1
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Littlejohn M, Jaskowski LA, Edwards R, Jackson K, Yuen L, Crawford D, Locarnini SA, Cooksley G. Molecular epidemiology of hepatitis B among Indigenous Australians in Queensland and the Torres Strait Islands. Intern Med J 2024; 54:129-138. [PMID: 37357696 DOI: 10.1111/imj.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Chronic hepatitis B virus (HBV) infection is a major health problem for all Indigenous Australians. Post-2000, Hepatitis B surface antigen prevalence has decreased, although remaining four times higher among Indigenous compared with non-Indigenous people. AIMS This study aimed to characterise the HBV from Indigenous populations in Queensland and the Torres Strait Islands. METHODS Serum samples were collected, with consent, from people within Queensland Indigenous communities prior to 1990 as part of the Queensland Health vaccination programme. Ethics approval was subsequently obtained to further characterise the HBV from 93 of these stored samples. HBV DNA was extracted and genotype was obtained from 82 samples. HBV full genome sequencing was carried out for a subset of 14 samples. RESULTS Seventy-eight samples were identified as genotype C (2 × C12, 3 × C13 and 73 × C14), one sample as genotype A (A2) and three samples as genotype D (1 × D2, 1 × D3 and 1 × D4). The HBV/C sequences identified were most closely related to sequences isolated from Papua New Guinea and Indonesia (Papua Province). CONCLUSIONS The HBV isolated from the Torres Strait Islanders was notably different to the HBV/C4 strain isolated from Indigenous people of mainland northern Australia, with no evidence of recombination. This reflects the differences in culture and origin between Torres Strait Islanders and mainland Indigenous people.
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Affiliation(s)
- Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, and Department of Infectious Disease, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lesley-Anne Jaskowski
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ros Edwards
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lilly Yuen
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Darrel Crawford
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Stephen A Locarnini
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Graham Cooksley
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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2
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Sullivan RP, Davies J, Binks P, McKinnon M, Dhurrkay RG, Hosking K, Bukulatjpi SM, Locarnini S, Littlejohn M, Jackson K, Tong SYC, Davis JS. Preventing early childhood transmission of hepatitis B in remote aboriginal communities in Northern Australia. Int J Equity Health 2022; 21:186. [PMID: 36575515 PMCID: PMC9795589 DOI: 10.1186/s12939-022-01808-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic hepatitis B is a public health concern in Aboriginal communities in the Northern Territory of Australia with prevalence almost four times the non-Aboriginal population. Infection is suspected to mainly occur in early life, however, the mode of transmission and vaccine effectiveness is not known in this population. WHO has set a target for hepatitis B elimination by 2030; elimination in this disproportionately affected population in Australia will require understanding of the modes of transmission and vaccine effectiveness. METHODS We conducted the study at four very remote Aboriginal communities. We approached mothers who had chronic hepatitis B and had given birth between 1988 and 2013 for consent. We obtained hepatitis B serology, immunisation and birth details from the medical record. If both mother and child had hepatitis B viral DNA detected, we performed viral whole genome sequencing. RESULTS We approached 45 women for consent, of whom 23 agreed to participate. We included 20 mothers and 38 of their children. Of the 20 included mothers, 5 (25%) had children who were hepatitis B immune by exposure and 3 (15%) had children with evidence of chronic hepatitis B infection at the time of assessment. Hepatitis B immunoglobulin (HBIg) had been given at birth in 29/38 (76.3, 95% CI 59.8-88.6) children, and 26 children (68.4, 95% CI 51.3-82.5) were fully vaccinated. Of the 3 children who had chronic hepatitis B, all had received HBIg at birth and two were fully vaccinated. Of the 5 who were immune by exposure, 4 had received HBIg at birth and one was fully vaccinated. Whole genome sequencing revealed one episode of definite mother to child transmission. There was also one definite case of horizontal transmission. CONCLUSIONS Chronic hepatitis B in this context is a sensitive issue, with a high proportion of women refusing consent. Although uncommon, there is ongoing transmission of hepatitis B to Aboriginal children in remote northern Australia despite vaccination, and this is likely occurring by both vertical and horizontal routes. Prevention will require ongoing investment to overcome the many barriers experienced by this population in accessing care.
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Affiliation(s)
- Richard P. Sullivan
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia ,grid.240634.70000 0000 8966 2764Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory Australia ,grid.1005.40000 0004 4902 0432Department of Infectious Diseases, Immunology and Sexual Health, St George and Sutherland Hospital, School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales Australia
| | - Jane Davies
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia ,grid.240634.70000 0000 8966 2764Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory Australia
| | - Paula Binks
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Melita McKinnon
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Roslyn Gundjirryiir Dhurrkay
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Kelly Hosking
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia ,grid.483876.60000 0004 0394 3004Population and Primary Health Care, Top End Health Service, Northern Territory Government, Darwin, Northern Territory Australia
| | | | - Stephen Locarnini
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC Australia
| | - Margaret Littlejohn
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC Australia
| | - Kathy Jackson
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC Australia
| | - Steven Y. C. Tong
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia ,grid.416153.40000 0004 0624 1200Victorian Infectious Disease Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria Australia
| | - Joshua S. Davis
- grid.1043.60000 0001 2157 559XMenzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia ,grid.414724.00000 0004 0577 6676John Hunter Hospital, Newcastle, New South Wales Australia
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3
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Kumar M, Abbas Z, Azami M, Belopolskaya M, Dokmeci AK, Ghazinyan H, Jia J, Jindal A, Lee HC, Lei W, Lim SG, Liu CJ, Li Q, Al Mahtab M, Muljono DH, Niriella MA, Omata M, Payawal DA, Sarin SK, Ségéral O, Tanwandee T, Trehanpati N, Visvanathan K, Yang JM, Yuen MF, Zheng Y, Zhou YH. Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy. Hepatol Int 2022; 16:211-253. [PMID: 35113359 DOI: 10.1007/s12072-021-10285-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.
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Affiliation(s)
- Manoj Kumar
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Zaigham Abbas
- Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - A K Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Hasmik Ghazinyan
- Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Ankur Jindal
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India
| | - Han Chu Lee
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wei Lei
- Hepatopancreatobiliary Center, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Seng Gee Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun-Jen Liu
- Department of Internal Medicine and Hepatitis Research Center, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Qiang Li
- Division of Liver Diseases Jinan Infectious Disease Hospital, Shandong University, Jinan, China
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Colombo, Sri Lanka
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Tokyo, Japan
| | - Diana A Payawal
- Fatima University Medical Center Manila, Manila, Philippines
| | - Shiv K Sarin
- Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi, 110070, India.
| | - Olivier Ségéral
- French Agency for Research on AIDS and Viral Hepatitis, University of Health Science, Phnom Penh, Cambodia
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nirupma Trehanpati
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Kumar Visvanathan
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Man-Fung Yuen
- Li Shu Fan Medical Foundation Professor in Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yingjie Zheng
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Y H Zhou
- Department of Laboratory Medicine, Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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4
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Qama A, Allard N, Cowie B, Davis JS, Davies J. Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition. Intern Med J 2021; 51:910-922. [PMID: 32975893 PMCID: PMC8362129 DOI: 10.1111/imj.15069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/04/2023]
Abstract
Background Aboriginal and Torres Strait Islander people are disproportionately affected by hepatitis B virus (HBV) infection. A proposed mismatch between standard vaccines and the HBV/C4 sub‐genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness. Aims To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset. Methods A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti‐HBs and anti‐HBc serology over repeated tests. Results 100 790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211 802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti‐HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non‐Indigenous individuals living with CHB. Conclusions The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross‐sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.
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Affiliation(s)
- Ashleigh Qama
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,cohealth, Parkville, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Division of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jane Davies
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,The Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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5
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Menner AS, Kinkel HT, Dixit S, Morrison A, Rieke B, Küpper T. Prevalence and behavioural risk factors for hepatitis B in Upper Dolpo, Nepal. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01152-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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6
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Lubel JS, Roberts SK, Howell J, Ward J, Shackel NA. Current issues in the prevalence, diagnosis and management of hepatocellular carcinoma in Australia. Intern Med J 2021; 51:181-188. [DOI: 10.1111/imj.15184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Affiliation(s)
- John S. Lubel
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Stuart K. Roberts
- Department of Gastroenterology Alfred Hospital Melbourne Victoria Australia
- Central Clinical School Monash University Melbourne Victoria Australia
| | - Jessica Howell
- Department of Gastroenterology St Vincent's Hospital Melbourne Melbourne Victoria Australia
- Department of Medicine University of Melbourne Melbourne Victoria Australia
- Disease Elimination Program Burnet Institute Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Victoria Australia
| | - James Ward
- School of Public Health University of Queensland Brisbane Queensland Australia
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7
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Howell J, Ward JS, Davies J, Clark PJ, Davis JS. Hepatocellular carcinoma in Indigenous Australians: a call to action. Med J Aust 2021; 214:201-202.e1. [DOI: 10.5694/mja2.50961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - James S Ward
- University of Queensland Brisbane QLD
- Poche Centre for Indigenous Health University of Queensland Brisbane QLD
| | | | | | - Joshua S Davis
- Menzies School of Health Research Darwin NT
- John Hunter Hospital Newcastle NSW
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8
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Bayliss J, Nissen M, Prakash D, Richmond P, Oh KB, Nolan T. Control of vaccine preventable diseases in Australian infants: reviewing a decade of experience with DTPa-HBV-IPV/Hib vaccine. Hum Vaccin Immunother 2021; 17:176-190. [PMID: 32573398 PMCID: PMC7872029 DOI: 10.1080/21645515.2020.1764826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
The combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis, and Haemophilus influenzae b (DTPa-HBV-IPV/Hib, Infanrix Hexa, GSK) has been used for childhood immunization in Australia according to a two-, four-, six-month schedule since 2009. We reviewed data available in the Australian National Notifiable Diseases Surveillance System, annual vaccination coverage reports, the Database of Adverse Event Notifications, and peer-reviewed literature to assess vaccine coverage rates, incidence of all six vaccine preventable diseases, and the safety profile of DTPa-HBV-IPV/Hib vaccine in Australian infants over a period of ten years of exclusive use. Between 2009 and 2018 vaccine coverage for infants aged 12 months increased from 91.7% to 94.0% and from 84.9% to 92.6% for all and for Indigenous infants, respectively. Over the same time period, there were no reports of poliomyelitis, diphtheria or tetanus in infants <12 months of age. The incidence of hepatitis B among Australian infants <12 months of age remains 10 to 20-fold lower than the national average. Control of Haemophilus influenzae b (Hib) and pertussis disease has continued to be challenging. Timely administration of the primary series, as well as increasing coverage rates, particularly among Indigenous children, has contributed to improvements in Hib and pertussis disease control. The incorporation of additional strategies such as adjustment of the first vaccination encounter to six weeks of age, parental cocooning, and most recently maternal vaccination has further reduced the burden of pertussis, particularly during the first six months of life. The frequency of the ten most common adverse events related to the DTPa-HBV-IPV/Hib vaccine demonstrates an acceptable safety profile. Data collected over ten years of consistent, exclusive use of the DTPa-HBV-IPV/Hib vaccine in Australia highlights combination vaccination as a cornerstone in maintaining infant health.
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Affiliation(s)
| | - Michael Nissen
- Scientific Affairs & Public Health, GSK, Singapore, Singapore
| | | | - Peter Richmond
- Division of Paediatrics and Centre for Child Health Research, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children’s Hospital, Perth, Australia
| | - Kyu-Bin Oh
- Medical Affairs, GSK, Singapore, Singapore
| | - Terry Nolan
- Vaccine and Immunisation Research Group (Virgo), University of Melbourne, School of Population and Global Health and Murdoch Children’s Research Institute, Melbourne, Australia
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9
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Lubel JS, Roberts SK, Strasser SI, Thompson AJ, Philip J, Goodwin M, Clarke S, Crawford DH, Levy MT, Shackel N. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2020; 214:475-483. [PMID: 33314233 DOI: 10.5694/mja2.50885] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths both globally and in Australia. Surveillance for HCC in at-risk populations allows diagnosis at an early stage, when potentially curable. However, most Australians diagnosed with HCC die of the cancer or of liver disease. In the changing landscape of HCC management, unique challenges may lead to clinical practice variation. As a result, there is a need to identify best practice management of HCC in an Australian context. This consensus statement has been developed for health professionals involved in the care of adult patients with HCC in Australia. It is applicable to specialists, general medical practitioners, nurses, health coordinators and hospital administrators. METHODS AND RECOMMENDATIONS This statement has been developed by specialists in hepatology, radiology, surgery, oncology, palliative care, and primary care, including medical practitioners and nurses. The statement addresses four main areas relevant to HCC management: epidemiology and incidence, diagnosis, treatment, and patient management. A modified Delphi process was used to reach consensus on 31 recommendations. Principal recommendations include the adoption of surveillance strategies, use of multidisciplinary meetings, diagnosis, treatment options and patient management. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This consensus statement will simplify HCC patient management and reduce clinical variation. Ultimately, this should result in better outcomes for patients with HCC.
