title: Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis.
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.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, Australia. sgraham@kirby.unsw.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Graham
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Guy
authors.forename: Benjamin
authors.initials: B
authors.lastname: Cowie
authors.forename: Handan C
authors.initials: HC
authors.lastname: Wand
authors.forename: Basil
authors.initials: B
authors.lastname: Donovan
authors.forename: Snehal P
authors.initials: SP
authors.lastname: Akre
authors.forename: James S
authors.initials: JS
authors.lastname: Ward
mesh_terms: D001315:Australia / Q000453:epidemiology / Q000208:ethnology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D014611:Vaccination; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines