Background: A high prevalence of hepatitis B (HBV) infection exists in Alaska, especially among Alaska Natives. Studies illustrate a strong association between chronic HBV infection and hepatocellular carcinoma (HCC).
Objective: To monitor the health status of Alaska Natives infected with chronic hepatitis B via a computerized Hepatitis B Registry.
Method: Phase One. A sero-survey (1982-87) of over 53,000 Alaska Natives was conducted to identify hepatitis B surface antigen (HBsAg) carriers, followed by hepatitis B immunization of sero-negative individuals in high-risk groups and routine infant immunization. Phase Two, Hepatitis B Registry. Biannually (1982-current) follow-up HbsAg carriers and complete blood draws to monitor alpha-fetoprotein (AFP) level, which is used to detect early HCC.
Results: Hepatitis B surface antigen carriers (N=1,487) were identified and followed-up for the development of HCC. Tumor-free survival rates for carriers having a normal AFP level on initial screening and who later developed HCC were 29% (P=.004) at 5 years and 24% (P=.024) at 10 years. After introducing routine infant hepatitis B immunization, a 1994 sero-survey revealed no Alaska Native HBV carriers under age ten.
Conclusions: Use of the Hepatitis B Registry has facilitated biannual AFP screening of HBsAg carriers and significantly improved the survival rates of Alaska Natives who develop HCC. Biannual screening also allows us to evaluate carriers who may be pregnant, thereby giving us an opportunity to prevent perinatal HBV transmission via hepatitis B immunization. Health care professionals serving Alaska Natives and other endemic populations might consider the potential benefits of establishing disease registries.
Learning Objectives: At the conclusion of this session, the participant in this session will be able to: 1. Understand the association between chronic hepatitis B infection and hepatocellular caricinoma. 2. Understand the process and health benefits of utilizing a Hepatitis B Registry. 3. Discuss the potential benefits of establishing disease registries for Alaska Natives or other populations they may serve.
Keywords: Hepatitis B, Disease Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Alaska Native Medical Center
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed as Deputy Director of the Viral Hepatitis Program