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Affiliation(s)
- John S Lubel
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Jennifer Philip
- University of Melbourne, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
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10
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The evolution and clinical impact of hepatitis B virus genome diversity. Nat Rev Gastroenterol Hepatol 2020; 17:618-634. [PMID: 32467580 DOI: 10.1038/s41575-020-0296-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 02/06/2023]
Abstract
The global burden of hepatitis B virus (HBV) is enormous, with 257 million persons chronically infected, resulting in more than 880,000 deaths per year worldwide. HBV exists as nine different genotypes, which differ in disease progression, natural history and response to therapy. HBV is an ancient virus, with the latest reports greatly expanding the host range of the Hepadnaviridae (to include fish and reptiles) and casting new light on the origins and evolution of this viral family. Although there is an effective preventive vaccine, there is no cure for chronic hepatitis B, largely owing to the persistence of a viral minichromosome that is not targeted by current therapies. HBV persistence is also facilitated through aberrant host immune responses, possibly due to the diverse intra-host viral populations that can respond to host-mounted and therapeutic selection pressures. This Review summarizes current knowledge on the influence of HBV diversity on disease progression and treatment response and the potential effect on new HBV therapies in the pipeline. The mechanisms by which HBV diversity can occur both within the individual host and at a population level are also discussed.
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11
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Hla TK, Bukulatjpi SM, Binks P, Gurruwiwi GG, Dhurrkay RG, Davies J. A "one stop liver shop" approach improves the cascade-of-care for Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in the Northern Territory of Australia: results of a novel care delivery model. Int J Equity Health 2020; 19:64. [PMID: 32381081 PMCID: PMC7206741 DOI: 10.1186/s12939-020-01180-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Aboriginal and Torres Strait Islander Australians are disproportionately affected by Chronic Hepatitis B (CHB) with a prevalence of 6.08% in the Northern Territory (NT) and liver cancer rates 6 times higher than non-Indigenous Australians. Without appropriate care, overall 25% of those living with CHB will die from either liver failure or liver cancer, outcomes that can be minimised with regular follow up, antiviral treatment and hepatocellular carcinoma (HCC) screening. This care including antiviral treatment is publicly funded in the Australian setting however the care cascade still shows inequities in access to treatment for Aboriginal Australians. We describe the impact of a mobile care delivery model, “One Stop Liver Shop”, on the cascade of care for people living with CHB in a remote Australian setting. Methods A retrospective analysis was performed for CHB care received between 2013 and 2018 in one very remote Northern Territory community, where the “One Stop Liver Shop” was iteratively developed with the community. Patients with positive Hepatitis B virus surface antigen (HBsAg) were identified through electronic medical records. Proportions of patients who are up-to-date with monitoring investigations and HCC screening were evaluated and compared to national guidelines and targets. Results Eighty-three HBsAg positive patients were evaluated. Eighty-eight percent were engaged in care, 16% of whom were receiving antiviral treatment. Liver function tests (LFT) were up to date in 71% of patients in 2013 and 88% in 2018. Viral load (VL) monitoring was up to date for 61 (73%) of patients. There were 44 patients in whom HCC screening was indicated. Of these, 38 (86.4%) were up to date with 6 monthly alpha-fetoprotein (AFP), 35 (79.5%) were up to date with 6 monthly liver ultrasound scan (USS), and 34 (77.3%) were up-to-date for both. Conclusions A “One Stop Liver Shop” developed with and including Aboriginal Health Practitioners bridges gaps in the availability of services to those living with CHB in a very remote community and improves the cascade of care.
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Affiliation(s)
- Thel K Hla
- Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Sarah M Bukulatjpi
- Menzies School of Health Research, Charles Darwin University, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Paula Binks
- Menzies School of Health Research, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - George G Gurruwiwi
- Menzies School of Health Research, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Roslyn G Dhurrkay
- Menzies School of Health Research, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia
| | - Jane Davies
- Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia. .,Menzies School of Health Research, Rocklands Drive, Tiwi, Darwin, NT, 0810, Australia.
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12
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Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, Jia J, Tian Q, Aggarwal R, Muljono DH, Omata M, Ooka Y, Han KH, Lee HW, Jafri W, Butt AS, Chong CH, Lim SG, Pwu RF, Chen DS. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2020; 5:167-228. [PMID: 31852635 PMCID: PMC7164809 DOI: 10.1016/s2468-1253(19)30342-5] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 07/20/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023]
Abstract
The Asia-Pacific region is home to more than half of the global population and accounted for 62·6% of global deaths due to liver diseases in 2015. 54·3% of global deaths due to cirrhosis, 72·7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20·8%), non-alcoholic fatty liver disease (NAFLD; 12·1%), and chronic infection with hepatitis C virus (HCV; 15·7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birth-dose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.
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Affiliation(s)
- Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India.
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi, India
| | - Mohammed Eslam
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, University of Sydney and Westmead Hospital, Westmead, Australia
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sheikh M Fazle Akbar
- Department of Pathology, Ehime University Proteo-Science Center, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Qiuju Tian
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, China
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan; University of Tokyo, Tokyo, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology, Chiba University Hospital, Chiba, Japan
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Wasim Jafri
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Amna S Butt
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan
| | - Chern H Chong
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Division of General Medicine, Woodlands Health Campus, Singapore
| | - Seng G Lim
- Division of Gastroenterology & Hepatology, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raoh-Fang Pwu
- National Hepatitis C Program Office, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Genomics Research Center, Academia Sinica, Taipei, Taiwan
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13
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He WQ, Duong MC, Gidding H, MacLachlan J, Wood J, Kaldor JM, Liu B. Trends in chronic hepatitis B prevalence in Australian women by country of birth, 2000 to 2016. J Viral Hepat 2020; 27:74-80. [PMID: 31498941 DOI: 10.1111/jvh.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/08/2019] [Accepted: 08/24/2019] [Indexed: 01/19/2023]
Abstract
Routine antenatal screening for chronic hepatitis B (HBV) in countries with high migrant populations provides an opportunity to monitor trends in HBV prevalence and can inform estimates locally and in countries with limited seroprevalence data. We linked perinatal birth register records with HBV notifications in the largest Australian state, over the period 2000-2016. Among women aged 15-44 years, we estimated age-standardized chronic HBV prevalence overall and by country of birth and also estimated trends in age-standardized HBV prevalence over time using regression modelling. Among 903 831 women, 8001 linked to a chronic HBV infection record (overall age-standardized prevalence 0.76%, 95% CI: 0.74-0.78). Prevalence varied by country of birth with the highest estimates among women born in Sierra Leone (11.13%, 95% CI: 8.29-13.96), Taiwan (8.08%, 95% CI: 6.74%-9.43%), Cambodia (7.47%, 95% CI: 6.50%-8.45%) and Vietnam (7.36%, 95% CI: 6.97%-7.75%); more moderate estimates among women from North Korea (2.76%, 95% CI: 1.99-3.53) and Samoa (2.64%, 95% CI: 1.99%-3.29%); prevalence was 0.18% (95% CI: 0.17-0.19) in Australian-born women. Over 17 years, there were significant reductions in HBV prevalence among all women (from 0.88% in 2000 to 0.57% in 2016; P < .0001). Among women from high prevalence countries, the greatest absolute reductions were observed among those from Taiwan (10.1%, P < .001) followed by Tonga (5.4%, P < .001), whereas no reductions were observed for women born in Vietnam (P = .08), South Korea (P = .41) and Sudan (P = .06). In conclusion, routine antenatal HBV testing can be used to inform HBV prevalence estimates and vaccine programme impact in countries with limited surveillance and high migration to Australia.
