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

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.