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 在阿拉斯加实施普遍的儿童疫苗接种之前，阿拉斯加本地人的乙型肝炎 比其他种族/族裔人口高五倍以上。[2]需要进一步的数据 确定丙型肝炎的可能要求疫苗促进剂量以确保持续保护。 丙型肝炎病毒（HBV）会导致慢性感染，导致肝脏，肝癌，肝衰竭，肝硬化， 和死亡。[4] [5]很像乙型肝炎A疫苗，儿童，儿童，乙型肝炎免疫策略 青少年和成年人显着降低了急性和慢性的发病率和患病率 乙型肝炎感染。[6]乙型肝炎B疫苗接种后的完整保护持续时间 因此，是否需要加强剂量的疫苗来维持针对HBV感染的保护 不确定。对于在出生时发起丙型肝炎疫苗的人来说，重要性更高。最近的 数据，包括来自阿拉斯加土著部落健康财团，肝病和肝炎计划的数据 研究团队表明，随着新生儿失去保护性抗体，接种疫苗的人比例增加 与儿童或成人接种疫苗相比。[7，8]在乙型肝炎疫苗接种之前，患病率 阿拉斯加土著人中的乙型肝炎感染是地方性的。[9]尽管乙型肝炎的发生率 自从阿拉斯加本地婴儿，儿童和成人实施疫苗接种以来，急剧下降 仍有大量的阿拉斯加原住民长期感染了HBV，并留在 疾病后遗症的风险增加，包括肝细胞癌。[10]阿拉斯加的土著人长期 感染HBV的还表现出肝细胞癌的发生率增加 人。[11]除慢性HBV外，其他慢性肝病病因包括慢性丙型肝炎，非 - 酒精性脂肪肝病和自身免疫性肝炎已被证明会引起大量发病率和 阿拉斯加土著人的死亡率。[12] [13]慢性临床管理的进一步并发症 阿拉斯加的B和C型乙型肝炎是由于人口的偏远和缺乏专业护理的途径所致。 需要新的诊断测试，这些测试较小，更敏感并且不需要专业临床 服务。我们建议通过确定疫苗的进一步持续时间来解决这些公共卫生问题 乙型肝炎和乙型肝炎疫苗可为儿童和成人提供的保护 纵向人群。我们还打算衡量临床干预措施对 与慢性丙型肝炎和慢性丙型肝炎有关的死亡率和发病率，包括筛查，早期 诊断和治疗。安全地延迟升高剂量的丙型肝炎或丙型肝炎的需求 疫苗可以从暴露于这些病毒和节省医疗保健成本的安全性上。理解 临床干预措施的影响可以为慢性病毒肝炎预后提供新的诊断工具 以及新的临床管理策略，可用于各种医疗机构。