Published 22 Jun, 2022

Chronic hepatitis B and C infections are the most common risk factor for liver cancer.1 Together these diseases are estimated to account for 80% of liver cancer cases globally.2  In Australia, the prevalence of chronic hepatitis B is approximately 1%3, with a higher prevalence occurring in people born in certain other countries (e.g., Vietnam, Cambodia, China, Taiwan and Afghanistan) and in Aboriginal and Torres Strait Islander peoples.3,4 Studies indicate that the risk of developing liver cancer can be 20-30 times higher in people with chronic hepatitis infection than among the general population.5,6

    Charts

    In 2021, it was estimated that there were 2,832 new diagnoses and 2,424 deaths due to liver cancer in Australia. In addition, the age-standardised mortality rate for liver cancer increased over time, from 1.6 deaths per 100,000 persons in 1980 to 7.4 per 100,000 in 2021 (see NCCI Indicator – Mortality).

    There are effective vaccines in Australia for combating hepatitis B. Since 2000, the hepatitis vaccine has been available free-of-charge for the vaccination of infants. Vaccinations are provided under the National Immunisation Program Schedule;7 doses are administered to infants soon after birth, followed by doses at two, four and six months of age. ‘Immunisation coverage’ is defined as including children notified to the Australian Immunisation Register (AIR) as receiving three doses of any hepatitis B vaccine at 24-27 months.8

    Hepatitis B immunisation coverage is very high (96.4% in 2020) among Australian children aged 24-27 months.

    Aboriginal and Torres Strait Islander children

    Hepatitis B immunisation coverage for children aged 24-27 months is similar or higher in most years among Indigenous children compared with non-Indigenous children: in 2018, the coverage rate for Indigenous children was reported at 97.1%, compared with 95.8% for non-Indigenous children [Chart 2]. Immunisation coverage rates at 12 months of age are marginally lower among Aboriginal and Torres Strait Islander children (note: 92.6% compared to 94.4% in non-Indigenous children for 2018), which may predispose them to a slightly higher risk of hepatitis B-related disease.4

    International comparisons

    Hepatitis B immunisation coverage rates for Australian infants (less than one year old) are similar to those seen in most other comparable countries. Almost all economically developed countries having infant coverage rates above 90% for Hepatitis B, except Canada, where the reported coverage rate in 2018 was 71%.

    With the exception of Indigenous peoples, national hepatitis B immunisation data for other population groups (e.g., groups classified by sex, remoteness or socioeconomic status) are not readily available.

    This measure shows the proportion of Australian children aged 12 to 15 months and 24 to 27 months who have been notified in the Australian Immunisation Register (AIR) as receiving three doses of any hepatitis B vaccine. A three-month lag period (i.e., 24 to 27 months) is used to provide for late notifications to the AIR. The cohort method has been used for calculating immunisation coverage at the population level (refer to Reference 8 for more information).

    Numerator: Children aged 12 to 15 and 24 to 27 months who have been notified to the Australian Immunisation Register (AIR) as receiving three doses of a hepatitis B vaccine.

    Denominator: Total number of Medicare-registered children aged 12 or 24 months, as relevant.

    Data sources:

    Australian data are sourced from the AIR. Participation in the AIR is based on an “opt-out process”, which has achieved close to complete population coverage.8

    Analyses of AIR data are presented in Communicable Diseases Intelligence reports.10  Data are also published in annual immunisation coverage reports by the National Centre for Immunisation Research & Surveillance11 and by the Kirby Institute as Annual surveillance reports on HIV, viral hepatitis and sexually transmissible infections in Australia.4

    International data are sourced from the Organisation for Economic Co-operation and Development (OECD)12 that utilises the WHO/UNICEF published estimates of national immunisation coverage. Most of the data are derived from official reports by WHO Member States reported annually through the WHO/UNICEF joint reporting process.

    Data caveats:

    International data

    International immunisation coverage data sourced from OECD. Statistics on % of children immunised for 2018.  Percentage of children under one year old who have received three doses of hepatitis B vaccine in a given year.
    The age of complete immunisation differs across countries due to different immunisation schedules. Note: immunisation against Hepatitis B is mandatory in some countries while only optional in others (e.g., Canada and France).

