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Chronic Hepatitis B Recommendations

CHB affects over 400 million people worldwide, approximately 75% of whom reside in Asia and the Western Pacific.

Although many individuals eventually achieve a state of nonreplicative infection, the prolonged immunological response to infection leads to the development of cirrhosis, liver failure, or hepatocellular carcinoma (HCC) in up to 40% of people.3 Each year around 1.2 million die of HBVrelated chronic liver disease.4-6 CHB is the major cause of HCC, causing 60-80% of the world’s liver cancer. Acute and chronic HBV infection is a major public health problem in Australia and New Zealand even though both countries are considered by the World Health Organisation (WHO) to have a low prevalence (<2%) of HBV infection. However population groups with a high prevalence of HBV markers exist within both countries.

Australia
Recent estimates of the prevalence of CHB infection obtained from the first national serosurvey in Australia in 1996–99 range from 91,500 to 163,500 persons (0.49-0.87%). This is considerably more than the number infected with the human immunodeficiency virus (HIV) and comparable to the estimated 260,000 people infected with hepatitis C virus (HCV) infection. There are 6,000-8,000 new notifications to the National Notifiable Diseases Surveillance System (NNDS) annually. A large proportion of these infections are known to occur in selected populations, including indigenous people. Studies in the 1980s and early 1990s estimated that nearly half of all indigenous schoolchildren had serological markers of HBV infection and up to 26% of rural Aboriginal and Torres Strait Islander populations were HBsAg positive. In 1991-1995, the death rates (for all causes of chronic liver disease and cirrhosis) were 4 and 5.5 times higher for Aboriginal men and women, respectively, compared with rates for the general Australian population.

New Zealand
Recent conservative figures estimate 67,000 people in New Zealand (NZ) have CHB infection. The prevalence of HBsAg among 177,000 participants in the successful NZ Hepatitis B Screening Programme was 5.6% for Maori, 7.3% for Pacific Islanders, 6.2% for Asian and 0.43% for New Zealanders of European extraction. Men were more likely to test HBsAgpositive (6.1%) than women (5.4%). HBV DNA was detected in 30-40% of HBeAg-negative patients with persistently elevated enzymes. HBV related morbidity is similar to that in Australia.