Screening for hepatitis B in East Arnhem Land: a high prevalence of chronic infection despite incomplete screening

Abstract

Infection with hepatitis B virus (HBV) is common in Aboriginal Australians, but current seroprevalences in Northern Territory communities are unknown. We performed an audit of HBV serology on a convenience sample of 112 adults at an East Arnhem Land Health Service. Complete HBV serology was only available in 26 (23%) patients. Evidence of HBV exposure (core antibody-positive) was found in 43 of 68 (63%) patients tested, and current HBV infection (surface antigen-positive) was found in nine of 76 (12%). HBV is an incompletely defined, under-resourced and substantial public health problem in Aboriginal Australians.

The molecular epidemiology of hepatitis B in the Indigenous people of northern Australia

“…Universal hepatitis B vaccination at birth has been in place for Indigenous children since 1988 and all children since 1990 in the NT. Despite this, there are concerning reports from small studies suggesting reduced hepatitis B vaccine efficacy in fully vaccinated Australian Indigenous populations …”

“…Despite this, there are concerning reports from small studies suggesting reduced hepatitis B vaccine efficacy in fully vaccinated Australian Indigenous populations. 12,13 There are currently 10 genotypes of HBV (A-J) described in the literature based on sequence divergence of more than 8% and within these multiple subgenotypes based on sequence divergence of 4-8%. 14 There is a distinct geographical distribution of genotypes and subgenotypes described to date that is continually being updated.…”

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia

“…Indigenous Australians in the Northern Territory (NT) experience a disproportionate burden of hepatitis B infection with an estimated 6% seroprevalence compared to 1.6% in the non‐Indigenous population . Many are unaware of their diagnosis as there are suboptimal screening rates . Increased rates of testing are urgently required due to the association of hepatitis B with cirrhosis and hepatocellular carcinoma, while liver disease is among the top three diseases contributing to the reduced life expectancy of Indigenous Australians compared to non‐Indigenous Australians…”

“…This strategy names Indigenous Australians as a priority population. However, achieving high screening rates is difficult in remote parts of the Northern Territory due to the mobile population, cultural and communication barriers and high staff turnover …”

“…2 Many are unaware of their diagnosis as there are suboptimal screening rates. 3 Increased rates of testing are urgently required due to the association of hepatitis B with cirrhosis and hepatocellular carcinoma, 4,5 while liver disease is among the top three diseases contributing to the reduced life expectancy of Indigenous Australians compared to non-Indigenous Australians. 6,7 Australia's third National Strategy for hepatitis B aims to reduce the burden of hepatitis B in Australia, with targets of 80% for proportion diagnosed and 20% for proportion receiving antiviral treatment.…”