Hepatitis B immunization for indigenous adults, Australia.
OBJECTIVE
To quantify the disparity in incidence of hepatitis B between indigenous and non-indigenous people in Australia, and to estimate the potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults.


METHODS
Using national data on persons with newly acquired hepatitis B disease notified between 2005 and 2012, we estimated incident infection rates and rate ratios comparing indigenous and non-indigenous people, with adjustments for underreporting. The potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults was projected using a Markov chain Monte Carlo simulation model.


RESULTS
Of the 54 522 persons with hepatitis B disease notified between 1 January 2005 and 31 December 2012, 1953  infections were newly acquired. Acute hepatitis B infection notification rates were significantly higher for indigenous than non-indigenous Australians. The rates per 100 000 population for all ages were 3.6 (156/4 368 511) and 1.1 (1797/168 449 302) for indigenous and non-indigenous people respectively. The rate ratio of age-standardized notifications was 4.0 (95% confidence interval: 3.7-4.3). If 50% of non-immune indigenous adults (20% of all indigenous adults) were vaccinated over a 10-year programme a projected 527-549 new cases of acute hepatitis B would be prevented.


CONCLUSIONS
There continues to be significant health inequity between indigenous and non-indigenous Australians in relation to vaccine-preventable hepatitis B disease. An immunization programme targeting indigenous Australian adults could have considerable impact in terms of cases of acute hepatitis B prevented, with a relatively low number needed to vaccinate to prevent each case.
National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia .
Andre Louis
AL
Wattiaux
National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia .
J Kevin
JK
Yin
National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia .
Frank
F
Beard
South Australian Health and Medical Research Institute, Adelaide, Australia .
Steve
S
Wesselingh
WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia .
Benjamin
B
Cowie
South Australian Health and Medical Research Institute, Adelaide, Australia .
James
J
Ward
National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia .
Kristine
K
Macartney
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D007114:Immunization; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D000073887:Vaccination Coverage; D055815:Young Adult