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Alaska's history of handling hepatitis

May 4th 1:03 pm | Brian McMahon Print this article   Email this article   Create a Shortlink for this article

In the 1970s, Alaska had some of the nation's highest levels of hepatitis A and B infections. Nearly 40 years later, Alaska health care providers and professionals are world leaders in prevention, control and treatment of viral hepatitis.

Successful Alaska vaccine programs have pioneered a model that is now used for prevention and control of hepatitis globally by groups like the World Health Organization and the Gates Foundation, which supports universal infant vaccination in more than 150 countries. The Institute of Medicine recommended to the U.S. government a screening, vaccination, comprehensive care and treatment program that parallels the current program already in place in Alaska.

For Alaska, becoming a world leader didn't happen overnight.

Hepatitis was rampant around Alaska in the 1970s. Alaskans had the nation's highest incidence of acute hepatitis A (HAV) infection; Alaska Natives in Western Alaska had the highest rate of acute hepatitis B virus (HBV) infection in the U.S. and the highest rate of HBV-related liver cancer of any U.S.-born ethnic group; and there was a disproportionate rate of liver cancer among Alaska Native children, ultimately resulting in death.

Staff from the Alaska Native Tribal Health Consortium (ANTHC) — then known as the Alaska Area Native Health Service — teamed with the Arctic Investigations Program (AIP) of the Centers for Disease Control and Prevention for research. They found HBV primarily spread from infected mothers to their children and from child to child through open cuts and scratches, and even from environmental surfaces such as school lunch room tabletops. The virus survived for long periods outside the body. HAV spread through contaminated water and food, and close personal contact with ill persons.

By the '80s, a trial for a HBV vaccine used in the Yukon-Kuskokwim and Norton Sound regions prevented infection and inspired a grassroots effort by several Alaska Native tribal health corporations. The effort prompted the Alaska congressional delegation to introduce legislation to fund a pioneering HBV control program.

The program was the world's first designed to vaccinate all newborns, screen as many Alaska Natives as possible, and vaccinate those never exposed to this virus. Altogether 52,000 Alaska Natives (three-quarters of the population at that time) were screened and 40,000 vaccinated. In a short time, new infections from HBV in the Yukon-Kuskokwim Delta disappeared and Alaska had the lowest HBV rate in the U.S. Since the mid-'90s, no child has had an HBV-related liver cancer.

However, more than 1,500 Alaska Natives in remote communities were found to have chronic hepatitis B, and for them, the vaccine was too late. Their lifetime risk of dying of liver cancer or cirrhosis was projected to be about 25 percent without intervention. A program was established to monitor these people and detect liver cancer early, when it might be cured by surgery. Previously, anyone with liver cancer died within six months. Fifteen years after institution, 70 percent of liver cancers can be found early and half of those Alaska Natives were alive and cancer free 10 years later.

Just as acute hepatitis B was getting under control, an HAV outbreak caused four deaths and serious illness in more than 4,000 people. ANTHC's Liver Disease and Hepatitis Program (LDHP) and the AIP, working with the State of Alaska and several Alaska Native health corporations, conducted a trial. By giving the majority of residents just one shot, the epidemic ended in 25 communities. The vaccine was licensed and is now a universal vaccine for all Alaska children. Alaska has gone from the U.S.'s highest rate of hepatitis A to its lowest.

In the late 1990s, antiviral agents were used to treat people with chronic HBV infection and very active liver disease — the drugs decreased the risk of liver cancer. LDHP now follows 1,100 Alaska Natives with chronic hepatitis B by drawing blood at regional clinics or in villages and sending the blood for testing at the Alaska Native Medical Center, where they are reviewed weekly.

First discovered in 1992, the hepatitis C virus (HCV) has infected 2 percent of the U.S. population, including more than 2,000 Alaska Natives. Alaska Natives with chronic HCV are 15 times more likely to die of liver disease than Alaska Natives without HCV. LDHP works to learn more about this disease and to identify and treat Alaska Natives who are at the highest risk of cirrhosis or liver cancer.

Through diligence, collaboration, innovation and action, Alaska is now a leader in hepatitis care and prevention. LDHP conducts several research projects, including studying how long protection from HAV and HBV vaccinations will last and if booster doses are needed. They also study new blood tests that might better detect liver cancer and cirrhosis early.

These studies have captured worldwide attention and have great potential benefits not only for Alaska Native people, but for populations in the U.S. and around the world.

Dr. Brian McMahon is the director of the Liver Disease and Hepatitis Program at the Alaska Native Tribal Health Consortium.

 


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