1
|
Howell J, Pedrana A, Cowie BC, Doyle J, Getahun A, Ward J, Gane E, Cunningham C, Wallace J, Lee A, Malani J, Thompson A, Hellard ME. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030. J Gastroenterol Hepatol 2019; 34:40-48. [PMID: 30151932 DOI: 10.1111/jgh.14457] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/18/2018] [Accepted: 08/15/2018] [Indexed: 12/16/2022]
Abstract
Viral hepatitis affects more than 320 million people globally, leading to significant morbidity and mortality due to liver failure and hepatocellular carcinoma (HCC). More than 248 million people (3.2% globally) are chronically infected with hepatitis B virus (HBV), and an estimated 80 million people (1.1% globally) are chronically infected with hepatitis C virus (HCV). In 2015, more than 700 000 deaths were directly attributable to HBV, and nearly 500 000 deaths were attributable to HCV infection; 2-5% of HBV-infected people develop HCC per annum irrespective of the presence of cirrhosis, whereas 1-5% HCV-infected people with advanced fibrosis develop HCC per annum. The rapidly escalating global mortality related to HBV and HCV related viral hepatitis to be the 7th leading cause of death worldwide in 2013, from 10th leading cause in 1990. Australia, New Zealand, and Pacific Island Countries and Territories fall within the World Health Organization Western Pacific Region, which has a high prevalence of viral hepatitis and related morbidity, particularly HBV. Remarkably, in this region, HBV-related mortality is greater than for tuberculosis, HIV infection, and malaria combined. The region provides a unique contrast in viral hepatitis prevalence, health system resources, and approaches taken to achieve World Health Organization global elimination targets for HBV and HCV infection. This review highlights the latest evidence in viral hepatitis epidemiology and explores the health resources available to combat viral hepatitis, focusing on the major challenges and critical needs to achieve elimination in Australia, New Zealand, and Pacific Island Countries and Territories.
Collapse
Affiliation(s)
- Jess Howell
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
| | - Benjamin C Cowie
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Doyle
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Aneley Getahun
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
| | - James Ward
- Head Aboriginal Health, Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Matthew Flinders Fellow, Flinders University Adelaide, Adelaide, South Australia, Australia
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, and Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Chris Cunningham
- Research Centre for Maõri Health and Development, Massey University, Wellington, New Zealand
| | - Jack Wallace
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Alice Lee
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, University of Sydney, Camperdown, New South Wales, Australia.,Hepatitis B Free, Australia
| | - Jioji Malani
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
| | - Alex Thompson
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.,School of Population Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Aluzaite K, Tewhaiti-Smith J, Fraser M, Johnson S, Glen E, Beck A, Smith B, Dummer J, Schultz M. A liver health hui: hepatitis C knowledge and associated risk factors in New Zealand gang members and their families. ROYAL SOCIETY OPEN SCIENCE 2018; 5:172167. [PMID: 30224989 PMCID: PMC6124044 DOI: 10.1098/rsos.172167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
Hepatitis C virus (HCV) and B virus (HBV) infections are highly prevalent, with a high percentage of undiagnosed cases. Knowledge of HCV and its modes of transmission are essential for disease prevention and management. We studied a high-risk New Zealand gang population on viral hepatitis prevalence, their level of knowledge and the liver health risk factors in a community setting. Participants completed demographic, risk factor and knowledge questionnaires in three health meetings in New Zealand. Participants' blood samples were tested for HBV, HCV, biochemical indicators of liver disease. Liver fibrosis levels were assessed using a Fibroscan® device. We studied 52 adult Mongrel Mob members, affiliates and whānau (extended family) throughout New Zealand. We identified no HCV and two HBV cases, confirmed high-risk factor levels and poor associated knowledge, with a significant association between lack of knowledge and presence of specific risk factors. We successfully conducted a community-focused, high-risk, hard-to-reach gang population study, and found a link between lack of knowledge and risk factors for HCV infection. This study provided first-of-its-kind data on viral hepatitis in a gang population and demonstrated the need for educational screening programmes to aid early HCV detection, prevention and treatment.
