Chronic hepatitis B in remote, tropical Australia; successes and challenges

Autor: Allison Hempenstall, Charles H. Williams, Peter Boyd, Melissa Fox, Richard J. Bagshaw, Penny Fox, Josh Hanson, Kate Webster, Norma Solomon, Simon Smith, Blake Nield, Adam Anderson
Rok vydání: 2020
Předmět:
Male
Disease
medicine.disease_cause
Hepatitis
Geographical Locations
0302 clinical medicine
Indigenous Australian people
Epidemiology
Medicine and Health Sciences
Ethnicities
Public and Occupational Health
030212 general & internal medicine
Pathology and laboratory medicine
Multidisciplinary
Geography
Liver Diseases
Hepatitis B
Middle Aged
Population groupings
Medical microbiology
Vaccination and Immunization
Vaccination
Infectious hepatitis
Cirrhosis
Viruses
Medicine
Infectious diseases
030211 gastroenterology & hepatology
Female
Queensland
Pathogens
Research Article
Adult
Medical conditions
medicine.medical_specialty
Hepatitis B virus
Science
Oceania
Immunology
MEDLINE
Gastroenterology and Hepatology
Viral diseases
Microbiology
Indigenous
03 medical and health sciences
Hepatitis B
Chronic
Antiviral Therapy
medicine
Humans
Aged
Tropical Climate
Health Care Policy
business.industry
Australia
Viral pathogens
Organisms
Biology and Life Sciences
medicine.disease
Hepatitis viruses
Microbial pathogens
Health Care
Tropical australia
Family medicine
People and Places
Preventive Medicine
business
Screening Guidelines
Zdroj: PLoS ONE
PLoS ONE, Vol 15, Iss 9, p e0238719 (2020)
ISSN: 1932-6203
Popis: IntroductionAboriginal and Torres Strait Islander Australians living in remote locations suffer disproportionately from chronic hepatitis B (CHB). Defining the temporospatial epidemiology of the disease-and assessing the ability of local clinicians to deliver optimal care-is crucial to improving patient outcomes in these settings.MethodsThe demographic, laboratory and radiology findings in all patients diagnosed with CHB after 1990, and presently residing in remote Far North Queensland (FNQ), tropical Australia, were correlated with their management and clinical course.ResultsOf the 602 patients, 514 (85%) identified as Aboriginal and Torres Strait Islander Australians, 417 (69%) of whom had Torres Strait Islander heritage. Among the 514 Aboriginal and Torres Strait Islander Australians, there were only 61 (12%) born after universal postnatal vaccination was introduced in 1985. Community CHB prevalence varied significantly across the region from 7/1707 (0.4%) in western Cape York to 55/806 (6.8%) in the Eastern Torres Strait Islands. Although 240/602 (40%) are engaged in care, with 65 (27%) meeting criteria for antiviral therapy, only 43 (66%) were receiving this treatment. Among 537 with complete data, 32 (6%) were cirrhotic, of whom 15 (47%) were engaged in care and 10 (33%) were receiving antiviral therapy. Only 64/251 (26%) in whom national guidelines would recommend hepatocellular carcinoma (HCC) surveillance are receiving screening, however, only 20 patients have been diagnosed with HCC since 1999.ConclusionVaccination has had a dramatic effect on CHB prevalence in FNQ in only a generation. However, although engagement in care is the highest in Australia, this is not translating into initiation of antiviral therapy in all those that should be receiving it, increasing their risk of developing cirrhosis and HCC. New strategies are necessary to improve the care of Indigenous Australians living with CHB to reduce the morbidity and mortality of this preventable disease.
Databáze: OpenAIRE
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