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

An internet-based software program on Viral Hepatitis care in the North was developed, implemented, distributed, and is being regularly updated. The program allows healthcare providers to learn about HBV and diagnose/manage infected persons more effectively. The various forms of hepatitis B can be divided into more aggressive forms (subtypes B2-5) that frequently result in cirrhosis/liver cancer and more "benign" forms (subtypes B1 or B6) that rarely do so. Team members analyzed samples from Northern Canadians known to be infected with hepatitis B in the early 1980s. Representative sera from the 1983-85 serum bank were identified and transferred to the investigator's laboratory for testing for occult hepatitis B virus infection. The results revealed that the majority of Northern Canadians are infected with the more "benign" B6 subtype. Moreover, the amount of virus present in the circulation was relatively low, another predictor of a good outcome. The study also determined what percent of Northern Canadians are infected despite testing negative by standard diagnostic tests. Finally, the virus itself was analyzed to determine why in some instances it does not cause problems while in others, cirrhosis or liver cancer develop. The latter project was performed in conjunction with researchers from the United States and Denmark. Because HBV-induced rates of cirrhosis and liver cancer are higher in Alaska and Greenland than Northern Canada, collaborations were secured with investigators from these regions who submitted samples from infected individuals. The samples were used for genotyping, sequencing and identifying which HBV mutations are associated with adverse versus benign outcomes.一款面向北部地区病毒性肝炎（Viral Hepatitis）诊疗的互联网软件已完成开发、部署与推广，并持续定期更新。该程序可帮助医疗从业者了解乙型肝炎病毒（HBV）相关知识，并更高效地完成感染者的诊断与管理工作。乙型肝炎的不同分型可分为侵袭性更强的亚型（B2-5型）与更具“良性”的亚型（B1或B6型）：前者常引发肝硬化/肝癌，后者则极少出现此类并发症。研究团队于20世纪80年代初，对已确诊感染乙型肝炎的加拿大北部居民样本展开分析。研究人员从1983-1985年的血清库（serum bank）中筛选出代表性血清样本，并移送至研究者所在实验室，用于隐匿性乙型肝炎病毒感染（occult hepatitis B virus infection）检测。检测结果显示，多数加拿大北部居民感染的是更具“良性”的B6亚型；且感染者循环血液中的病毒载量相对较低，这也是预后良好的另一项预测指标。本研究同时明确了在标准诊断检测呈阴性的加拿大北部居民中，仍存在乙型肝炎病毒感染的人群比例。最后，研究团队对病毒本身进行分析，以探究为何部分感染者不会出现相关症状，而另一部分感染者则会发展为肝硬化或肝癌。该项后续研究与美国及丹麦的研究人员合作完成。由于阿拉斯加与格陵兰地区的乙型肝炎病毒相关肝硬化及肝癌发病率高于加拿大北部，研究团队与这两个地区的研究者建立了合作，获取了感染者的样本。这些样本被用于基因分型、测序，以及鉴定与不良预后和良性预后相关的乙型肝炎病毒突变位点。