, Eduardo
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Alaska Native Tribal Health Consortium
United States
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McMahon, Brian J; Bruden, Dana; Townshend-Bulson, Lisa et al. (2017) Infection With Hepatitis C Virus Genotype 3 Is an Independent Risk Factor for End-Stage Liver Disease, Hepatocellular Carcinoma, and Liver-Related Death. Clin Gastroenterol Hepatol 15:431-437.e2
Plumb, I D; Bulkow, L R; Bruce, M G et al. (2017) Persistence of antibody to Hepatitis A virus 20 years after receipt of Hepatitis A vaccine in Alaska. J Viral Hepat 24:608-612
Bruden, Dana J T; McMahon, Brian J; Townshend-Bulson, Lisa et al. (2017) Risk of end-stage liver disease, hepatocellular carcinoma, and liver-related death by fibrosis stage in the hepatitis C Alaska Cohort. Hepatology 66:37-45
Connelly, Marc; Bruce, Michael G; Bulkow, Lisa et al. (2016) The changing epidemiology and aetiology of hepatocellular carcinoma from 1969 through 2013 in Alaska Native people. Liver Int 36:1829-1835
Simons, Brenna C; Spradling, Philip R; Bruden, Dana J T et al. (2016) A Longitudinal Hepatitis B Vaccine Cohort Demonstrates Long-lasting Hepatitis B Virus (HBV) Cellular Immunity Despite Loss of Antibody Against HBV Surface Antigen. J Infect Dis 214:273-80
Livingston, Stephen E; Townshend-Bulson, Lisa J; Bruden, Dana J T et al. (2016) Results of interferon-based treatments in Alaska Native and American Indian population with chronic hepatitis C. Int J Circumpolar Health 75:30696
McMahon, Brian J; Bulkow, Lisa; Simons, Brenna et al. (2014) Relationship between level of hepatitis B virus DNA and liver disease: a population-based study of hepatitis B e antigen-negative persons with hepatitis B. Clin Gastroenterol Hepatol 12:701-6.e1-3
Raczniak, Gregory A; Thomas, Timothy K; Bulkow, Lisa R et al. (2013) Duration of protection against hepatitis A for the current two-dose vaccine compared to a three-dose vaccine schedule in children. Vaccine 31:2152-5
Raczniak, Gregory A; Bulkow, Lisa R; Bruce, Michael G et al. (2013) Long-term immunogenicity of hepatitis A virus vaccine in Alaska 17 years after initial childhood series. J Infect Dis 207:493-6
Tohme, Rania A; Bulkow, Lisa; Homan, Chriss E et al. (2013) Rates and risk factors for hepatitis B reactivation in a cohort of persons in the inactive phase of chronic hepatitis B-Alaska, 2001-2010. J Clin Virol 58:396-400