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1.  Chronic Liver Disease-Associated Hospitalizations Among Adults with Diabetes, National Inpatient Sample, 2001–2012 
Public Health Reports  2015;130(6):693-703.
Objective
Many people with diabetes have a variety of diabetes-related complications. Among the variety of conditions associated with diabetes, however, liver diseases are less well recognized. As such, we aimed to describe chronic liver disease (CLD)-associated hospitalization rates among U.S. adults with diabetes from 2001–2012.
Methods
We used a nationally representative database of hospitalizations, the National Inpatient Sample, to determine CLD-associated hospitalization rates among U.S. adults aged ≥18 years with and without diabetes, from 2001–2012. Hospitalizations listing an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for CLD on the discharge record were selected for analysis and were further classified by diabetes status based on concurrent presence of a diabetes ICD-9-CM code. We calculated average annual age-adjusted hospitalization rates and 95% confidence intervals (CIs), and conducted a test for trend.
Results
For 2001–2012, the total age-adjusted CLD-associated hospitalization rate among adults with diabetes (1,680.9 per 100,000 population; 95% CI 1,577.2, 1,784.6) was approximately four times the rate of adults without diabetes (424.2 per 100,000 population; 95% CI 413.4, 435.1). Total age-adjusted hospitalization rates of adults with and without diabetes increased 59% and 48%, respectively, from 2001–2002 to 2011–2012 (p<0.001). Hepatitis C- and chronic hepatitis and cirrhosis-associated hospitalizations comprised the largest proportion of total CLD-associated hospitalizations among adults with and without diabetes.
Conclusion
Providers should be aware of the potential existence of CLD among adults with diabetes and counsel patients on preventive methods to avoid progressive liver damage.
PMCID: PMC4612178  PMID: 26556941
2.  Hepatitis B Vaccination Coverage Among Health-Care Personnel in the United States 
Public Health Reports  2013;128(6):498-509.
Objectives
We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP.
Methods
We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥1- and ≥3-dose HepB vaccine coverage among HCP aged ≥18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004–2010 NHIS.
Results
Overall, 69.5% (95% confidence interval [CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥1 and ≥3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥1 and ≥3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010.
Conclusion
The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.
PMCID: PMC3804093  PMID: 24179261
3.  Changing Trends in Viral Hepatitis-Associated Hospitalizations in the American Indian/Alaska Native Population, 1995–2007 
Public Health Reports  2011;126(6):816-825.
SYNOPSIS
Objective
We described the changing epidemiology of viral hepatitis among the American Indian/Alaska Native (AI/AN) population that uses Indian Health Service (IHS) health care.
Methods
We used hospital discharge data from the IHS National Patient Information Reporting System to determine rates of hepatitis A-, B-, and C-associated hospitalization among AI/ANs using IHS health care from 1995–2007 and summary periods 1995–1997 and 2005–2007.
Results
Hepatitis A-associated hospitalization rates among AI/AN people decreased from 4.9 per 100,000 population during 1995–1997 to 0.8 per 100,000 population during 2005–2007 (risk ratio [RR] = 0.2, 95% confidence interval [CI] 0.1, 0.2). While there was no significant change in the overall hepatitis B-associated hospitalization rate between time periods, the average annual rate in people aged 45–64 years increased by 109% (RR=2.1, 95% CI 1.4, 3.2). Between the two time periods, the hepatitis C-associated hospitalization rate rose from 13.0 to 55.0 per 100,000 population (RR=4.2, 95% CI 3.8, 4.7), an increase of 323%. The hepatitis C-associated hospitalization rate was highest among people aged 45–64 years, males, and those in the Alaska region.
Conclusions
Hepatitis A has decreased to near-eradication levels among the AI/AN population using IHS health care. Hepatitis C-associated hospitalizations increased significantly; however, there was no significant change in hepatitis B-associated hospitalizations. Emphasis should be placed on continued universal childhood and adolescent hepatitis B vaccination and improved vaccination of high-risk adults. Prevention and education efforts should focus on decreasing hepatitis C risk behaviors and identifying people with hepatitis C infection so they may be referred for treatment.
PMCID: PMC3185317  PMID: 22043097
4.  Characterizing wild bird contact and seropositivity to highly pathogenic avian influenza A (H5N1) virus in Alaskan residents 
Background
Highly pathogenic avian influenza A (HPAI) H5N1 viruses have infected poultry and wild birds on three continents with more than 600 reported human cases (59% mortality) since 2003. Wild aquatic birds are the natural reservoir for avian influenza A viruses, and migratory birds have been documented with HPAI H5N1 virus infection. Since 2005, clade 2.2 HPAI H5N1 viruses have spread from Asia to many countries.
Objectives
We conducted a cross-sectional seroepidemiological survey in Anchorage and western Alaska to identify possible behaviors associated with migratory bird exposure and measure seropositivity to HPAI H5N1.
Methods
We enrolled rural subsistence bird hunters and their families, urban sport hunters, wildlife biologists, and a comparison group without bird contact. We interviewed participants regarding their exposures to wild birds and collected blood to perform serologic testing for antibodies against a clade 2.2 HPAI H5N1 virus strain.
Results
Hunters and wildlife biologists reported exposures to wild migratory birds that may confer risk of infection with avian influenza A viruses, although none of the 916 participants had evidence of seropositivity to HPAI H5N1.
Conclusions
We characterized wild bird contact among Alaskans and behaviors that may influence risk of infection with avian influenza A viruses. Such knowledge can inform surveillance and risk communication surrounding HPAI H5N1 and other influenza viruses in a population with exposure to wild birds at a crossroads of intercontinental migratory flyways.
doi:10.1111/irv.12253
PMCID: PMC4181814  PMID: 24828535
Alaska; H5N1; influenza
5.  Long-Term Immunogenicity of Hepatitis A Virus Vaccine in Alaska 17 Years After Initial Childhood Series 
The Journal of Infectious Diseases  2012;207(3):493-496.
The Centers for Disease Control and Prevention recommends hepatitis A virus (HAV) vaccination for all children at age 1 year and for high-risk adults. The vaccine is highly effective; however, protection duration is unknown. We report HAV antibody concentrations 17 years after childhood immunization, demonstrating that protective antibody levels remain and have stabilized over the past 7 years.
doi:10.1093/infdis/jis710
PMCID: PMC3611760  PMID: 23204169
hepatitis A; inactivated hepatitis A vaccine; enterovirus infections; immunogenicity; infectious hepatitis

Results 1-5 (5)