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Affiliation(s)
- Wen-Qiang He
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Minh Cuong Duong
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Heather Gidding
- Clinical and Population Perinatal Health Researchs, Kolling Institute, St Leonards, New South Wales, Australia
| | - Jennifer MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Melbourne, Victoria, Australia
| | - James Wood
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - John M Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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14
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Wallace J, Hanley B, Belfrage M, Gregson S, Quiery N, Lucke J. Delivering the hepatitis C cure to Aboriginal people: documenting the perspectives of one Aboriginal Health Service. Aust J Prim Health 2019; 24:491-495. [PMID: 30336799 DOI: 10.1071/py18024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
Aboriginal and Torres Strait Islander peoples are disproportionately affected by hepatitis C, an infection that is curable with direct acting antivirals (DAAs). The Australian Government funded access to DAAs from March 2016 for all people with hepatitis C, with primary care physicians, along with clinical specialists, permitted to prescribe these treatments. The Victorian Aboriginal Health Service, in recognising the effect of liver disease from viral hepatitis within their community, and of the increased availability to DAAs, established a Liver Clinic to facilitate access to treatment for people attending the service. This study conducted semi-structured interviews to document the health service provider perspectives on the barriers and enablers to treatment; explored patients' experiences of hepatitis C treatment and cure; and sought to identify possible health system-level changes to facilitate increased access and uptake of treatment by Aboriginal people. The study found the success of the clinic was supported by the multidisciplinary and accessible nature of the health service, and the relationships built over time between clinic staff and people with, or at risk of, hepatitis C. For those treated, the individual effect of the cure not only eliminated the hepatitis C virus, but reduced shame and increased broader social participation.
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Affiliation(s)
- Jack Wallace
- Burnet Institute, 185 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Bev Hanley
- Deceased. Victorian Aboriginal Health Service, 186 Nicholson Street, Fitzroy, Vic. 3065, Australia
| | - Mary Belfrage
- Victorian Aboriginal Health Service, 186 Nicholson Street, Fitzroy, Vic. 3065, Australia
| | - Sandra Gregson
- Victorian Aboriginal Health Service, 186 Nicholson Street, Fitzroy, Vic. 3065, Australia
| | - Niall Quiery
- Victorian Aboriginal Health Service, 186 Nicholson Street, Fitzroy, Vic. 3065, Australia
| | - Jayne Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, Vic. 3086, Australia
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15
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MacLachlan JH, Romero N, Higgins N, Coutts R, Chan R, Stephens N, Cowie BC. Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance. Aust N Z J Public Health 2019; 44:59-64. [PMID: 31535439 DOI: 10.1111/1753-6405.12934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/01/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. METHODS Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015-June 2016, and during enhanced surveillance of the period July 2016-June 2017, during which time doctors were contacted for information about new diagnoses. RESULTS During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18-37% to 48-65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4-fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. CONCLUSIONS Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.
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Affiliation(s)
- Jennifer H MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Victoria.,Department of Medicine, University of Melbourne, Victoria
| | - Nicole Romero
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Victoria.,Department of Medicine, University of Melbourne, Victoria
| | - Nasra Higgins
- Victorian Government Department of Health and Human Services, Victoria
| | - Rachel Coutts
- Victorian Government Department of Health and Human Services, Victoria
| | - Rachel Chan
- Victorian Government Department of Health and Human Services, Victoria
| | - Nicola Stephens
- Victorian Government Department of Health and Human Services, Victoria
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, Victoria.,Department of Medicine, University of Melbourne, Victoria.,Victorian Government Department of Health and Human Services, Victoria.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria
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16
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Ioannides S, Beard F, Larter N, Clark K, Wang H, Hendry A, Hull B, Dey A, Chiu C, Brotherton J, Jayasinghe S, Macartney K, McIntyre P. Vaccine Preventable Diseases and Vaccination Coverage in Aboriginal and Torres Strait Islander People, Australia, 2011–2015. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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18
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Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, Dusheiko G, Feld JJ, Gore C, Griswold MG, Hamid S, Hellard ME, Hou J, Howell J, Jia J, Kravchenko N, Lazarus JV, Lemoine M, Lesi OA, Maistat L, McMahon BJ, Razavi H, Roberts T, Simmons B, Sonderup MW, Spearman CW, Taylor BE, Thomas DL, Waked I, Ward JW, Wiktor SZ. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2019; 4:135-184. [PMID: 30647010 DOI: 10.1016/s2468-1253(18)30270-x] [Citation(s) in RCA: 355] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.
