Natural History and Prevention of Viral Hepatitis Among Alaska Natives

阿拉斯加原住民病毒性肝炎的自然史和预防

• 批准号: 8686648
• 负责人: Brian James McMahon
• 金额: $ 18.19万
• 依托单位: ALASKA NATIVE TRIBAL HEALTH CONSORTIUM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8686648
• 关键词: Natural; History; Prevention; Viral; Hepatitis

Project Summary Prior to implementing universal childhood vaccination in Alaska, rates of hepatitis A in Alaska Native persons were more than five times higher than those in other racial/ethnic populations.[2] Further data are needed to determine the possible requirement of hepatitis A vaccine booster doses to ensure continued protection. Hepatitis B virus (HBV) can cause chronic infection, resulting in cirrhosis of the liver, liver cancer, liver failure, and death.[4] [5] Much like the hepatitis A vaccine, hepatitis B immunization strategies for infants, children, adolescents and adults have significantly decreased the incidence and prevalence of acute and chronic hepatitis B infection.[6] The complete duration of protection after primary vaccination with hepatitis B vaccine and thus whether booster doses of vaccine to maintain protection against HBV infection are required is undetermined. There is elevated importance for persons who initiated hepatitis B vaccination at birth. Recent data, including that from the Alaska Native Tribal Health Consortium, Liver Disease and Hepatitis Program research team, suggest an increased proportion of persons vaccinated as newborns lose protective antibody compared with those vaccinated as children or adults.[7, 8] Prior to hepatitis B vaccination, prevalence of hepatitis B infection amongst Alaska Native persons was endemic.[9] Although hepatitis B incidence has declined dramatically since implementation of vaccination among Alaska Native infants, children and adults, there remain a substantial number of Alaska Native persons chronically infected with HBV and remain at an increased risk of disease sequelae including hepatocellular carcinoma.[10] Alaska Native persons chronically infected with HBV also exhibited increased incidence of hepatocellular carcinoma amongst younger people.[11] In addition to chronic HBV, other chronic liver disease etiologies including chronic hepatitis C, non- alcoholic fatty liver disease and autoimmune hepatitis have been shown to cause substantial morbidity and mortality among Alaska Native persons.[12] [13] Further complication in the clinical management of chronic hepatitis B and C in Alaska is due to the remoteness of the population and the lack of access to specialty care. New diagnostic tests are needed that are less invasive, more sensitive and do not require specialty clinical service. We propose to address these public health issues by determining the further duration of vaccine protection afforded by both hepatitis A and hepatitis B vaccines in children and adults in well-established longitudinal cohorts. We also intend to measure the effectiveness and impact of clinical interventions on mortality and morbidity associated with chronic hepatitis B and chronic hepatitis C including screening, early diagnostics and treatment. To safely delay the need for booster doses of either hepatitis A or hepatitis B vaccines can result in both safety from exposure to these viruses and healthcare cost savings. Understanding the influence of clinical interventions can provide new diagnostic tools for chronic viral hepatitis outcome as well as new clinical management strategies that could be useful to apply in a variety of healthcare settings.

项目摘要 在阿拉斯加实施普及儿童疫苗接种之前，阿拉斯加土著人的甲型肝炎发病率 比其他种族/民族人群高五倍以上。[2]需要更多的数据， 确定可能需要的甲型肝炎疫苗加强剂量，以确保持续的保护。 B型肝炎病毒（HBV）可引起慢性感染，导致肝硬化、肝癌、肝功能衰竭， 与死[4][5]就像甲型肝炎疫苗一样，婴儿、儿童、 青少年和成人的急性和慢性疾病的发病率和患病率显著降低， B型肝炎感染。[6]初次接种B型肝炎疫苗后的完整保护期 因此，是否需要加强剂量的疫苗来维持对HBV感染的保护， 不确定。对于出生时就开始接种B型肝炎疫苗的人来说，这一点非常重要。最近 数据，包括来自阿拉斯加土著部落健康联盟，肝病和肝炎计划 研究小组建议，随着新生儿失去保护性抗体，接种疫苗的人数比例增加 与儿童或成人接种疫苗的人相比。[7，8]接种B型肝炎疫苗前， 在阿拉斯加土著人中，B型肝炎感染是地方病。[9]虽然B型肝炎的发病率 自从在阿拉斯加土著婴儿、儿童和成人中实施疫苗接种以来， 仍然有相当数量的阿拉斯加土著人慢性感染HBV， 增加疾病后遗症的风险，包括肝细胞癌。[10]阿拉斯加原住民 HBV感染者也表现出肝细胞癌的发病率增加， 人[11]除慢性HBV外，其他慢性肝病病因包括慢性丙型肝炎、非乙型肝炎和乙型肝炎。 酒精性脂肪肝病和自身免疫性肝炎已经显示出可引起大量的发病率， 阿拉斯加原住民的死亡率。[12][13]在慢性胰腺炎的临床管理中， 在阿拉斯加，B型和C型肝炎是由于人口偏远和缺乏专业护理。 需要新的诊断测试，侵入性更小，更敏感，不需要专业的临床 的服务.我们建议通过确定疫苗的进一步使用期限来解决这些公共卫生问题 甲型肝炎和B型肝炎疫苗在儿童和成人中提供的保护， 纵向队列我们还打算衡量临床干预的有效性和影响， 与慢性B型肝炎和慢性丙型肝炎相关的死亡率和发病率，包括筛查、早期 诊断和治疗。安全地延迟对甲型肝炎或B型肝炎加强剂量的需求 疫苗既可以避免接触这些病毒，又可以节省医疗费用。理解 临床干预的影响可以为慢性病毒性肝炎的结局提供新的诊断工具， 以及新的临床管理策略，可用于各种医疗保健环境。