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Open Access Highly Accessed Research article

Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis

Simon Graham1*, Rebecca J Guy1, Benjamin Cowie234, Handan C Wand1, Basil Donovan15, Snehal P Akre1 and James S Ward6

Author Affiliations

1 The Kirby Institute, University of New South Wales, Sydney, Australia

2 The Victorian Infectious Diseases Reference Laboratory (VIDRL), Melbourne, Australia

3 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia

4 Department of Medicine, University of Melbourne, Melbourne, Australia

5 Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia

6 Baker IDI Heart and Diabetes Institute, Sydney, Alice Springs, Australia

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BMC Infectious Diseases 2013, 13:403  doi:10.1186/1471-2334-13-403

Published: 31 August 2013

Abstract

Background

In Australia, higher rates of chronic hepatitis B (HBsAg) have been reported among Aboriginal and Torres Strait Islander (Indigenous) compared with non-Indigenous people. In 2000, the Australian government implemented a universal infant/adolescent hepatitis B vaccination program. We undertook a systematic review and meta-analysis to assess the disparity of HBsAg prevalence between Indigenous and non-Indigenous people, particularly since 2000.

Methods

We searched Medline, Embase and public health bulletins up to March 2011. We used meta-analysis methods to estimate HBsAg prevalence by Indigenous status and time period (before and since 2000).

Results

There were 15 HBsAg prevalence estimates (from 12 studies) among Indigenous and non-Indigenous people; adults and pregnant women (n = 9), adolescents (n = 3), prisoners (n = 2), and infants (n = 1). Of these, only one subgroup (adults/pregnant women) involved studies before and since 2000 and formed the basis of the meta-analysis. Before 2000, the pooled HBsAg prevalence estimate was 6.47% (95% CI: 4.56-8.39); 16.72% (95%CI: 7.38-26.06) among Indigenous and 0.36% (95%CI:-0.14-0.86) in non-Indigenous adults/pregnant women. Since 2000, the pooled HBsAg prevalence was 2.25% (95% CI: 1.26-3.23); 3.96% (95%CI: 3.15-4.77) among Indigenous and 0.90% (95% CI: 0.53-1.28) in non-Indigenous adults/pregnant women.

Conclusions

The disparity of HBsAg prevalence between Indigenous and non-Indigenous people has decreased over time; particularly since the HBV vaccination program in 2000. However HBsAg prevalence remains four times higher among Indigenous compared with non-Indigenous people. The findings highlight the need for opportunistic HBV screening of Indigenous people to identify people who would benefit from vaccination or treatment.

Keywords:
Indigenous; HBV; Sexually transmissible infection; STI; Hepatitis