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Affiliation(s)
- Graham S Cooke
- Division of Infectious Diseases, Imperial College London, London, UK.
| | | | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | - Jordan J Feld
- Toronto Center for Liver Disease, Toronto General Hospital, Toronto, Canada
| | | | - Max G Griswold
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - JinLin Hou
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Guangzhou, China
| | - Jess Howell
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Jidong Jia
- Liver Research Center, Beijing Friendship Hospital, Beijing, China
| | | | - Jeffrey V Lazarus
- Health Systems Research Group, Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Maud Lemoine
- Division of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AL, USA
| | - Homie Razavi
- Center for Disease Analysis Foundation, Lafayette, CO, USA
| | | | - Bryony Simmons
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, South Africa
| | | | - David L Thomas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Imam Waked
- National Liver Institute, Menoufiya University, Egypt
| | - John W Ward
- Program for Viral Hepatitis Elimination, Task Force for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stefan Z Wiktor
- Department of Global Health, University of Washington, Seattle, WA, USA
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19
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Turpin J, Yurick D, Khoury G, Pham H, Locarnini S, Melamed A, Witkover A, Wilson K, Purcell D, Bangham CRM, Einsiedel L. Impact of Hepatitis B Virus Coinfection on Human T-Lymphotropic Virus Type 1 Clonality in an Indigenous Population of Central Australia. J Infect Dis 2019; 219:562-567. [PMID: 30307560 PMCID: PMC6350946 DOI: 10.1093/infdis/jiy546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022] Open
Abstract
The prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) coinfection is high in certain Indigenous Australian populations, but its impact on HTLV-1 has not been described. We compared 2 groups of Indigenous adults infected with HTLV-1, either alone or coinfected with HBV. The 2 groups had a similar HTLV-1 proviral load, but there was a significant increase in clonal expansion of HTLV-1-infected lymphocytes in coinfected asymptomatic individuals. The degree of clonal expansion was correlated with the titer of HBV surface antigen. We conclude that HTLV-1/HBV coinfection may predispose to HTLV-1-associated malignant disease.
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Affiliation(s)
- Jocelyn Turpin
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - David Yurick
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Georges Khoury
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Hai Pham
- Baker Heart and Diabetes Institute Central Australia, Alice Springs Hospital, Northern Territory, Melbourne, Victoria, Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | - Anat Melamed
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Aviva Witkover
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Kim Wilson
- National Serological Reference Laboratory, Melbourne, Victoria, Australia
| | - Damian Purcell
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Charles R M Bangham
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute Central Australia, Alice Springs Hospital, Northern Territory, Melbourne, Victoria, Australia
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20
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Coles T, Simpson P, Saulo D, Kaldor J, Richards A, Levy M, Wake C, Siddall DA, Harrod ME, Kariminia A, Butler T. Trends in hepatitis B prevalence and associated risk factors among Indigenous and non-Indigenous prison entrants in Australia, 2004 to 2013. Aust N Z J Public Health 2019; 43:236-240. [PMID: 30690821 DOI: 10.1111/1753-6405.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/01/2018] [Accepted: 12/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non-Indigenous prison entrants. METHODS A cross-sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. RESULTS The study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti-HBc) prevalence than non-Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti-HBc prevalence to non-Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)ᶺ . Being more than 30 years old and coming from an area classified as 'non-highly accessible' were associated with anti-HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti-HBc positivity. For non-Indigenous participants, a history of injecting drug use and body piercings was associated with anti-HBc positivity. CONCLUSION There are unique risk factors associated with HBV prevalence for both Indigenous and non-Indigenous prison entrants. Implications for public health: In developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non-Indigenous offenders is required.
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Affiliation(s)
- Tayla Coles
- The Kirby Institute, University of New South Wales
| | - Paul Simpson
- The Kirby Institute, University of New South Wales
| | - Dina Saulo
- The Kirby Institute, University of New South Wales
| | - John Kaldor
- The Kirby Institute, University of New South Wales
| | | | - Michael Levy
- Australian National University Medical School, Australian Capital Territory
| | - Christopher Wake
- Tasmania Health Services - Mental Health and Statewide Services, Tasmania
| | | | | | | | - Tony Butler
- The Kirby Institute, University of New South Wales
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21
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Cunningham C. Accelerating the elimination of viral hepatitis for Indigenous peoples. Lancet Gastroenterol Hepatol 2019; 4:93-94. [PMID: 30647015 DOI: 10.1016/s2468-1253(18)30412-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Chris Cunningham
- Research Centre for Maori Health and Development, Massey University, Wellington, New Zealand; The Hepatitis Foundation of New Zealand, Whakatane, New Zealand.
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22
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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.
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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
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23
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Myran DT, Morton R, Biggs BA, Veldhuijzen I, Castelli F, Tran A, Staub LP, Agbata E, Rahman P, Pareek M, Noori T, Pottie K. The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091898. [PMID: 30200406 PMCID: PMC6164421 DOI: 10.3390/ijerph15091898] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
Abstract
Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3–100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention.
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Affiliation(s)
- Daniel T Myran
- University of Ottawa School of Epidemiology and Public Health, Ottawa, ON K1G 5Z3, Canada.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Beverly-Ann Biggs
- Department of Medicine at the Doherty Institute, University of Melbourne, and Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne 3000, Australia.
| | - Irene Veldhuijzen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven 3720, The Netherlands.
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases University of Brescia and ASST Spedali Civili, Brescia 25123, Italy.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Lukas P Staub
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney 2006, Australia.
| | - Eric Agbata
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universität Autònoma de Barcelona, Barcelona 08193, Spain.
| | - Prinon Rahman
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON K1R 7G5, Canada.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm 169 73, Sweden.
| | - Kevin Pottie
- Bruyere Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1R 7G5, Canada.
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24
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Sub-optimal protection against past hepatitis B virus infection where subtype mismatch exists between vaccine and circulating viral genotype in northern Australia. Vaccine 2018; 36:3533-3540. [DOI: 10.1016/j.vaccine.2018.01.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
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25
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Mrklas KJ, MacDonald S, Shea-Budgell MA, Bedingfield N, Ganshorn H, Glaze S, Bill L, Healy B, Healy C, Guichon J, Colquhoun A, Bell C, Richardson R, Henderson R, Kellner J, Barnabe C, Bednarczyk RA, Letendre A, Nelson GS. Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol. Syst Rev 2018; 7:40. [PMID: 29499749 PMCID: PMC5833130 DOI: 10.1186/s13643-018-0692-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the existence of human papilloma virus (HPV) vaccines with demonstrated safety and effectiveness and funded HPV vaccination programs, coverage rates are persistently lower and cervical cancer burden higher among Canadian Indigenous peoples. Barriers and supports to HPV vaccination in Indigenous peoples have not been systematically documented, nor have interventions to increase uptake in this population. This protocol aims to appraise the literature in Canadian and global Indigenous peoples, relating to documented barriers and supports to vaccination and interventions to increase acceptability/uptake or reduce hesitancy of vaccination. Although HPV vaccination is the primary focus, we anticipate only a small number of relevant studies to emerge from the search and will, therefore, employ a broad search strategy to capture literature related to both HPV vaccination and vaccination in general in global Indigenous peoples. METHODS Eligible studies will include global Indigenous peoples and discuss barriers or supports and/or interventions to improve uptake or to reduce hesitancy, for the HPV vaccine and/or other vaccines. Primary outcomes are documented barriers or supports or interventions. All study designs meeting inclusion criteria will be considered, without restricting by language, location, or data type. We will use an a priori search strategy, comprised of key words and controlled vocabulary terms, developed in consultation with an academic librarian, and reviewed by a second academic librarian using the PRESS checklist. We will search several electronic databases from date of inception, without restrictions. A pre-defined group of global Indigenous websites will be reviewed for relevant gray literature. Bibliographic searches will be conducted for all included studies to identify relevant reviews. Data analysis will include an inductive, qualitative, thematic synthesis and a quantitative analysis of measured barriers and supports, as well as a descriptive synthesis and quantitative summary of measures for interventions. DISCUSSION To our knowledge, this study will contribute the first systematic review of documented barriers, supports, and interventions for vaccination in general and for HPV vaccination. The results of this study are expected to inform future research, policies, programs, and community-driven initiatives to enhance acceptability and uptake of HPV vaccination among Indigenous peoples. SYSTEMATIC REVIEW REGISTRATION PROSPERO Registration Number: CRD42017048844.
