The Liver Disease and Hepatitis Program, which includes universal newborn hepatitis B vaccination and mass screening and immunization, has eliminated acute HBV and early-onset hepatocellular carcinoma as a public health threat among Alaska Native children, according to a study presented at the World Indigenous Peoples’ Conference on Viral Hepatitis.
“The elements of this program that we introduced — which include screening and interventions to reduce perinatal transmission and universal vaccination — are recommended as the standard of care for all U.S. populations, including Indigenous populations,” Brian J. McMahon, MD, from the Alaska Native Tribal Health Consortium, said in a press release. “Elimination in other populations, however, depends on how effectively those interventions are applied, which might not be as comprehensive as took place in the [Alaskan Native] tribal system.”
According to the National Immunization Survey, established in 1996, HBV vaccine coverage in 1996 among American Indian and Alaska Native children aged 19 months to 35 months residing in Alaska was significantly higher (93.5%; 95% CI, 87.2-100) than among the general U.S. population (81.8%; 95% CI, 80.9-82.7), and remained higher through 2008.
The annual incidence rate of acute HBV among Alaska Native children in Alaska decreased from 19 cases per 100,000 people between 1981 and 1982 to no cases per 100,000 people between 1993 and 1994 with no observed cases since 1992.
Between 1969 and 2008, there were 17 cases of HCC identified in Alaska Native children aged younger than 20 years. While the incidence rates for HCC were 3 per 100,000 people between 1984 and 1988, the rate fell to zero in 1999 and has remained so since (P < .001).
“The widespread impact of our program was related to the rapid reduction of transmission in the entire population accomplished by mass screening and vaccination of all age groups,” McMahon and colleagues wrote. “The Alaska experience can serve a model for control of HBV in other populations. Universal hepatitis B vaccination in infants and catch-up screening and vaccination in children is the most rapid way to achieve the goals of elimination of HCC and chronic HBV infection in children.”
As HCC incidence does not rise substantially until after age 40 years, the researchers recognize that it could take two more decades to confirm the reduction rate of HCC among the study’s population. – by Talitha Bennett
Disclosure: McMahon reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.