Image courtesy of World Hepatitis Alliance
July 28 marks World Hepatitis Day, dedicated to raising awareness on hepatitis B and hepatitis C. New evidence from Australian research institutions shows why this is important to us, and how we can help.
Of the more than 175,000 people living with chronic hepatitis B infection in this country, most were born overseas in high prevalence countries, especially in Asia and the Pacific, a region that accounts for two thirds of all migration to Australia.
Hepatitis B is among the 10 most common causes of human death. WHO estimates that world-wide about two billion people are living with the virus, and over 350 million are chronically infected.
Long-term infection can lead to life threatening chronic liver disease and liver cancer. After tobacco, hepatitis B is the second most important known cause of human cancer. Around 600,000 people die every year from hepatitis B related illnesses.
Hepatitis B is preventable through vaccination. It is usually started at birth (the WHO recommends within 24 hours of birth), followed by three doses in the first year of life. The vaccine is safe and provides protection in over 95 per cent of healthy people. Starting at birth is important because it can prevent transmission from mother to baby. Young infants are the most vulnerable to chronic infection.
In Australia, hepatitis B vaccination has been free for all newborns since 2000 and Australia is doing well at providing this essential vaccine to newborns. However some health services are struggling to reach the group at highest risk: babies born in nearby countries where vaccination is not provided or is not reaching all newborns.
Hepatitis B is endemic in the Asia Pacific, which is also home to the highest number of deaths from hepatitis B globally. Reaching babies with a vaccine within 24 hours of birth is a tough ask in many places, especially where many are born at home, or live in remote locations difficult to access, or where health services are not working well.
It is essential that Australia adopt a broader prevention approach that includes supporting our neighbours in improving coverage of vaccination. Though we are a generally low prevalence country for hepatitis B, liver cancer (most of which is attributable to chronic viral hepatitis) is the equal fastest increasing cause of cancer death nationally.
The number of cases is increasing by five per cent every year. Being born in Asia or the Pacific is acknowledged as an important risk factor for infection. So, given that the cost of hepatitis B vaccine for newborns of less than 30 cents a dose, there is a real cost-benefit in supporting our neighbours.
Several of these neighbours are leading the way – showing what could be done to vaccinate babies at birth, even in difficult situations.
These practical ideas are collected in a Burnet Institute review, done with help from the Victorian Infectious Diseases Reference Laboratory, and submitted to the WHO earlier this year. Some of the best practices have been demonstrated in China, Indonesia, Vietnam, and Papua New Guinea.
If some new ideas about vaccine storage and simpler injection devices (one known as UnijectTM) are put into practice, they can all help to increase the number of newborns being vaccinated.
Other practices proven effective include national health policy support providing training to health professionals, and increasing the number of births occurring in health facilities. None of these interventions require investments in new technologies or processes and all fit with the Australian overseas aid strategies.
While hepatitis B remains an important threat to health in our region, we also know what works in prevention.
Today is World Hepatitis Day and in keeping with this year’s theme, we are truly ‘closer than we think’!
Dr Chris Morgan, Principal Fellow, Team Leader - Infectious Diseases, Centre for International Health, Burnet Institute, Melbourne
Priya Mannava, Fellow, Centre for International Health, Burnet Institute, Melbourne
Dr Benjamin Cowie, Epidemiologist & Physician, Victorian Infectious Diseases Service, Royal Melbourne Hospital
This article was also published in The Conversation on Saturday 28 July.