Collapse
Affiliation(s)
- Kristina Aluzaite
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | | | - Margaret Fraser
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Steve Johnson
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Elizabeth Glen
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| | - Allison Beck
- Otago Hepatitis C Resource Centre, Dunedin, New Zealand
| | - Barbara Smith
- Dunedin Intravenous Organization Needle Exchange, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
- Gastroenterology Unit, Southern District Health Board, Dunedin Hospital, Dunedin, New Zealand
| |
Collapse
|
3
|
Coppell KJ, Miller JC, Gray AR, Schultz M, Mann JI, Parnell WR. Obesity and the extent of liver damage among adult New Zealanders: findings from a national survey. Obes Sci Pract 2015; 1:67-77. [PMID: 27774250 PMCID: PMC5063157 DOI: 10.1002/osp4.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 12/18/2022] Open
Abstract
Objective Non‐alcoholic fatty liver disease (NAFLD), defined as excessive fat accumulation in hepatocytes when no other pathologic causes are present, is an increasingly common obesity‐related disorder. We sought to describe the prevalence of elevated liver enzymes, a marker of liver damage, among New Zealand adults, and high‐risk subgroups including those with an elevated body mass index and those with pre‐diabetes or diabetes, to gain a better understanding of the burden of liver disease. Methods A total of 4,721 New Zealanders aged 15+ years participated in a nationally representative nutrition survey. Liver enzymes, alanine transaminase (ALT) and gamma glutamyl transpeptidase (GGT) were measured in serum. Results were available for 3,035 participants, of whom 10.8% were Māori and 4.5% Pacific. Results Overall, the prevalence of elevated ALT and elevated GGT was 13.1% (95% confidence interval [CI]: 11.2 – 15.0) and 13.7% (95% CI: 12.0 – 15.4), respectively. Odds ratios for an elevated ALT or GGT markedly increased with increasing body mass index. Men with obesity had the highest elevated ALT prevalence (28.5%; 95% CI: 21.7–35.4), and women with diabetes had the highest elevated GGT prevalence (36.5%; 95% CI: 26.0–47.0). Adding alcohol consumption categories to each of the adjusted models did not meaningfully change any results, although for women, heavy alcohol consumption was associated with an elevated GGT (overall p = 0.03). Conclusions Obesity‐related liver disease is likely to increasingly burden the New Zealand health sector and contribute to health disparities unless effective obesity treatment and prevention measures are given high priority. © 2015 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.
Collapse
Affiliation(s)
- K J Coppell
- Edgar Diabetes and Obesity Research, Department of Medicine University of Otago Dunedin New Zealand
| | - J C Miller
- Department of Human Nutrition University of Otago Dunedin New Zealand
| | - A R Gray
- Department of Preventive and Social Medicine University of Otago Dunedin New Zealand
| | - M Schultz
- Gastroenterology, Department of Medicine University of Otago Dunedin New Zealand
| | - J I Mann
- Edgar Diabetes and Obesity Research, Department of Medicine University of Otago Dunedin New Zealand; Department of Human Nutrition University of Otago Dunedin New Zealand
| | - W R Parnell
- Department of Human Nutrition University of Otago Dunedin New Zealand
| |
Collapse
|
4
|
Lim TH, Gane E, Moyes C, Borman B, Cunningham C. Serological and clinical outcomes of horizontally transmitted chronic hepatitis B infection in New Zealand Māori: results from a 28-year follow-up study. Gut 2015; 64:966-72. [PMID: 25006011 DOI: 10.1136/gutjnl-2013-306247] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 06/19/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic hepatitis B infection is endemic in New Zealand and has high prevalence in New Zealand Māori. Previous longitudinal studies in populations with predominantly vertically acquired chronic hepatitis B have shown low spontaneous hepatitis B surface-antigen (HBsAg) seroclearance rates: 0.5-1.4% annually (mean age of clearance 48 years). We report the 28-year follow-up data on clinical and serological outcomes in indigenous New Zealand Māori with early horizontally acquired HBV. METHODS In 1984, community seroprevalence study identified 572 HBsAg-positive individuals, followed for 28 years. Liver-related mortality and hepatocellular carcinoma (HCC) incidence were compared between these 572 HBV carriers and 1140 HBsAg-negative matched case-controls. Surviving HBsAg-positive individuals have been followed up in 2012 with clinical assessment, blood tests and liver transient elastography. Rates of hepatitis B e-antigen (HBeAg) and HBsAg seroconversion were determined. RESULTS After total 13 187.4 person-years follow-up, 15 HBsAg-positive patients have developed HCC compared with none of the HBsAg-negative controls (p<0.001). 