NATURAL HISTORY PREVENTION OF VIRAL HEPATITIS IN ALASKA NATIVE PEOPLE

甲型肝炎病毒(HAV)和乙肝病毒(乙肝)的感染是 阿拉斯加原住民。甲型和乙型肝炎疫苗已成为阿拉斯加当地人的常规免疫接种 分别是1984年和1994年以来。所有1岁以上的儿童都接种甲型肝炎疫苗 美国的年龄和追赶甲型肝炎病毒(HAV)疫苗计划在 为所有儿童提供几个州。所有新生儿都接种了乙肝疫苗， 过去十年美国的儿童和高危人群。 此外，慢性乙肝和丙型肝炎感染是发病率和死亡率的重要原因。 美国高危人群中的肝细胞癌和肝硬变。阿拉斯加州 土著居民的慢性乙肝病毒感染率是美国所有种族中最高的之一 丙型肝炎的发病率和死亡率都很高。并不是所有的慢性病患者 乙型或丙型肝炎会发展成肝硬变或肝细胞癌，而进展的危险因素不是 完全阐明了。需要进行人口研究来研究疾病进展的危险因素。 慢性乙肝和丙型肝炎。 阿拉斯加土著部落健康联盟的肝病和肝炎计划(LDHP) (ANTHC)与该中心的北极调查方案(AIP)合作 疾病控制和预防中心(CDC)有一批甲型和乙型肝炎患者 疫苗作为婴幼儿、儿童和成人可获得的长期保护措施。此外, LDHP招募了大量患有慢性乙肝或丙型肝炎的阿拉斯加原住民。 相关性 甲型和乙型肝炎疫苗接种计划的战略和成本效益取决于 假设这些疫苗将对甲型和乙型肝炎提供长期保护 感染。同样令人关注的是，慢性乙肝或丙型肝炎感染者有患上 肝硬变等严重肝病。利用几个阿拉斯加原住民队列，研究 建议(A)确定预防甲型和乙型肝炎感染的保护期 15-30年前接种疫苗的人和(B)更好地了解治疗和自然病史 慢性乙型或丙型肝炎感染。

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.