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Affiliation(s)
- Kelly J. Mrklas
- Research Innovation and Analytics, Alberta Health Services, Edmonton, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Melissa A. Shea-Budgell
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nancy Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather Ganshorn
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Sarah Glaze
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | - Chyloe Healy
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | - Juliet Guichon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Colquhoun
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada
| | - Christopher Bell
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada
| | - Ruth Richardson
- Health Canada First Nations and Inuit Health Branch, Edmonton, Canada
| | - Rita Henderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James Kellner
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | - Gregg S. Nelson
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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26
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Davies J, Li SQ, Tong SY, Baird RW, Beaman M, Higgins G, Cowie BC, Condon JR, Davis JS. Establishing contemporary trends in hepatitis B sero-epidemiology in an Indigenous population. PLoS One 2017; 12:e0184082. [PMID: 28886050 PMCID: PMC5590876 DOI: 10.1371/journal.pone.0184082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Indigenous populations globally are disproportionately affected by chronic hepatitis B virus (HBV) infection however contemporary sero-prevalence data are often absent. In the Indigenous population of the Northern Territory (NT) of Australia the unique C4 sub-genotype of HBV universally circulates. There are no studies of the sero-prevalence, nor the impact of the vaccination program (which has a serotype mismatch compared to C4), at a population-wide level. METHODS We examined all available HBV serology results obtained from the three main laboratories serving NT residents between 1991 and 2011. Data were linked with a NT government database to determine Indigenous status and the most recent test results for each individual were extracted as a cross-sectional database including 88,112 unique individuals. The primary aim was to obtain a contemporary estimate of HBsAg positivity for the NT by Indigenous status. RESULTS Based on all tests from 2007-2011 (35,633 individuals), hepatitis B surface antigen (HBsAg) positivity was 3·40% (95%CI 3·19-3·61), being higher in Indigenous (6·08%[5·65%-6·53%]) than non-Indigenous (1·56%[1·38%-1·76%]) Australians, p<0·0001. Birth cohort analysis showed HBsAg positivity fell over time for Indigenous people, with this decrease commencing prior to universal infant vaccination (which commenced in 1990), with an ongoing but slower rate of decline since 1990, (0·23% decrease per year versus 0·17%). CONCLUSIONS HBsAg positivity is high in the NT, particularly in the Indigenous population. HBsAg positivity has fallen over time but a substantial part of this decrease is due to factors other than the universal vaccination program.
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Affiliation(s)
- Jane Davies
- Department of Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- The Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- * E-mail:
| | - Shu Qin Li
- Health Gains Planning Branch, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Y. Tong
- Department of Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rob W. Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Miles Beaman
- Western Diagnostic Pathology, Myaree, Western Australia, Australia
- University of Western Australia, Perth, Western Australia, Australia
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Benjamin C. Cowie
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Victoria, Australia
| | - John R. Condon
- Department of Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Health Gains Planning Branch, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Joshua S. Davis
- Department of Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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27
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MacLachlan J, Allard N, Carville K, Haynes K, Cowie B. Mapping progress in chronic hepatitis B: geographic variation in prevalence, diagnosis, monitoring and treatment, 2013-15. Aust N Z J Public Health 2017; 42:62-68. [DOI: 10.1111/1753-6405.12693] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/01/2017] [Accepted: 04/01/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jennifer MacLachlan
- WHO Collaborating Centre for Viral Hepatitis; The Doherty Institute; Victoria
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis; The Doherty Institute; Victoria
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria
- cohealth; Victoria
| | - Kylie Carville
- WHO Collaborating Centre for Viral Hepatitis; The Doherty Institute; Victoria
| | - Katelin Haynes
- Australasian Society for HIV; Viral Hepatitis and Sexual Health Medicine; New South Wales
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis; The Doherty Institute; Victoria
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Victoria
- Victorian Infectious Diseases Service; Royal Melbourne Hospital
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28
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Kinchin I, Mccalman J, Bainbridge R, Tsey K, Lui FW. Does Indigenous health research have impact? A systematic review of reviews. Int J Equity Health 2017; 16:52. [PMID: 28327137 PMCID: PMC5361858 DOI: 10.1186/s12939-017-0548-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry. Methods Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples’ health would be explicated. Results Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated. Conclusions The findings of our study serve two main purposes. First, we have identified knowledge and methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0548-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia. .,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia.
| | - Janya Mccalman
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Felecia Watkin Lui
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
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Wattiaux AL, Yin JK, Beard F, Wesselingh S, Cowie B, Ward J, Macartney K. Hepatitis B immunization for indigenous adults, Australia. Bull World Health Organ 2016; 94:826-834A. [PMID: 27821885 PMCID: PMC5096351 DOI: 10.2471/blt.16.169524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 12/01/2022] Open
Abstract
Objective To quantify the disparity in incidence of hepatitis B between indigenous and non-indigenous people in Australia, and to estimate the potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults. Methods Using national data on persons with newly acquired hepatitis B disease notified between 2005 and 2012, we estimated incident infection rates and rate ratios comparing indigenous and non-indigenous people, with adjustments for underreporting. The potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults was projected using a Markov chain Monte Carlo simulation model. Findings Of the 54 522 persons with hepatitis B disease notified between 1 January 2005 and 31 December 2012, 1953 infections were newly acquired. Acute hepatitis B infection notification rates were significantly higher for indigenous than non-indigenous Australians. The rates per 100 000 population for all ages were 3.6 (156/4 368 511) and 1.1 (1797/168 449 302) for indigenous and non-indigenous people respectively. The rate ratio of age-standardized notifications was 4.0 (95% confidence interval: 3.7–4.3). If 50% of non-immune indigenous adults (20% of all indigenous adults) were vaccinated over a 10-year programme a projected 527–549 new cases of acute hepatitis B would be prevented. Conclusion There continues to be significant health inequity between indigenous and non-indigenous Australians in relation to vaccine-preventable hepatitis B disease. An immunization programme targeting indigenous Australian adults could have considerable impact in terms of cases of acute hepatitis B prevented, with a relatively low number needed to vaccinate to prevent each case.
