The current pattern of hepatitis B virus infection in Australia

Abstract

There is little recent data of the seroprevalence of hepatitis B in Australia. We have surveyed a large cohort of endoscopy patients attending a teaching hospital in central Sydney, and related the presence of hepatitis B virus (HBV) markers with putative risk factors for exposure using the SAS statistical package. Of the 2115 patients tested: 2.1% (45/2115) were HBV surface antigen positive, 0.75% (14/2115) viraemic, 9.5% (200/2115) anti-HBs and anti-HBc positive, 20.1% (430/2115) vaccinated (anti-HBs only) and the remaining 70% were susceptible. The adjusted OR of HBV infection was significantly increased in patients who had been diagnosed with human immunodeficiency virus (36.3-fold), born in Asia or Pacific islands (12.4-fold), born in North Africa, Middle East & Mediterranean countries (6-fold) or born abroad elsewhere in the world (2.7-fold), had household contact with someone diagnosed with hepatitis between 1980 and 1990 (3.9-fold), injected drugs between 1980 and 1990 (4.4-fold), resided in a military establishment for 3 months (2.3-fold) or in a hospital for 3 months (2.2-fold), never been vaccinated for hepatitis B (2.8-fold), received blood transfusion due to an accident and/or a haemorrhage (1.92-fold) and finally been a male gender (1.59-fold). The prevalence of HBV in this hospital population was higher than predicted on the basis of notifications to the passive surveillance scheme. Most HBV patients had multiple risk factors for infection, but the hierarchy of odds ratios provides a rational basis for targeted programmes to identify asymptomatic HBV carriers who might benefit from treatment.

A survey of Sydney general practitioners' management of patients with chronic hepatitis B

“…In Australia, between 0.5 and 2.0% of the population are chronically infected, and approximately half of these are Asian immigrants (O'Sullivan et al 2004, Tawk et al 2006.…”

“…However, no large-scale population-level seroprevalence studies have been undertaken in Australia. Two published opportunistic seroprevalence studies were carried out between 1996(O'Sullivan et al 2004, Tawk et al 2006. In one study, O'Sullivan and colleagues tested for HBV infection in 3,336 stored sera samples that were collected from 45 laboratories around Australia between July 1996and May 1999(O'Sullivan et al 2004.…”

Developing an evidence‐based guideline for the management of exposure to hepatitis B at a Victorian tertiary hospital

“…A national laboratory-based serosurvey has estimated the population prevalence of HBV in Australia to be 0.47-0.87%, while a hospitalbased study found HBsAg seroprevalence of 2.1%. 4,5 A more recent paper based on numbers of people in priority populations and estimates of seroprevalence in these groups, as well as mathematical modelling, estimated overall seroprevalence of 1%. 6 The majority of chronic HBV infections are accounted for by people who were born overseas, especially in the Asia-Pacific region, with estimates from 38% to up to 65%.…”

“…6,4 In the hospital study of Tawk et al, 70% of those infected were born overseas. 5 Other population groups with higher prevalence include Aboriginal and Torres Strait Islander peoples, people who inject drugs (PWID) and MSM. 6,7 While up to 50% of PWID have markers of HBV infection, the rate of chronic infection is much lower.…”

Treatment of hepatitis B: the next five years

“…This study indicates how important it is to identify those individuals who, for whatever reason, have not been tested for hepatitis B. were individuals with HIV, those who were Asian, or those from the Pacific Islands (adjusted odds ratio 36.3-fold and 12.4-fold respectively). 29 Now that we have effective therapies which can prevent both liver disease progression and liver cancer, 1 it is vital that we identify these silent carriers.…”