Elimination of Hepatitis B virus transmission in an endemic area in Western Alaska

IJID Regions · 2025-09-27

Objectives: In the US, hepatitis B virus (HBV) is only endemic in western Alaska, where 90% of the population are Alaska Native (AN) peoples; in the 1970s, the incidence of hepatocellular carcinoma (HCC) in children was the highest in the world. In the 1980s, we screened 53,860 AN peoples for HBV infection, administered HBV vaccine to 43,618 HBV seronegative persons, and initiated universal newborn vaccination. In this study, we examine the impact of this effort 40 years later. Methods: This is a population-based outcome study. We used vaccine and electronic health records to examine rates of newborn vaccination between 2015 and 2019 and changes in HBV incidence rates, as well as the prevalence of HCC in persons under 30 years of age over a 50-year period. Results: Between 2015 and 2019, approximately 90% of newborns received an HBV birth dose, and over 80% received a second HBV vaccine dose by 18 months of age. Annual incidence of new hepatitis B surface antigen-positive tests among AN peoples ranged from 1.4-2.6 per 100,000, down from 6.2 between 1993 and 1997. No hepatitis B surface antigen-positive or HCC cases have been identified in AN peoples under 20 since 1993. Conclusions: Mass population-based vaccination of seronegative persons, with continuing universal newborn immunization, halted transmission of HBV in western Alaska.

Standardising HBV nomenclature: a call to action from the HBV Forum

˜The œLancet. Gastroenterology & hepatology · 2025-05-29 · 1 citations

HCC surveillance in hepatitis C: A longitudinal algorithm improves alpha-fetoprotein screening

Hepatology Communications · 2025-05-23 · 2 citations

BACKGROUND: Surveillance for HCC remains important after hepatitis C cure. Improved sensitivity of screening with alpha-fetoprotein (AFP) by using a parametric empirical Bayes (PEB) algorithm, which incorporates an individual patient's longitudinal AFP measurements, was previously demonstrated in a retrospective analysis of clinical trial data prior to widespread hepatitis C cure. METHODS: We analyzed de-identified data extracted from the medical records of participants in the Alaska Hepatitis C Study, which aims to enroll all Alaska Native persons living in Alaska with a history of hepatitis C.We compared the performance characteristics of AFP as a screening test using the PEB method versus a fixed cutoff (FC) method in an observational setting, separately for HCC surveillance in active and cured hepatitis C. RESULTS: The PEB and FC methods were applied to AFP levels from participants with F3/F4 fibrosis who had active hepatitis C (173 no HCC, 14 HCC) or after they achieved hepatitis C cure (162 no HCC, 12 HCC). Compared to a fixed 20 ng/mL cutoff, demonstrating 91.2% specificity in active hepatitis C, PEB increased sensitivity from 64.3% to 71.4%. After cure, a fixed 7.2 ng/mL cutoff demonstrated 91.2% specificity, and PEB increased sensitivity from 58.3% to 91.7%. CONCLUSIONS: The PEB algorithm can increase sensitivity and lead to earlier detection of HCC among patients with F3/F4 fibrosis, both in active and even more so in cured hepatitis C. Lower AFP levels after cure indicate that for either PEB or FC methods, screening parameters, such as cutoffs for a target specificity, should be specified separately by hepatitis C treatment status for HCC surveillance.

Heat Transfer Enhancement to Transcritical Hydrocarbons due to Wall Roughness within Microtube Heat Exchangers

SSRN Electronic Journal · 2025-01-01

Modeling 5-Year Hepatocellular Carcinoma Risk in Alaska Native Peoples With Hepatitis B Virus Infection

Gastro Hep Advances · 2025-01-01

Background and Aims: Modeling hepatocellular carcinoma (HCC) risk in Alaska Native (AN) peoples with chronic hepatitis B virus (HBV) infection is important for risk stratification and surveillance. Existing HCC risk prediction models use baseline characteristics ascertained at the time of HBV diagnosis, rather than predicting HCC risk within 5 years of a relevant time point (such as a clinic visit), and do not include the HBV genotype (GT). We aimed to develop an HCC risk prediction model that addresses these limitations. Methods: We used longitudinal data from a cohort of 1163 AN peoples with HBV. We considered age, sex, GT, serum alpha fetoprotein (AFP), along with serum alanine transaminase, albumin, aspartate aminotransferase, bilirubin, hepatitis B-e-antigen, platelet count, and fibrosis 4 score. To build a 5-year risk model, we structured the longitudinal data into multiple 5-year segments, using AFP as the landmark biomarker. We used the generalized estimation equation approach as well as the Random Forest approach to build risk prediction models. Results: Among the 11 predictors included in our final models, AFP was the most important followed by platelet count and GT. Based on cross-validation, the generalized estimation equation model had an area under the receiver operating characteristic curve of 0.81, with 46.5% sensitivity at 90% specificity for 5-year HCC risk prediction. The Random Forest model was superior with an area under the receiver operating characteristic curve of 0.88 and 70% sensitivity at 90% specificity, outperforming the PAGE-B, mPAGE-B, REACH-B and REAL-B models. Conclusion: We developed an HCC risk prediction model using rich information from different time points in a patient's disease trajectory. Our model can accurately estimate HCC risk at different time points during follow-up for risk stratification and risk-based surveillance.

Changes in liver stiffness measurements following hepatitis C sustained virologic response among Alaska Native adults treated with sofosbuvir-based direct acting anti-viral therapy

International Journal of Circumpolar Health · 2025-07-29

= 0.827). The majority of AN/AI adults successfully treated with sofosbuvir-based DAAs experienced a reduction in LSM, with LSM subsequently remaining stable up to 4 years following end-of-treatment. Liver function and blood-based estimates of fibrosis also improved. The most important predictor of LSM improvement was pre-treatment fibrosis stage.

Atypical Presentation of Appendicitis Leading to Exploratory Laparotomy

Cureus · 2024-04-08 · 1 citations

Appendicitis typically presents with characteristic symptoms such as right lower quadrant abdominal pain, localizing to McBurney's point, facilitating diagnosis. Here, we report a case of a 19-year-old female who exhibited atypical manifestations, including lower abdominal pain and associated hematochezia. Despite inconclusive findings from imaging modalities and laboratory investigations, persistent pain prompted exploratory laparotomy, revealing appendicitis. This case highlights the diagnostic challenge posed by variant presentations of appendicitis, emphasizing the importance of clinical judgment and vigilance in surgical decision-making.

Sa1625 FIBROSIS REDUCTION IN ALASKA NATIVE/AMERICAN INDIAN PEOPLES TREATED WITH SOFOSBUVIR-BASED DIRECT ACTING ANTIVIRALS 2014-2018

Gastroenterology · 2024-05-01

Factors Associated With Hepatitis A Seropositivity at 23 Years After Childhood Vaccination

Open Forum Infectious Diseases · 2024-06-28 · 1 citations

We evaluated factors associated with the presence of hepatitis A virus antibodies 23 years after initiating vaccination at ages 6-15 months. Among 67 participants, 86% (42/49) of those vaccinated at ages 12-15 months and 61% (11/18) of those vaccinated at 6 months remained seropositive at 23 years. Lack of maternal antibodies at enrollment and higher initial vaccine response were independently associated with higher antibody concentrations at 23 years. Further research is needed to assess the duration of hepatitis A vaccine protection and possible need for a booster dose.