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Affiliation(s)
- Andre Louis Wattiaux
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
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30
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van Gemert C, Wang J, Simmons J, Cowie B, Boyle D, Stoove M, Enright C, Hellard M. Improving the identification of priority populations to increase hepatitis B testing rates, 2012. BMC Public Health 2016; 16:95. [PMID: 26832144 PMCID: PMC4735953 DOI: 10.1186/s12889-016-2716-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background It is estimated that over 40 % of the 218,000 people with chronic hepatitis B (CHB) in Australia in 2011 are undiagnosed. A disproportionate number of those with undiagnosed infection were born in the Asia-Pacific region. Undiagnosed CHB can lead to ongoing transmission and late diagnosis limits opportunities to prevent progression to hepatocellular carcinoma (HCC) and cirrhosis. Strategies are needed to increase testing for hepatitis B virus (HBV) (including culturally and linguistically diverse communities, Aboriginal and/or Torres Strait Islander (Indigenous) people and people who inject drugs). General practitioners (GPs) have a vital role in increasing HBV testing and the timely diagnosis CHB. This paper describes the impact of a GP-based screening intervention to improve CHB diagnosis among priority populations in Melbourne, Australia. Methods A non-randomised, pre-post intervention study was conducted between 2012 and 2013 with three general practices in Melbourne, Australia. Using clinic electronic health records three priority populations known to be at increased CHB risk in Australia (1: Asian-born patients or patients of Asian ethnicity living in Australia; 2: Indigenous people; or 3): people with a history of injecting drugs were identified and their HBV status recorded. A random sample were then invited to attend their GP for HBV testing and/or vaccination. Baseline and follow-up electronic data collection identified patients that subsequently had a consultation and HBV screening test and/or vaccination. Results From a total of 33,297 active patients, 2674 (8 %) were identified as a priority population at baseline; 2275 (85.1 %) of these patients had unknown HBV status from which 338 (14.0 %) were randomly sampled. One-fifth (n = 73, 21.6 %) of sampled patients subsequently had a GP consultation during the study period; only four people (5.5 %) were subsequently tested for HBV (CHB detected in n = 1) and none were vaccinated against HBV. Conclusion CHB infection is an important long-term health issue in Australia and strategies to increase appropriate and timely testing are required. The study was effective at identifying whether Asian-born patients and patients of Asian had been tested or vaccinated for HBV; however the intervention was not effective at increasing HBV testing.
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Affiliation(s)
- Caroline van Gemert
- Centre for Population Health, Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Julie Wang
- Centre for Population Health, Burnet Institute, Melbourne, Australia
| | | | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Douglas Boyle
- GRHANITE™ Health Informatics Unit, Health and Biomedical Informatics Centre, University of Melbourne, Melbourne, Australia
| | - Mark Stoove
- Centre for Population Health, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
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32
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Rowe SL, Cowie BC. Using data linkage to improve the completeness of Aboriginal and Torres Strait Islander status in communicable disease notifications in Victoria. Aust N Z J Public Health 2015; 40:148-53. [PMID: 26337430 DOI: 10.1111/1753-6405.12434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/01/2014] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The burden of notifiable diseases in Aboriginal and Torres Strait Islander Victorians cannot be accurately estimated due to under-reporting of Indigenous status. We used data linkage to improve completeness of Indigenous status in people notified with viral hepatitis and gonococcal infection. METHODS Notifications made between 2009 and 2010 were linked with Victorian hospitalisation data (1997-2011). Notification rates by Indigenous status and rate ratios were calculated before and after linkage. RESULTS There were 12,448 cases of hepatitis B, hepatitis C and gonococcal infection notified in Victoria in 2009-2010, with Indigenous status missing in 61.6%, 67.8%, 33.1% of these conditions, respectively. Of the total notified cases, 82% were able to be linked. Following linkage, the proportion of notifications with missing Indigenous status decreased to less than 0.2% for all conditions. Age-standardised notification rates among both Aboriginal people and non-Aboriginal people increased for all conditions. CONCLUSIONS Data linkage improved completeness of Indigenous status in notifications for viral hepatitis and gonococcal infection in Victoria. Completeness of these data is integral to monitoring progress in closing the Indigenous life expectancy gap. IMPLICATIONS Greater emphasis is needed on addressing prevention, treatment and care for viral hepatitis and sexually transmissible infections for Indigenous Victorians.
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Affiliation(s)
- Stacey L Rowe
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Department of Health Victoria
| | - Benjamin C Cowie
- Communicable Disease Epidemiology and Surveillance, Health Protection Branch, Department of Health Victoria.,WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, University of Melbourne, Victoria
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33
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Anderson E, Ellard J, Wallace J. Torres Strait Islanders' understandings of chronic hepatitis B and attitudes to treatment. Aust J Prim Health 2015; 22:316-319. [PMID: 26329779 DOI: 10.1071/py14130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/11/2015] [Indexed: 11/23/2022]
Abstract
Indigenous Australians are disproportionally affected by hepatitis B compared with non-Indigenous Australians. The higher prevalence of hepatitis B among Indigenous Australians has been linked to an increased incidence of liver cancer in this population. There is evidence that comprehensive programs of hepatitis B virus management, which include liver cancer surveillance and appropriate antiviral therapy, offer a cost-effective approach to reduce the incidence of liver cancer in Australia. This paper reports on data from the first study investigating understandings of hepatitis B and attitudes to treatment among Torres Strait Islanders living with chronic hepatitis B. Forty-two participants completed an interview questionnaire. Participants typically had an unclear understanding of hepatitis B and reported significant gaps in monitoring and follow up. A majority of participants indicated a willingness to use treatment if required. The findings of this study suggest the need for a new service delivery model that is appropriate to remote communities such as the Torres Strait Islands, to improve hepatitis B follow up, disease monitoring and management, and where appropriate, the uptake of treatment.
