Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2022; 28(35): 5217-5229
Published online Sep 21, 2022. doi: 10.3748/wjg.v28.i35.5217
High prevalence of chronic viral hepatitis B and C in Minnesota Somalis contributes to rising hepatocellular carcinoma incidence
Essa A Mohamed, Nasra H Giama, Abubaker O Abdalla, Hassan M Shaleh, Abdul M Oseini, Hamdi A Ali, Fowsiyo Ahmed, Wesam Taha, Hager Ahmed Mohammed, Jessica Cvinar, Ibrahim A Waaeys, Hawa Ali, Loretta K Allotey, Abdiwahab O Ali, Safra A Mohamed, William S Harmsen, Eimad M Ahmmad, Numra A Bajwa, Mohamud D Afgarshe, Abdirashid M Shire, Joyce E Balls-Berry, Lewis R Roberts
Essa A Mohamed, Nasra H Giama, Hassan M Shaleh, Abdul M Oseini, Hamdi A Ali, Fowsiyo Ahmed, Wesam Taha, Hager Ahmed Mohammed, Jessica Cvinar, Hawa Ali, Loretta K Allotey, Eimad M Ahmmad, Numra A Bajwa, Abdirashid M Shire, Lewis R Roberts, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Essa A Mohamed, Joyce E Balls-Berry, Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN 55905, United States
Nasra H Giama, School of Nursing, University of Minnesota, Minneapolis, MN 55455, United States
Abubaker O Abdalla, Division of Digestive Diseases, Emory School of Medicine, Atlanta, GA 30322, United States
Hassan M Shaleh, Ibrahim A Waaeys, Abdiwahab O Ali, Safra A Mohamed, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
Wesam Taha, Department of Internal Medicine, NewYork-Presbyterian Queens, Flushing, NY 11355, United States
Hager Ahmed Mohammed, Department of Pediatrics, University of Nevada Las Vegas, Las Vegas, NV 89154, United States
William S Harmsen, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, United States
Mohamud D Afgarshe, Department of Medicine, Gargar Urgent Care and Clinic, Minneapolis, MN 55406, United States
Abdirashid M Shire, Office of the Director, Shire Scientific, Minneapolis, MN 55405, United States
Joyce E Balls-Berry, Department of Neurology, Washington University School of Medicine in St Louis, St Louis, MO 63130, United States
Joyce E Balls-Berry, Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO 63130, United States
Author contributions: Mohamed EA, Giama NH, Abdalla AO, Shire AM, Shaleh HM, Oseini AM, Ali HA, Ahmed F, Taha W, Ahmed Mohammed H, Cvinar J, Waaeys IA, Ali H, Allotey LK, Ali AO, Mohamed SA, Harmsen WS, Ahmmad EM, Bajwa NA, and Afgarshe MD, Balls-Berry JE, and Roberts LR contributed to the study concept and design, acquisition of data, data analysis and interpretation of data; Mohamed EA, Giama NH, Abdalla AO, and Shire AM drafted the manuscript; Shaleh HM, Oseini AM, Ali HA, Ahmed F, Taha W, Ahmed Mohammed H, Cvinar J, Waaeys IA, Ali H, Allotey LK, Ali AO, Mohamed SA, Harmsen WS, Ahmmad EM, Bajwa NA, Afgarshe MD, Balls-Berry JE, and Roberts LR contributed to the critical revision of the manuscript; All authors contributed to manuscript revision, read and approved the submitted version.
Supported by the Mayo Clinic Center for Clinical and Translational Science from the National Center for Advancing Translational Sciences (5UL1TR000135-10); the Mayo Clinic Hepatobiliary SPORE from the National Cancer Institute (5P50CA210964-04); the Mayo Clinic Center for Cell Signaling in Gastroenterology (5P30DK084567-14); and Gilead Sciences, Inc. (IN-US-174-0230).
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board (19-001670).
Clinical trial registration statement: This study does not include any interventions and is not a randomized controlled trial. The study is registered on ClinicalTrials.Gov (NCT02366286).
Informed consent statement: Written informed consent was obtained from study subjects prior to enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Roberts.Lewis@mayo.edu. No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lewis R Roberts, MBChB, PhD, Professor, Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, United States. roberts.lewis@mayo.edu
Received: January 19, 2022
Peer-review started: January 19, 2022
First decision: March 8, 2022
Revised: March 28, 2022
Accepted: August 17, 2022
Article in press: August 17, 2022
Published online: September 21, 2022
ARTICLE HIGHLIGHTS
Research background

Somali immigrants come from regions of the world where viral hepatitis is endemic. Since the start of the Somali civil war in 1991, limited data is available on the impact of viral hepatitis in the community, especially those individuals in the diaspora.

Research motivation

The impetus of this project was communal outcry about community members succumbing to liver disease. In partnership with the community, our research team worked to assess the burden of viral hepatitis in Minnesota. Addressing this pressing communal matter, we were able to connect those who tested positive for hepatitis infections and/or were not vaccinated for hepatitis B virus (HBV) with the needed healthcare.

Research objectives

Our objective was to determine the prevalence of viral hepatitis infections within the community. This is significant because it laid the foundation to start conducting studies on host-viral interactions and the unique development of liver disease among this population. This is relevant to clinical practice because we can use this information to tailor screening practices and treatments for individuals from endemic regions which are historically under studied.

Research methods

In partnership with the community stakeholders, we conducted a prospective study using community-based participatory research from 2010 to 2015. We screened for viral hepatitis infections and reported the results back to the study participant. This is the first study of its kind to screen community based Somali immigrants in Minnesota at a large scale.

Research results

Viral hepatitis infections are a major under recognized disease within the Somali immigrant population. Age-adjusted prevalence rates are high and call for prioritizing responses from health agencies. This data will be used to lobby public health institutions to help address the unique needs of the Minnesota Somali population and for healthcare providers to implement programs to screen community members for both HBV and hepatitis C virus. Furthermore, the follow-up after the patients have enrolled into the study was quite difficult. We should consider effective methods to follow-up patients to assess the potential for development of liver disease sequelae.

Research conclusions

Although there were limitations to the study, we have learned that chronic viral hepatitis infection in the Somali community is high. Effective screening programs need to be implemented in order to prevent suffering and needless death. The use of community-based participatory research was a success and was the first of its kind with this community regarding a disease considered taboo. We will continue this partnership and expand research within this population historically under reported in clinical research.

Research perspectives

We will continue maintaining the partnership and will continue to understand the unique host-viral interactions. We have studies on immunoprofiling as well as examining the influence of the viral genome on liver disease progression. These studies will be used to improve the health of persons from this region of the world.