Although insufficient data existed to adjust for the effects of all potential confounders, residence in a wet village was associated with alcohol-related injury death among Alaska Native residents of remote Alaska villages. These findings indicate that measures limiting access to alcoholic beverages in this region may decrease alcohol-related injury deaths.

Foodborne botulism remains a public health problem in Alaska. Incidence might be decreasing, but it remains >800 times the overall US rate (0.0068 cases per 100,000 persons). Prevention messages should highlight the additional risk to female individuals and older persons. Early diagnosis is critical for timely access to antitoxin and supportive care.

A measles outbreak occurred among a highly vaccinated population in Alaska during 1998, providing an opportunity to determine the incremental efficacy of >or=2 doses of measles-containing vaccine (MCV) compared with 1 dose. Of 33 confirmed case patients identified, 31 had been vaccinated with 1 dose of MCV, 1 had received 2 doses, and vaccination status was unknown in 1 case. Seventy percent of cases were school-associated; 58% of cases occurred in 2 high schools. Of 3679 students attending the 2 schools, 50.4% and 45.5% had received >or=2 doses of MCV before measles introduction at the schools. The relative risk of developing measles among persons vaccinated with >or=2 doses of MCV compared with 1 dose was 0.06 (95% confidence interval, 0.01-0.44; P<.001), yielding an estimated incremental vaccine efficacy of 94.1% (95% confidence interval, 55.9%-99.2%; P<.001). Rapid implementation of a mandatory second-dose MCV requirement probably limited the extent of this outbreak.

The dynamics of population-based immunity were examined by using serologic surveys of 7 villages in rural Alaska between 2 epidemics of hepatitis A virus (HAV) and after the second epidemic (1988-1990). Among persons aged 2-30 years, the overall age-adjusted prevalence of antibody to HAV (anti-HAV) was 51% in 1983 and 49% in 1993 (P=.506). In children aged <5 years, prevalence rates were 0% and 11% in 1983 and 1993, respectively. The prevalence of HAV infection increased with age in both surveys. When examined by 5-year birth cohorts, anti-HAV prevalence increased in children born between 1979 and 1983 (P<.001). Between the 2 survey periods, 43 clinical cases of HAV infection were reported in these villages; all occurred from 1988 to 1990. Despite high overall prevalence of immunity, transmission during epidemics was facilitated by children aged <15 years susceptible to HAV. Little transmission occurred between epidemics. Vaccination of children against HAV should prevent future epidemics.

We document an echovirus 18 meningitis outbreak occurring at a remote overnight children's camp in Alaska. The outbreak involved 26% of 113 camp residents, was associated with building overcrowding and occurred in a camp with a contaminated drinking water source. Lack of specific children's camp regulations and failure to implement and enforce existing regulations may have contributed to the outbreak.