TY - JOUR
T1 - Preventing early childhood transmission of hepatitis B in remote Aboriginal communities in Northern Australia
AU - Sullivan, Richard P.
AU - Davies, Jane
AU - Binks, Paula
AU - McKinnon, Melita
AU - Dhurrkay, Roslyn Gundjirryiir
AU - Hosking, Kelly
AU - Bukulatjpi, Sarah Mariyalawuy
AU - Locarnini, Stephen
AU - Littlejohn, Margaret
AU - Jackson, Kathy
AU - Tong, Steven Y.C.
AU - Davis, Joshua S.
N1 - Funding Information:
This work was supported by the Australian National Health and Medical Research Council (project grants No. 1060811 and No. 1156722, fellowships to SYCT (No. 1145033, No. 1065736), JSD (No. 1160331) and JD (No. 1123427). Funders played no role in the study design, the analysis or the decision to publish.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Hepatitis B
KW - Infectious disease transmission
KW - Prevention
UR - http://www.scopus.com/inward/record.url?scp=85144775524&partnerID=8YFLogxK
U2 - 10.1186/s12939-022-01808-z
DO - 10.1186/s12939-022-01808-z
M3 - Article
C2 - 36575515
AN - SCOPUS:85144775524
SN - 1475-9276
VL - 21
SP - 1
EP - 9
JO - International Journal for Equity in Health
JF - International Journal for Equity in Health
IS - 1
M1 - 186
ER -
