Efforts to End Viral Hepatitis in Indigenous People Show Promise

WASHINGTON — Many indigenous populations suffer from high rates of viral hepatitis, and are 2 to 5 times as likely as the surrounding general population to contract it. But efforts to eliminate the diseases have begun to show promise, some researchers say.

Globally, 71 million people have hepatitis C and 257 million have hepatitis B. The viruses cause inflammation of the liver and can lead to cirrhosis and, especially with hepatitis C, liver cancer.

Most cases come from contact with infected blood, drug use, tattoos with unclean needles, or sexual transmission. Before the screening of blood in 1992, blood transfusions were a frequent source. The infection also can pass from a mother to her newborn child.

At the World Indigenous People’s Conference on Viral Hepatitis this week in Anchorage, Alaska, scientists reported on the problem and the efforts to solve it, including one of the first efforts to eliminate hepatitis C from a population.

Reasons for high rates of infection

Homie Razavi and Devin Razavi-Shearer, epidemiologists from the Polaris Observatory, examined why infection rates were so high among indigenous communities. In Canada, hepatitis B rates were five times higher than the general population, and hepatitis C, three times higher. In Australia, indigenous people were four times as likely to contract hepatitis B and three times as likely to contract hepatitis C.

The researchers said the rates were likely because to “disproportionately high rates of poverty, injection drug use, and incarceration in indigenous populations. This, in combination with the lack of access to health care and prevention measures, greatly increases the risk and thus prevalence of hepatitis C.”

But great progress is being made. In the 1980s, vaccination programs began to cut infection rates of hepatitis B.

Dr. Brian McMahon, director of the Alaska Native Tribal Health Consortium, told the conference that new surveys have shown that the disease has been virtually eliminated in young indigenous people in Alaska.

Eliminating infection

Jorge Mera, director of infectious diseases for Cherokee Nation Health Services in Oklahoma, reported on an effort there to eliminate hepatitis C.

“Of the people we think have hepatitis C in the community, we’ve treated one-third of them,” he told VOA, “and that’s pretty good for a program that we started two years ago.”

That program is the first effort in the United States, and one of the first in the world, to attempt to wipe out the virus. Treatments for hepatitis C have improved dramatically over the past decade, making these efforts possible.

Mera said there are many programs around the world in the planning stages, and he pointed to a number of things those programs can learn from the Cherokee Nation’s effort.

“Most of the patients that we’re detecting positive are coming in through the urgent care and emergency department,” he said, “so if you have limited resources, these are areas that I would focus on.”

Health officials in the Cherokee Nation are screening everyone between the ages of 20 and 69. This effort includes screening people during dental appointments.

The Centers for Disease Control and Prevention has recommended screening older adults, but Mera said there were high rates of hepatitis infection in people in their 20s and 30s. He suggested that others setting up elimination programs first determine the prevalence of infection in their respective communities before deciding whom to screen.

He said history has led to high rates of hepatitis in indigenous populations.

“When you have a population that has been oppressed or traumatized for centuries due to the nature of how the Western colonization process developed, those are factors that may lead substantial portions of that population to seek some relief in nonconventional ways like intravenous drug use,” Mera said.

Preventing transmission is crucial to eliminating hepatitis C, Mera said. One way to combat transmission, he said, is to legalize and expand needle exchanges and opiate-substitution programs.

STP

 

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