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18 Jun 2019

Has the implementation of a hep B vaccination program decreased chronic hep B prevalence in Aboriginal Australians?

Most news items about Aboriginal health paint a dark story about the high rates of disease – not this one.

In a study recently published in CSIRO’s Sexual Health journal, Doherty Institute Research Fellow Dr Simon Graham looked at the rates of chronic hepatitis B in Australian Aboriginal and Torres Straight Islander people before and after the implementation of a universal vaccination program.

He found overall the prevalence of chronic hepatitis B decreased among Aboriginal people from 10.8 percent before the introduction of the vaccination program in 2000 to 3.5 per cent after 2000.

“In Australia, the prevalence of CHB is estimated to be one per cent, Aboriginal people account for 11 per cent of people living with CHB, even though they only account for about three per cent of the Australian population,” Dr Graham said.

“The incidence of poor chronic hepatitis B-related outcomes such as liver cancer are up to eight times higher in Aboriginal Australians compared with non-Aboriginal people.”

Dr Graham and his research team reviewed research studies from before and after 2000, which is when a publicly funded universal infant HBV vaccination program commenced in Australia.

The Australian National Immunisation Strategy 2013-2018 provides a schedule of when infants, children and adults should be vaccinated against hepatitis B and sets a target of 95 per cent HBV vaccination coverage for infants born in Australia

The studies included Aboriginal adults, pregnant women, children and teenagers, prisoners and infants.

Pregnant women in Australia have a very high rate of hepatitis B testing due to strong antenatal programs, and as a result the prevalence among pregnant women provides us with the most accurate prevalence but also the most accurate indication of a true decrease in prevalence.

The prevalence of chronic hepatitis B decreased:

  • Among women 4.2% to 2.2% and in men 17.5% to 3.5%
  • In regional areas 7.8% to 3.9% and remote areas 14.4% to 5.7%
  • In NSW 12.3% to 3% and NT 6.1% to 5.1%
  • In adults 15.3% to 4.3%
  • In pregnant women 3.6% to 2.6%

“Although our review suggests that the prevalence of chronic hepatitis B has significantly reduced since 2000, the prevalence of chronic hepatitis B is still higher among Aboriginal Australians (3.6 per cent) compared with non-Aboriginal Australians,” Dr Graham said.

“Uptake of treatment and care is substantially lower in remote areas of Australia, where the proportion of people living with chronic hepatitis B who are Aboriginal is higher than non-Aboriginal people, highlighting the need for access to services in regional and remote areas.”

Dr Graham said it’s important to acknowledge that although a vaccine can protect people from being infected and reduce incidence and prevalence, it can only achieve significant reductions if it is made available along with health promotion and education programs, and increased access to testing and treatment and other prevention programs.

“Measures such as how to get tested and where to get tested, antenatal testing, treatment of hepatitis B, access to testing and treatment and ongoing monitoring for those living with chronic hepatitis B, access to prevention programs such as needle and syringe programs for those who inject are essential,” he said.

“Moving forward it is important that Aboriginal people are offered hepatitis B testing when they access health services opportunistically, especially when young Aboriginal people are being tested for other sexually transmitted infections such as chlamydia and gonorrhoea.”

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