BACKGROUND: Alaska Native (AN) children were at high risk of acquiring hepatitis B virus (HBV) infection before vaccination began in 1983. We evaluated the long-term protection from hepatitis B (HB) vaccination among AN children immunized when infants. METHODS: During 1984-1995, we recruited a convenience sample of AN children who had received a three dose series of HB vaccine starting at birth and had serum antibody to hepatitis B (anti-HBs) concentrations of >/= 10 mIU/mL at 7-26 months of age. We evaluated anti-HBs concentrations and the presence of anti-HBc in participants' sera every other year up to age 16 years. Anti-HB core antigen (anti-HBc)-positive specimens were tested for hepatitis B surface antigen and for HBV DNA. RESULTS: We followed 334 children for 3151 person-years (median, 10 years per child) with 1610 specimens collected. Anti-HBs concentrations dropped rapidly among all participants. Among children 2, 5 and 10 years of age, 37 of 79 (47%), 33 of 176 (19%) and 8 of 95 (8%), respectively, had anti-HBs concentrations of >/= 10 mIU/mL. Receipt of recombinant vaccine was significantly associated with a more rapid antibody decline (P
Haemophilus influenzae type b (Hib) invasive disease and oropharyngeal carriage continue in rural Alaska despite widespread vaccination. This study investigated whether invasive-disease reemergence during 1996-1997 could be attributed to strains distinguishable from strains carried by vaccinated children. Twenty-four invasive and 42 carriage Hib isolates, collected during 1992-1997, were characterized by pulsed-field gel electrophoresis (PFGE), multilocus enzyme electrophoresis, and biotyping. This Hib population was highly clonal, since only 2 strains, electrophoretic type (ET) 55/PFGE 1 and ET 56/PFGE 3, accounted for 62% of all isolates. The ET 55/PFGE 1 and ET 56/PFGE 3 strains were found in 74% of the carriers and caused 80% of the invasive Hib disease that occurred during April 1996-March 1997. Strains causing invasive disease could not be distinguished from strains carried by vaccinated children. Continued monitoring of Hib carriage may provide insights into the epidemiology of continued transmission in an era of widespread vaccination.