The viral hepatitis Northern : A Platform for Addressing Viral Hepatitis in the Canadian North

Regions: North Slave Region

Tags: health, social sciences, sexually transmitted infection

Principal Investigator: Minuk, Gerald Y (1)
Licence Number: 14722
Organization: Section of Hepatology, Health Sciences Centre, University of Manitoba, JBRC
Licenced Year(s): 2010
Issued: May 20, 2010
Project Team: Minuk G (PI, University of Manitoba), Uhanova Julia (Statistician and Data Analysis, University of Manitoba), Sokol Issac (Medical Officer of health, Nunavut), Osiowy C (Virologist, National Microbiology Laboratory), Larke Bryce (Virilogist and Consultatnt, University of Alberta), Preiksaitis Jutta (Virologist and Serum Bank management , University of Alberta), Schutt V (Research Coordinator, University of Manitoba)

Objective(s): To increase the awareness and confidence of Northern health care providers when managing patients with chronic HBV infections; To compare HBV mutations from infected Northern Canadians with benign outcomes to those from Alaska (and perhaps Greenland) who have gone on to develop cirrhosis or HCC;and To identify individuals with HBsAg positive and occult HBV in 1983-85 and describe their clinical outcomes over the intervening 25-30 years.

Project Description: The objectives of the present proposal are threefold:
1) To increase the awareness and confidence of Northern health care providers when managing patients with chronic HBV infections;
2) To compare HBV mutations from infected Northern Canadians with benign outcomes to those from Alaska ( and perhaps Greenland) who have gone on to develop cirrhosis or HCC; and
3) To identify individuals with HBsAg positive and occult HBV in 1983-85 and describe their clinical outcomes over the intervening 25-30 years.

The applicants will distribute to all Northern Nursing stations specifically designed computer software programs that outline all aspects of HBV management. They will also travel to 2-3 Northern communities and provide tutorials and seminars to community representatives, caregivers and government officials on HBV. These mailings and visits will serve to establish lines of communication between the research team and individual Nursing Stations.

The applicants will also analyze and compare the rate, nature and sites of viral genomic mutations in paired sera from Alaskan Eskimo (and perhaps Inuit from Greenland) where HBV- induced cirrhosis and HCC are common with those already described in Canadian Inuit with benign clinical outcomes. Finally, clinics will be held in 2-3 large Northern communities where HBsAg positive and occult HBV carriers (identified by PCR testing of 1983-85 stored sera from those communities) will be invited to undergo clinical assessments, blood testing and ultrasound examinations of the liver for evidence of advanced liver disease and HCC.

Relevance: This proposal will serve to link experts in the field of viral hepatitis with that segment of the Canadian population (Inuit and First Nations) with the highest rates of HBV infections in the country.
The proposal will provide important insights into the molecular biology of HBV and its pathogenesis and hitherto unavailable community- based data regarding the prevalence and clinical relevance of occult HBV infection. Together, these data are essential for the development of safe, efficient and practical strategies for managing HBV in Circumpolar populations.

The study will help to identify which of the 3-5% of Northern Canadians with Hepatitis B viral infections are at greatest risk of developing cirrhosis (extensive scarring of the liver) and/or liver cancer. By doing so, doctors and nurses will better be able to identify who needs treatment and/or cancer screening. The establishment of a database for HBV infected individuals that will assist in their health care for decades to come.

Written information about the results of the evaluations will be sent to the nurse in charge at the Bechoko nursing station, who will forward the findings to participants. Dr. Minuk as the PI also plans to present the results in an aggregate form to meetings with health officer and nurses in Iqaluit and Yellowknife.

The fieldwork for this study will be conducted from May 21, 2010 to December 31, 2010.