Liver Disease and Hepatitis Program

Bethel, Alaska, United States

Liver Disease and Hepatitis Program

Bethel, Alaska, United States
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McMahon B.J.,Liver Disease and Hepatitis Program | Block J.,Hepatitis B Foundation | Haber B.,Children's Hospital of Philadelphia | London T.,Fox Chase Cancer Center | And 3 more authors.
American Journal of Medicine | Year: 2012

Chronic infection with the hepatitis B virus can lead to hepatocellular carcinoma and cirrhosis in up to 25% of infected individuals. As many as 2 million individuals in the US may have chronic hepatitis B infection, most of whom immigrated to the US from hepatitis B-endemic regions of the world. A 2010 report from the Institute of Medicine noted that two thirds of patients with hepatitis B are unaware of their infection, and most health care providers do not screen for hepatitis B or know how to manage hepatitis B-positive patients. In 2010, the Hepatitis B Foundation convened a group of primary care providers to consider the existing evidenced-based recommendations and strategies for implementation of hepatitis B screening into routine practice. The group designed an easy-to-use algorithm for screening, initial evaluation, ongoing management, and referral to a subspecialist when appropriate. Internal medicine specialists, including primary care providers and subspecialists, need to understand the steps they can take to address this often under-recognized disorder. © 2012 Elsevier Inc.

Bruce M.G.,Centers for Disease Control and Prevention | Bruden D.,Centers for Disease Control and Prevention | Hurlburt D.,Centers for Disease Control and Prevention | Zanis C.,Centers for Disease Control and Prevention | And 10 more authors.
Journal of Infectious Diseases | Year: 2016

Background. The duration of protection in children and adults resulting from hepatitis B vaccination is unknown. In 1981, we immunized a cohort of 1578 Alaska Native adults and children from 15 Alaska communities aged ≥6 months using 3 doses of plasma-derived hepatitis B vaccine. Methods. Persons were tested for antibody to hepatitis B surface antigen (anti-HBs) levels 30 years after receiving the primary series. Those with levels <10 mIU/mL received 1 booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days after the booster. Results. Among 243 persons (56%) who responded to the original primary series but received no subsequent doses during the 30-year period, 125 (51%) had an anti-HBs level ≥10 mIU/mL. Among participants with anti-HBs levels <10 mIU/mL who were available for follow-up, 75 of 85 (88%) responded to a booster dose with an anti-HBs level ≥10 mIU/mL at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 30 years. Conclusions. Based on anti-HBs level ≥10 mIU/mL at 30 years and an 88% booster dose response, we estimate that ≥90% of participants had evidence of protection 30 years later. Booster doses are not needed. © 2016 Published by Oxford University Press for the Infectious Diseases Society of America 2016.

McMahon B.J.,Liver Disease and Hepatitis Program | McMahon B.J.,Centers for Disease Control and Prevention | Bulkow L.R.,Centers for Disease Control and Prevention | Singleton R.J.,Liver Disease and Hepatitis Program | And 5 more authors.
Hepatology | Year: 2011

Alaska Native people experience the highest rates of acute and chronic hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC) in the United States. We examined the effect of a universal newborn immunization with hepatitis B vaccine and mass population screening immunization program initiated in 1984 on rates of HBV and HCC in children 25 years later. During this time, the population of Alaska Native people grew from an estimated 75,000 to 130,000 persons. A surveillance system to detect acute HBV infection in Alaska Native facilities was established in 1981. Cases of HCC in children under 20 years of age were identified using a National Cancer Institute (NCI)-funded Cancer Registry established in 1969 coupled with an active surveillance program of screening persons with chronic HBV semiannually for alpha-fetoprotein since 1982. The incidence of acute symptomatic HBV infection in persons <20 years of age fell from cases 19/100,000 in 1981-1982 to 0/100,000 in 1993-1994. No cases of acute HBV have occurred in children since 1992. The incidence of HCC in persons <20 years decreased from 3/100,000 in 1984-1988 to zero in 1995-1999 and no cases have occurred since 1999. The number of identified hepatitis B surface antigen-positive children <20 years in the Alaska Native population declined from 657 in 1987 to two in 2008. Conclusion: Universal newborn vaccination coupled with mass screening and immunization of susceptible Alaska Natives has eliminated HCC and acute symptomatic HBV infection among Alaska Native children and this approach is the best way to prevent HBV-related disease in children. © 2011 American Association for the Study of Liver Diseases.

PubMed | Liver Disease and Hepatitis Program
Type: | Journal: F1000 medicine reports | Year: 2010

In the past two years, several national and international bodies have made recommendations and published updated practice guidelines for hepatitis B. In addition, new drugs have become available for treatment of hepatitis B. This article will review the new recommendations for screening for hepatitis B and for first-line antiviral medications to use for treatment. In addition, I will discuss the recent recommendations on treating hepatitis B and human immunodeficiency virus co-infection and the screening of people receiving immunosuppressive therapy.

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