Why Australia needs to support its neighbours to stop hep B

Many people with chronic hepatitis B in Australia were born in nearby countries where vaccination is still not provided to many children. Andrew W. McGalliard

Of the more than 175,000 people living with chronic hepatitis B infection in this country, the majority were born overseas in high prevalence countries. Most have come from Asia and the Pacific, a region that accounts for two-thirds of all migration to Australia.

Hepatitis B is among the most common causes of human death. The World Health Organization (WHO) estimates that worldwide 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. And all up, around 600,000 people die every year from hepatitis B-related illnesses.

But the illness is preventable through vaccination, which 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% 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 the country 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 Asia and the 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 so they can improve hepatitis B vaccination coverage. Although 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 5% every year.

Hepatitis B is endemic in the Asia Pacific region. ASDFGH/Wikimedia Commons

Being born in Asia or the Pacific is acknowledged as an important risk factor for infection. Given that the cost of hepatitis B vaccine for newborns in resource poor settings is less than 50 cents a dose, there’s a real cost-benefit in supporting our neighbours through development aid and other partnership programs.

Several of our neighbours are leading the way in increasing vaccination coverage – showing what can 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 are put into practice, they could help to increase the number of newborns being vaccinated. Other practices proven to be 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 investment in new technologies or processes and all fit with the Australian overseas aid strategies.

The newly-formed Global Hepatitis Programme of the WHO recently published a Framework for Global Action in the Prevention and Control of Viral Hepatitis Infection - a central element of which is to scale up successful interventions and develop new approaches to reducing transmission of viral hepatitis, especially hepatitis B.

Even though hepatitis B remains an important threat to health in our region, we know what works in prevention. This is one major global health threat that is readily controlled – if we get prevention right.