    Activity in this area:

    Data:

    Australian Government Department of Health. About Communicable Diseases Intelligence. http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-cdiintro.htm

    The Kirby Institute for infection and immunity in society: Surveillance: http://kirby.unsw.edu.au/surveillance

    Immunisation coverage rates are published by the AIR at Statistical Area 3-level: https://beta.health.gov.au/topics/immunisation/childhood-immunisation-coverage/immunisation-coverage-rates-for-all-children

    International:

    Organization for Economic Co-operation and Development (OECD) https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT

    Immunisation coverage rates are published by the AIR at Statistical Area 3-level: https://www.health.gov.au/health-topics/immunisation/childhood-immunisation-coverage/immunisation-coverage-rates-for-all-children

    Policy:

    Department of Heath: Immunisation. https://www.health.gov.au/health-topics/immunisation

    Australian Government Department of Health. National Immunisation Program schedule for all Aboriginal and Torres Strait Islander people. Available from: https://www.health.gov.au/resources/publications/national-immunisation-program-schedule-for-all-aboriginal-and-torres-strait-islander-people

    Australian Government Department of Health. Third National Hepatitis B Strategy 2018-2022. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-bbvs-1//$File/Hep-B-Third-Nat-Strategy-2018-22.pdf

    Cancer Australia. National Aboriginal and Torres Strait Islander Cancer Framework. 2015. Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/overlay-context=affected-cancer/aboriginal-and-torres-strait-islander-people/national-aboriginal-and-torres-strait-islander-cancer-framework

     

     

    References:

    1. American Cancer Society 2019. Liver Cancer Risk Factors. Available from: https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html  (accessed December 2021).

    2. Cancer Council Victoria. Hepatitis & liver cancer. Available from: www.cancervic.org.au/for-health-professionals/community-health-professionals/hepatitis-b-and-liver-cancer (accessed December 2021).

    3. Antonsson A et. al. 2015. Cancers in Australia in 2010 attributable to infectious agents. Aust NZ J Public Health. 39:446-51.

    4. Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2018. Sydney: Kirby Institute, UNSW Sydney; 2018.

    5. Amin J et al. 2006. Cancer incidence in people with hepatitis B or C infection: a large community-based linkage study. J Hepatol. 45(2):197-203.

    6. Cancer Council Australia. National Cancer Control Policy – Liver Cancer. Available at: http://wiki.cancer.org.au/policy/Liver_cancer (accessed December 2021).

    7. National Immunisation Program Schedule. Available from: https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule%E3 (accessed December 2021)

    8. Department of Health. Immunisation Coverage Annual Report 2019. Available from:  https://www1.health.gov.au/internet/main/publishing.nsf/Content/5C71FABF639650F6CA2586520081286B/$File/immunisation_coverage_annual_report_2019.pdf (accessed December 2021)

    9. Australian Technical Advisory Group on Immunisation (ATAGI). 2016. The Australian immunisation handbook 10th ed (2016 update). Canberra: Australian Government Department of Health.

    10. Australian Government Department of Health. About Communicable Diseases Intelligence. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-cdiintro.htm (accessed December 2021).

    11. NCIRS. Immunisation coverage. Available from: http://www.ncirs.edu.au/surveillance/immunisation-coverage/ (accessed December 2021).

    12. OECD Health Statistics 2018. OECD.Stat. Available from: http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT# (accessed December 2021).

    Summary

    Hepatitis B Immunisation coverage rates are high for both Indigenous and non-Indigenous Australian children

    In 2018, Hepatitis B immunisation coverage was recorded at 97.1% in Indigenous Australian children and 95.8% in their non-Indigenous counterparts.

    Hepatitis B vaccination coverage rates have increased in Indigenous children aged 12-15 months

    Between 2013 and 2018, immunisation rates for Indigenous infants aged 12-15 months increased from around 87.3% to 95.6%.

    Hepatitis B immunisation coverage rates are similar in Australia to those in other developed countries

    The Hepatitis B immunisation coverage for Australian infants in 2018 was recorded at 95.9%, which is similar to that reported in most comparable countries. Almost all economically developed countries have an infant coverage rate above 90% for Hepatitis B.