Australian vaccine preventable disease epidemiological review series: Hepatitis B, 2000-2019.

Nicole Sonneveld, Joanne Jackson, Aditi Dey, Stephen B Lambert, Katrina K Clark, Benjamin C Cowie, Kristine Macartney, Frank Beard
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引用次数: 0

Abstract

Introduction: Hepatitis B vaccination was nationally funded for adolescents in 1996, with inclusion of universal infant immunisation under the National Immunisation Program (NIP) in May 2000. This study describes hepatitis B epidemiology in Australia in the two decades since 2000.

Methods: This article analyses newly-acquired (within the prior 24 months) and unspecified (all other) hepatitis B notifications (2000-2019) from the National Notifiable Diseases Surveillance System; acute hepatitis B hospitalisations (2001-2019) from the National Hospital Morbidity Database; and acute (2000-2019) and chronic (2006-2019) hepatitis B deaths from the Australian Bureau of Statistics and Australian Coordinating Registry. Rates over the reporting period were described overall, and by age group, sex, and Aboriginal and Torres Strait Islander status (Aboriginal and/or Torres Strait Islander versus other [neither Aboriginal nor Torres Strait Islander, unknown or not stated]). Trend analyses were performed using Poisson or negative binomial regression. Additional analyses were performed for the cohort born after May 2000.

Results and discussion: The annual all-age notification rate per 100,000 per year declined (p < 0.001) from 2.13 in 2000 to 0.65 in 2019 for newly-acquired hepatitis B and from 38.3 to 22.3 for unspecified hepatitis B (likely to predominantly represent chronic hepatitis B). Newly-acquired and unspecified hepatitis B notification rates were lowest among children aged < 15 years. The most substantial reductions in notification rates of newly-acquired hepatitis B were among adolescents aged 15-19 years and young adults aged 20-24 and 25-29 years (respectively 17-, 11-, and 7-fold); these age groups also recorded the most substantial reductions in unspecified hepatitis B notifications (respectively 5-, 3.5-, and 2-fold). Newly-acquired hepatitis B notification and acute hepatitis B mortality rates were two- to threefold higher in males than females. The all-age newly-acquired hepatitis B notification rate in Aboriginal and Torres Strait Islander people decreased twofold between 2000 and 2019, but remained threefold higher than in other people. Acute hepatitis B hospitalisations also declined over the study period (p < 0.001) and followed similar patterns. There were no acute or chronic hepatitis B deaths among people born after May 2000; this cohort featured 52 newly-acquired and 887 unspecified hepatitis B notifications. Due to lack of data on country of birth (and hence eligibility for infant vaccination under the NIP or overseas programs), vaccination status and likely transmission routes, we were unable to assess factors contributing to these potentially preventable infections.

Conclusion: Adolescent and infant immunisation under the NIP has led to significant reductions in notification rates of newly-acquired hepatitis B, and in acute hepatitis B hospitalisation rates, both overall and in Aboriginal and Torres Strait Islander people. Unspecified hepatitis B notification rates have also greatly decreased in children and young adults, likely largely due to the impact of overseas infant immunisation programs on prevalence in child and adolescent migrants. Work to improve completeness of variables within national datasets is crucial, along with enhanced surveillance of both newly-acquired and unspecified hepatitis B cases to investigate transmission routes, vaccination status and factors contributing to acquisition of hepatitis B, in order to optimise the impact of immunisation programs and ensure linkage with care.

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澳大利亚疫苗可预防疾病流行病学回顾系列:乙型肝炎,2000-2019 年。
导言:澳大利亚于 1996 年开始在全国范围内资助青少年接种乙型肝炎疫苗,并于 2000 年 5 月将婴儿普遍接种乙型肝炎疫苗纳入国家免疫计划 (NIP)。本研究描述了自 2000 年以来二十年间澳大利亚的乙型肝炎流行情况:本文分析了国家应通报疾病监测系统(National Notifiable Diseases Surveillance System)中的新感染(过去 24 个月内)和未指定(所有其他)乙型肝炎通报(2000-2019 年);国家医院发病率数据库(National Hospital Morbidity Database)中的急性乙型肝炎住院病例(2001-2019 年);以及澳大利亚统计局(Australian Bureau of Statistics)和澳大利亚协调登记处(Australian Coordinating Registry)中的急性(2000-2019 年)和慢性(2006-2019 年)乙型肝炎死亡病例。报告期内的发病率按总体情况、年龄组、性别、原住民和托雷斯海峡岛民身份(原住民和/或托雷斯海峡岛民与其他[既非原住民也非托雷斯海峡岛民、未知或未说明])进行了描述。趋势分析采用泊松或负二项回归法进行。此外,还对 2000 年 5 月以后出生的人群进行了分析:每年每 100,000 人中的全年龄段通报率从 2000 年的 2.13 降至 2019 年的 0.65(p < 0.001),新获得性乙型肝炎通报率从 2000 年的 38.3 降至 2019 年的 0.65,未指定乙型肝炎(可能主要代表慢性乙型肝炎)通报率从 2000 年的 38.3 降至 2019 年的 22.3。在年龄小于 15 岁的儿童中,新获得性乙型肝炎和非特异性乙型肝炎的通报率最低。15-19 岁的青少年以及 20-24 岁和 25-29 岁的年轻人新感染乙型肝炎的通报率下降幅度最大(分别为 17 倍、11 倍和 7 倍);这些年龄组的非特指乙型肝炎通报率下降幅度也最大(分别为 5 倍、3.5 倍和 2 倍)。男性的新感染乙型肝炎通报率和急性乙型肝炎死亡率是女性的两到三倍。2000 年至 2019 年间,土著居民和托雷斯海峡岛民的全年龄段新感染乙型肝炎通报率下降了两倍,但仍比其他人高出三倍。在研究期间,急性乙型肝炎住院率也有所下降(p < 0.001),并呈现出类似的模式。2000年5月以后出生的人中没有急性或慢性乙型肝炎死亡病例;该队列中有52例新感染的乙型肝炎病例和887例未明确通报的乙型肝炎病例。由于缺乏有关出生国(因此也就没有资格参加国家免疫计划或海外计划的婴儿疫苗接种)、疫苗接种状况和可能传播途径的数据,我们无法评估导致这些潜在可预防感染的因素:国家免疫计划下的青少年和婴儿免疫接种使新感染乙型肝炎的通报率和急性乙型肝炎的住院率显著下降,无论是在整体上还是在土著居民和托雷斯海峡岛民中。儿童和年轻成年人的不明乙型肝炎通报率也大大降低,这可能主要是由于海外婴儿免疫计划对儿童和青少年移民流行率的影响。努力提高国家数据集中变量的完整性至关重要,同时还要加强对新感染和不明乙型肝炎病例的监测,以调查传播途径、疫苗接种状况和导致感染乙型肝炎的因素,从而优化免疫接种计划的影响并确保与护理的联系。
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