Appropriate screening, and a coordinated and consistent hepatitis B diagnostic testing process, can reduce the impact of hepatitis B infection. The diagnostic process can provide people with chronic hepatitis B with relevant and accurate information about their infection. Unlike other BBVs, no formal process currently exists for providing a chronic hepatitis B diagnosis.
Ninety-five per cent of all hepatitis B notifications are for chronic hepatitis B. The primary public health response to these notifications is to follow up cases of acute hepatitis B infection, and yet approximately one third of people with chronic hepatitis B are undiagnosed.
Late diagnosis has a significant impact on mortality and morbidity, with one quarter of all hepatitis B-related deaths in one study occurring within six months of notification. Understanding of hepatitis B has changed and the concept of ‘healthy carriers’ is no longer valid and should no longer be used. Education is required, particularly targeting general practitioners and other clinicians, to ensure that current information regarding chronic hepatitis B, its treatment and other aspects of its management, is widely and better understood.
Practitioner-initiated testing, or screening, in primary healthcare—including general practice and awareness raising in the community—are the main approaches for identifying undiagnosed chronic hepatitis B. Programs to assist practitioners in primary care to take on this role have been developed.
These need to incorporate diagnosing, monitoring, supporting, treating and referring patients, all of which will benefit from developing partnerships between agencies.
It is important to raise awareness of hepatitis B among medical practitioners as various drugs, including chemotherapy, can cause hepatitis B flares which can be fatal. Hepatitis B can also complicate the management of a range of other conditions.
Priority actions in testing and diagnosis
- Review the Hepatitis C Testing Policy (2007) and consider expanding it to a Viral Hepatitis Testing Policy to include hepatitis B testing.
- Develop a model of care that helps doctors who diagnose chronic hepatitis B to conduct appropriate follow-up tests, assessments, referrals and management as appropriate.
- Promote household (and other appropriate contact) follow up for newly diagnosed chronic and acute hepatitis B cases with specific priority given to checking the immunisation profile and serostatus of household members—including, as a priority, vaccinating children in the same household.