12 HBsAg-positive patients died from liver-related causes compared with none in the controls (p<0.001). Spontaneous HBeAg-seroconversion occurred in 91% of HBeAg-positive patients. Spontaneous HBsAg loss occurred in 33% overall (annual clearance rate 1.34%), with higher rates at older ages (1.05% in patients<20 years at entry vs 4.3% per annum >40 years at entry, p<0.0001). Median ages of HBeAg loss and HBsAg loss were 23 years (range 6-66 years) and 40 years (range 4-80 years), respectively. CONCLUSIONS Horizontally transmitted HBV in Maori is similarly associated with increased risk of liver-related mortality and HCC compared with Chinese, although absolute incidence rates are lower. The rates of HBeAg and HBsAg loss are high, and occur at an earlier age than previously reported.
Collapse
Affiliation(s)
- Tien Huey Lim
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Chris Moyes
- The Hepatitis Foundation of New Zealand, Whakatane, New Zealand
| | - Barry Borman
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Chris Cunningham
- Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand
| |
Collapse
|
5
|
Treloar C, Jackson C, Gray R, Newland J, Wilson H, Saunders V, Johnson P, Brener L. Care and treatment of hepatitis C among Aboriginal people in New South Wales, Australia: implications for the implementation of new treatments. ETHNICITY & HEALTH 2015; 21:39-57. [PMID: 25665723 DOI: 10.1080/13557858.2015.1004870] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments. METHOD In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales. RESULTS Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison. CONCLUSIONS The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet individuals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people.
Collapse
Affiliation(s)
- Carla Treloar
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Clair Jackson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Rebecca Gray
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Jamee Newland
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Hannah Wilson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Veronica Saunders
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Priscilla Johnson
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| | - Loren Brener
- a Centre for Social Research in Health, UNSW , Sydney , NSW , Australia
| |
Collapse
|
6
|
Jain M, Chakravarti A, Kar P. Clinical significance of isolated anti-hbc positivity in cases of chronic liver disease in new delhi, India. J Glob Infect Dis 2011; 1:29-32. [PMID: 20300383 PMCID: PMC2840942 DOI: 10.4103/0974-777x.52978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: The presence of anti-HBc IgG in the absence of HBsAg is usually indicative of a past self-limiting HBV infection. But it is frequently associated with co-infection with HCV which can worsen the existing status of chronic liver disease (CLD). Objectives: The present study was planned to evaluate the significance of isolated HBc IgG positivity in patients of CLD and look for the presence of HCV co-infection in such patients. Methods: Clinical profiles and biochemical tests were done for all the 77 CLD cases included in the study. Blood samples were taken from these patients and tested by the commercially available EIA for the presence of HBsAg, anti-HBc IgG, anti-HBs and anti-HCV. HBV DNA was detected by amplifying the surface region in all the cases. Results: Isolated anti-HBc IgG positivity defined as the presence of anti-HBc IgG in absence of any other serological markers of HBV infection was detected in 28 patients. Out of 64 patients positive for anti-HBc IgG 36 had the markers of HBV, either HBsAg, HBV DNA or anti-HBs alone or in combination. There was a significant association between isolated anti-HBc IgG positivity and HCV co-infection. Conclusion: Anti-HBc IgG should be tested in all patients with CLD as it is frequently the only marker of HBV infection in such patients and they should be monitored closely as such patients can develop CLD. Presence of co-infection with HCV should be actively searched for in such patients.
