title: Hepatitis A epidemiology in Australia: national seroprevalence and notifications.
abstract: OBJECTIVE
  To determine hepatitis A seroprevalence and notification rates in Australia in order to inform vaccination policy.
  
  
  METHODS
  Seroprevalence was determined by cross-sectional survey of opportunistically collected sera; notifications were extracted from the National Notifiable Diseases Surveillance System.
  
  
  METHODS
  3,043 serum samples collected in 1998 were obtained from 46 laboratories around Australia. Sample size in each age group was based on expected seroprevalence, and States and Territories were sampled proportionally to their population size. Males and females were equally represented. Notifications were extracted for cases with onset between 1 January 1991 and 31 December 1998.
  
  
  METHODS
  Seroprevalence and notifications were analysed by age, sex and State/Territory.
  
  
  RESULTS
  41.1% of serum samples were seropositive for hepatitis A (95% CI, 39.4%-42.9%) (population-weighted seroprevalence, 38.3%). Seroprevalence was significantly associated with increasing age (P<0.001), but did not differ between the sexes (male:female ratio, 1.04:1; 95% CI, 0.95-1.14). However, significantly more notifications were recorded for males than females (male:female ratio, 1.65:1; 95% CI, 1.60-1.70). The Northern Territory had the highest seroprevalence (68.8%; 95% CI, 52.7%-84.8%) and annual notification rates (48.7 per 100,000 population; 95% CI, 45.0-52.4 per 100,000).
  
  
  CONCLUSIONS
  These data show that about half the Australian population has not been exposed to hepatitis A and is therefore susceptible to infection. However, any decision on national routine childhood hepatitis A vaccination requires a cost-benefit analysis. Routine vaccination of high-incidence communities remains controversial.
authors.affiliation: National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead and University of Sydney, NSW.
authors.forename: J
authors.initials: J
authors.lastname: Amin
authors.forename: G L
authors.initials: GL
authors.lastname: Gilbert
authors.forename: R G
authors.initials: RG
authors.lastname: Escott
authors.forename: T C
authors.initials: TC
authors.lastname: Heath
authors.forename: M A
authors.initials: MA
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018563:Disease Notification / Q000706:statistics & numerical data*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006285:Health Planning; D006506:Hepatitis A / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007114:Immunization; D007223:Infant; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric