Hepatitis B immunisation coverage of infants born to chronic carrier mothers in Victoria

Managing HBV in pregnancy. Prevention, prophylaxis, treatment and follow-up: position paper produced by Australian, UK and New Zealand key opinion leaders

Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These include the lack of a current cohesive strategy for treatment and follow-up of mothers and their babies; the uncertain risk of postpartum HBV flares; the lack of randomised trial data on the safety and efficacy of antiviral treatment in pregnancy; the lack of head-to-head studies comparing different antivirals in pregnancy; and the lack of epidemiologic information regarding infection across different populations globally. This position paper provides a comprehensive review of the management of women with HBV infection prior to conception, throughout each stage of pregnancy and postpartum, as well as recommendations and clinical approaches for the follow-up of children born to infected mothers, based on available evidence in the literature and recommendations from international experts. Prevention of perinatal transmission is an important component of global efforts to reduce the burden of chronic HBV since vertical transmission is responsible for most of the chronic infection worldwide.

Representations and coverage of non-English-speaking immigrants and multicultural issues in three major Australian health care publications

BACKGROUND

No recent Australian studies or literature, provide evidence of the extent of coverage of multicultural health issues in Australian healthcare research. A series of systematic literature reviews in three major Australian healthcare journals were undertaken to discover the level, content, coverage and overall quality of research on multicultural health. Australian healthcare journals selected for the study were The Medical Journal of Australia (MJA), The Australian Health Review (AHR), and The Australian and New Zealand Journal of Public Health (ANZPH). Reviews were undertaken of the last twelve (12) years (1996-August 2008) of journal articles using six standard search terms: 'non-English-speaking', 'ethnic', 'migrant', 'immigrant', 'refugee' and 'multicultural'.

RESULTS

In total there were 4,146 articles published in these journals over the 12-year period. A total of 90 or 2.2% of the total articles were articles primarily based on multicultural issues. A further 62 articles contained a major or a moderate level of consideration of multicultural issues, and 107 had a minor mention.

CONCLUSIONS

The quantum and range of multicultural health research and evidence required for equity in policy, services, interventions and implementation is limited and uneven. Most of the original multicultural health research articles focused on newly arrived refugees, asylum seekers, Vietnamese or South East Asian communities. While there is some seminal research in respect of these represented groups, there are other communities and health issues that are essentially invisible or unrepresented in research. The limited coverage and representation of multicultural populations in research studies has implications for evidence-based health and human services policy.

The impact of a new universal infant and school-based adolescent hepatitis B vaccination program in Australia

We compared the results of two national serosurveys in Australia to evaluate the impact of universal infant vaccination and school-based programs for adolescents. Immunity improved significantly overall, especially in 1-year-olds (40.0% versus 86%; p<0.0001); in adolescents it was significantly higher in regions with established school-based programs (56.6% versus 38.8%; p=0.0008). 6.1% of 1-59-year-olds were positive for HBcAb and 0.7% for HBsAg. We have demonstrated successful implementation of universal infant hepatitis B vaccination in Australia and that school-based programs for adolescents are effective. This experience should be applicable to low prevalence countries in northern Europe which have not implemented universal hepatitis B immunisation.

National serosurvey of cytomegalovirus in Australia

In anticipation of the development of a vaccine against cytomegalovirus (CMV), we conducted a large, nationally representative serosurvey to examine the seroprevalence of CMV in Australia. Sera were collected opportunistically from laboratories around Australia. Age- and gender-representative samples were tested for CMV antibody. The population-weighted rate of CMV seropositivity in subjects between 1 and 59 years of age was 57% (95% confidence interval, 55.2 to 58.6%). An association between CMV seroprevalence and increasing age was recognized; however, little overall difference in seroprevalence between the sexes was found. The finding that high levels of CMV exposure occur in the first few years of life suggests that for a universal vaccination program to have maximal impact, the vaccine would need to be delivered to infants and have a long duration of protective efficacy. This is the first national serosurvey looking at cytomegalovirus in the Australian community. This study provides valuable information that can be used to examine the incidence of infection in the community and help focus the administration of a future CMV vaccine to appropriate target populations.

Hepatitis A vaccination options for Australia

The epidemiology of hepatitis A is changing, with an increasing proportion of the population becoming susceptible to infection. The burden of hepatitis A is comparable to that of other vaccine-preventable diseases for which new vaccines are available. Options for vaccination include selective programmes for high-risk groups, which could involve screening prior to vaccination, or universal programmes for infants and/or adolescents. Selective programmes have been shown to be highly cost-effective if well implemented, but there is evidence that they might be poorly implemented. If a universal vaccination programme were considered for Australia, an infant programme, with doses at 18 months and 2 years, possibly with an additional adolescent programme, would be the recommended option. Universal hepatitis A vaccination for infants and/or adolescents is of comparable cost-effectiveness compared with other preventive strategies, but needs to be considered in the context of competing vaccination options.

An economic evaluation of universal infant vaccination against hepatitis B virus using a combination vaccine (Hib-HepB): a decision analytic approach to cost effectiveness

OBJECTIVE

To evaluate the health impact and cost effectiveness of two infant vaccination strategies for protection against hepatitis B virus (HBV) infection in the Australian population. Vaccinating only high-risk infants, assuming 65% compliance, was compared with universal vaccination of infants using a combination Hib-HepB vaccine, with 87.4% compliance.

METHOD

A Markov model simulated the natural history of HBV infection and disease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high-risk families) and low-risk infants. Clinical and epidemiological data used were obtained from published reports and a survey of clinical experts. The model included the health costs associated with acute and chronic HBV infection, and the sequelae of chronic HBV infection.

RESULTS

The model predicted that universal hepatitis B vaccination of an Australian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,862, which is low compared with many other health care interventions. With no discounting of costs or consequences, universal vaccination with the combination vaccine was predicted to save lives and reduce costs.

CONCLUSION

There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interventions. Nevertheless, based on these results, universal hepatitis B vaccination of Australian infants using a combination Hib-HepB vaccine would almost certainly be regarded as a worthwhile investment of public funds.

Three fatal pneumococcal polysaccharide vaccine failures

Three Indigenous Australian adults died of invasive pneumococcal disease, despite vaccination with the pneumococcal polysaccharide vaccine an average of 18 months previously. Pneumococcal isolates from the patients had serotypes that are included in the vaccine. Two of the adults were alcoholics and the other had heavy recent alcohol intake. The public health implications, and possible optimal vaccination schedules to minimise vaccine failures, are discussed.