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Affiliation(s)
- Elayne Anderson
- James Cook University, School of Medicine and Dentistry, 1 James Cook Drive, Townsville City, Qld 4811, Australia
| | - Jeanne Ellard
- La Trobe University, Australian Centre in Sex, Health and Society, 255 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Jack Wallace
- La Trobe University, Australian Centre in Sex, Health and Society, 255 Franklin Street, Melbourne, Vic. 3000, Australia
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Abstract
The epidemiology of hepatitis B virus (HBV) infection is geographically diverse, with population prevalence, age and mode of acquisition, and likelihood of progression to chronic infection mutually interdependent. The burden of chronic HBV infection is increasingly being recognized, with cirrhosis and liver cancer attributable to HBV continuing to increase. The outcomes of chronic HBV infection are affected by a range of factors, including viral genotype, the presence of coinfections with other blood-borne viruses, and the impact of other causes of liver disease. The increased recognition of HBV infection as a leading cause of death globally has resulted in the development of new structures and policies at the international level; immediate attention to implementing these strategies is now required.
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Affiliation(s)
- Jennifer H MacLachlan
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria 3000, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria 3050, Australia
| | - Benjamin C Cowie
- Epidemiology Unit, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria 3000, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria 3050, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
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Harrod ME, Couzos S, Delaney-Thiele D, Dore GJ, Hammond B, Saunders M, Belfrage M, Williams S, Kaldor JM, Ward J. Markers of hepatitis B infection and immunity in patients attending Aboriginal community controlled health services. Med J Aust 2014; 201:339-42. [PMID: 25222458 DOI: 10.5694/mja14.00121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. We aimed to increase the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data. DESIGN A cross-sectional study of de-identified records from electronic patient systems over 5 years (8 January 2009 to 11 July 2013). SETTING Four Aboriginal community controlled health services. PARTICIPANTS All patients attending for a clinical visit were included in the study. Hepatitis B testing records were included if at least one serological test for HBV was done. MAIN OUTCOME MEASURES Percentage of clinical patients tested for hepatitis B, compliance with guidelines and serological status. RESULTS A total of 2959 people aged 15-54 years were screened for HBV, representing 17.2% of all people with a clinical visit in the study period. A total of 865 Aboriginal patients were tested concurrently for hepatitis B surface antigen (HBsAg), hepatitis B core antibody and hepatitis B surface antibody. Of those, 352 (40.7%) were susceptible to HBV infection (95% CI, 37.4%-43.9%) and 34 (3.9%) had either an acute or chronic infection indicated by a positive HBsAg result (95% CI, 2.6%-5.2%). In 329 women with antenatal screening, six (1.8%) returned a positive HBsAg result (95% CI, 0.37%-3.28%). CONCLUSION A substantial proportion of patients tested were susceptible to HBV, with a high percentage potentially infectious compared with the general population. High levels of active infection and susceptibility to infection suggest many opportunities for transmission and indicate the potential benefit of routine HBV testing and vaccination in this population.
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Affiliation(s)
- Mary E Harrod
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Sophia Couzos
- General Practice and Rural Medicine, James Cook University, Townsville, QLD, Australia
| | - Dea Delaney-Thiele
- Public Health Unit, Aboriginal Medical Service Western Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Belinda Hammond
- Quality, Safety and Reporting, Nunkuwarrin Yunti of South Australia Inc, Adelaide, SA, Australia
| | - Mark Saunders
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Mary Belfrage
- Victorian Aboriginal Health Service, Melbourne, VIC, Australia
| | | | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Ward
- Baker IDI Central Australia, Alice Springs, NT, Australia
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Parker C, Tong SY, Dempsey K, Condon J, Sharma SK, Chen JW, Sievert W, Davis JS. Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome. Med J Aust 2014; 201:470-4. [DOI: 10.5694/mja13.11117] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Affiliation(s)
| | | | - Karen Dempsey
- Health Gains Planning Unit, Northern Territory Government, Darwin, NT
| | - John Condon
- Menzies School of Health Research, Darwin, NT
| | | | - John W C Chen
- South Australian Liver Transplant Unit, Flinders Medical Centre, Adelaide, SA
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Reekie JM, Levy MH, Richards AH, Wake CJ, Siddall DA, Beasley HM, Kumar S, Butler TG. Trends in HIV, hepatitis B and hepatitis C prevalence among Australian prisoners - 2004, 2007, 2010. Med J Aust 2014; 200:277-80. [PMID: 24641153 DOI: 10.5694/mja13.11062] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/02/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To report the prevalence of markers for HIV infection, hepatitis B and hepatitis C among Australian prison entrants. DESIGN Cross-sectional survey conducted over 2-week periods in 2004, 2007 and 2010. SETTING Reception prisons in New South Wales, Queensland, Tasmania and Western Australia. PARTICIPANTS Individuals entering prison from the community during the survey periods. MAIN OUTCOME MEASURE Prevalence of anti-HIV antibody (anti-HIV), hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc) and anti-hepatitis C virus antibody (anti-HCV). RESULTS The study included 1742 prison entrants: 588 (33.8%) in 2004, 536 (30.8%) in 2007 and 618 (35.5%) in 2010. The age-standardised prevalence estimates for anti-HIV, HBsAg and anti-HBc were 0.4%, 2.3% and 21.7% respectively, and remained stable over the three survey periods. The age-standardised prevalence estimate for anti-HCV was 29.0%; it decreased over time (33.3% in 2004 v 23.2% in 2010; P = 0.001), and this coincided with a decrease in prison entrants reporting injecting drug use (58.3% [343/588] in 2004 v 45.3% [280/618] in 2010; P < 0.001). Among injecting drug users, the prevalence of anti-HCV was 57.2% and did not change significantly over time. Of those who were anti-HCV positive, 33.7% (140/415) were unaware of their infection status, and 74.3% (185/249) of those who tested positive for anti-HBc reported that they had never had hepatitis B. CONCLUSIONS HIV prevalence is low in the Australian prisoner population but transmission remains a risk. Despite a decrease in the proportion of prison entrants reporting injecting drug use, prevalence of hepatitis B and hepatitis C has remained high. Treatment and prevention initiatives should be prioritised for this population.
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Affiliation(s)
- Joanne M Reekie
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Michael H Levy
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia
| | - Alun H Richards
- Communicable Diseases Unit, Queensland Health, Queensland Government, Brisbane, QLD, Australia
| | - Christopher J Wake
- Correctional Primary Health Service, Department of Health and Human Services, Tasmanian Government, Hobart, TAS, Australia
| | - Deborah A Siddall
- Forensic Health Services, Australasian Hepatology Association, Hobart, TAS, Australia
| | - Holly M Beasley
- Department of Corrective Services, Government of Western Australia, Perth, WA, Australia
| | - Shalin Kumar
- Justice Health and Forensic Mental Health Network, Sydney, NSW, Australia
| | - Tony G Butler
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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