Collapse
Affiliation(s)
- Manisha Jain
- Department of Microbiology and Maulana Azad Medical College, New Delhi, India
| | | | | |
Collapse
|
7
|
Prevalence of hepatitis B and C viral markers in chronic liver disease patients: A single center experience from Yemen. Arab J Gastroenterol 2010. [DOI: 10.1016/j.ajg.2010.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
8
|
Abbas SA, Haloob IA, Taylor SL, Curry EM, King BB, Van der Merwe WM, Marshall MR. Effect of antimicrobial locks for tunneled hemodialysis catheters on bloodstream infection and bacterial resistance: a quality improvement report. Am J Kidney Dis 2009; 53:492-502. [PMID: 19150156 DOI: 10.1053/j.ajkd.2008.09.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 09/18/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND Catheter-restricted antimicrobial lock (AML) use reduces catheter-associated bloodstream infection (CA-BSI) in clinical trial settings, but may not be as effective in clinical settings and may increase bacterial resistance. DESIGN Quality improvement report analyzed using a cross-sectional time series (unbalanced panel) design. SETTING & PARTICIPANTS The study cohort comprised all prevalent adults treated with hemodialysis through a tunneled catheter for any, but not necessarily all, of the time from January 1, 2003, to June 30, 2006, in Manukau City, New Zealand (135,346 catheter-days, 404 tunneled catheters, 320 patients). QUALITY IMPROVEMENT PLAN Catheter-restricted AMLs (heparin plus gentamicin) for all tunneled catheters from July 1, 2004. MEASURES Repeated observations of CA-BSI, hospitalization, tunneled catheter removal, and death from CA-BSI analyzed by using generalized estimating equations with a single level of clustering for each tunneled catheter and patterns of bacterial resistance analyzed by using simple descriptive statistics. RESULTS AML use was associated with reductions in rates of CA-BSI and hospitalization for CA-BSI by 52% and 69% for patients with tunneled catheters locked continuously with AMLs since their insertion compared with those with tunneled catheters that were not, respectively. AML exposure also was associated with a trend to increased gentamicin resistance amongst coagulase-negative staphylococci isolates, a pattern similar to that observed for BSIs in our general hemodialysis population in which tunneled catheters were not the source of BSI, but different from that in the general non-end-stage renal disease population in the region. LIMITATIONS This is an uncontrolled observational study and cannot prove causality. The follow-up period of 18 months is longer than for other studies, but still too short to definitely answer whether AML use drives bacterial resistance. CONCLUSIONS A change to use of AMLs may improve clinical outcomes; however, additional study of associated bacterial resistance is needed before AML use becomes standard care.
Collapse
Affiliation(s)
- Saib A Abbas
- Department of Renal Medicine, Middlemore Hospital, Counties-Manukau District Health Board, Manukau, New Zealand
| | | | | | | | | | | | | |
Collapse
|
9
|
Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. THE LANCET. INFECTIOUS DISEASES 2005; 5:558-67. [PMID: 16122679 DOI: 10.1016/s1473-3099(05)70216-4] [Citation(s) in RCA: 1901] [Impact Index Per Article: 100.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) is a major cause of liver disease worldwide and a potential cause of substantial morbidity and mortality in the future. The complexity and uncertainty related to the geographic distribution of HCV infection and chronic hepatitis C, determination of its associated risk factors, and evaluation of cofactors that accelerate its progression, underscore the difficulties in global prevention and control of HCV. Because there is no vaccine and no post-exposure prophylaxis for HCV, the focus of primary prevention efforts should be safer blood supply in the developing world, safe injection practices in health care and other settings, and decreasing the number of people who initiate injection drug use.
Collapse
Affiliation(s)
- Colin W Shepard
- Epidemiology Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
| | | | | |
Collapse
|