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1. A pilot project harnessing surveillance systems to support clinicians providing clinical care for people diagnosed with hepatitis C in Victoria, Australia, September 2021 to 31 March 2022

Author: Abbott, M, Maclachlan, JH, Romero, N, Matthews, N, Higgins, N, Lee, A, Stoove, M, Marukutira, T, Quinn, B, Allard, NL, Cowie, BC, Abbott, M, Maclachlan, JH, Romero, N, Matthews, N, Higgins, N, Lee, A, Stoove, M, Marukutira, T, Quinn, B, Allard, NL, and Cowie, BC
Abstract: BackgroundActive follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination.AimThis pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification.MethodsFor notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand.ResultsOf 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians.ConclusionsMost doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.
Published: 2024

2. Vaccination coverage among people who inject drugs: A systematic review

Author: Price, O, Swanton, R, Grebely, J, Hajarizadeh, B, Webb, P, Peacock, A, Dore, GJ, Cowie, BC, Vickerman, P, Degenhardt, L, Price, O, Swanton, R, Grebely, J, Hajarizadeh, B, Webb, P, Peacock, A, Dore, GJ, Cowie, BC, Vickerman, P, and Degenhardt, L
Abstract: BACKGROUND: People who inject drugs may be at excess risk of acquiring vaccine-preventable diseases and negative associated health outcomes, but experience barriers to vaccination. We aimed to determine vaccination coverage among people who inject drugs globally. METHODOLOGY: We conducted systematic searches of the peer-reviewed and grey literature, date limited from January 2008 to August 2023, focusing on diseases for which people who inject drugs are at elevated risk for and for which an adult vaccination dose is recommended (COVID-19, hepatitis A, hepatitis B, human papillomavirus, influenza, pneumococcal disease, tetanus). To summarise available data, we conducted a narrative synthesis. RESULTS: We included 78 studies/reports comprising 117 estimates of vaccination coverage across 36 countries. Most estimates were obtained from high income countries (80%, n=94). We located estimates for hepatitis B vaccination in 33 countries, which included 18 countries with data on serological evidence of vaccine-derived hepatitis B immunity (range: 6-53%) and 22 countries with self-report data for vaccine uptake (<1-96%). Data for other vaccines were scarcer: reported hepatitis A vaccination coverage ranged 3-89% (five countries), COVID-19 ranged 4-84% (five countries), while we located estimates from fewer than five countries for influenza, tetanus, pneumococcal disease, and human papillomavirus. CONCLUSION: Estimates were sparse but where available indicative of suboptimal vaccination coverage among people who inject drugs. Improving the consistency, timeliness, and geographic coverage of vaccine uptake data among this population is essential to inform efforts to increase uptake.
Published: 2024

3. Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author: Sheena, BS, Hiebert, L, Han, H, Ippolito, H, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abbastabar, H, Abdoli, A, Abubaker Ali, H, Adane, MM, Adegboye, OA, Adnani, QES, Advani, SM, Afzal, MS, Afzal, S, Aghaie Meybodi, M, Ahadinezhad, B, Ahinkorah, BO, Ahmad, S, Ahmad, T, Ahmadi, S, Ahmed, H, Ahmed, MB, Rashid, TA, Akalu, GT, Aklilu, A, Akram, T, Al Hamad, H, Alahdab, F, Alem, AZ, Alem, DT, Alhalaiqa, FAN, Alhassan, RK, Ali, L, Ali, MA, Alimohamadi, Y, Alipour, V, Alkhayyat, M, Almustanyir, S, Al-Raddadi, RM, Altawalah, H, Amini, S, Amu, H, Ancuceanu, R, Andrei, CL, Andrei, T, Anoushiravani, A, Ansar, A, Anyasodor, AE, Arabloo, J, Arab-Zozani, M, Argaw, AM, Argaw, ZG, Arshad, M, Artamonov, AA, Ashraf, T, Atlaw, D, Ausloos, F, Ausloos, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari Jafari, A, Azarian, G, Bagheri, S, Bahadory, S, Baig, AA, Banach, M, Barati, N, Barrow, A, Batiha, AMM, Bejarano Ramirez, DF, Belgaumi, UI, Berhie, AY, Bhagat, DS, Bhardwaj, N, Bhardwaj, P, Bhattacharyya, K, Bhojaraja, VS, Bijani, A, Biondi, A, Bodicha, BBA, Bojia, HA, Boloor, A, Bosetti, C, Braithwaite, D, Briko, NI, Butt, ZA, Cámera, LA, Chakinala, RC, Chakraborty, PA, Charan, J, Chen, S ; https://orcid.org/0000-0002-1108-3863, Choi, JYJ, Choudhari, SG, Chowdhury, FR, Chu, DT, Chung, SC, Cortesi, PA, Cowie, BC, Culbreth, GT, Sheena, BS, Hiebert, L, Han, H, Ippolito, H, Abbasi-Kangevari, M, Abbasi-Kangevari, Z, Abbastabar, H, Abdoli, A, Abubaker Ali, H, Adane, MM, Adegboye, OA, Adnani, QES, Advani, SM, Afzal, MS, Afzal, S, Aghaie Meybodi, M, Ahadinezhad, B, Ahinkorah, BO, Ahmad, S, Ahmad, T, Ahmadi, S, Ahmed, H, Ahmed, MB, Rashid, TA, Akalu, GT, Aklilu, A, Akram, T, Al Hamad, H, Alahdab, F, Alem, AZ, Alem, DT, Alhalaiqa, FAN, Alhassan, RK, Ali, L, Ali, MA, Alimohamadi, Y, Alipour, V, Alkhayyat, M, Almustanyir, S, Al-Raddadi, RM, Altawalah, H, Amini, S, Amu, H, Ancuceanu, R, Andrei, CL, Andrei, T, Anoushiravani, A, Ansar, A, Anyasodor, AE, Arabloo, J, Arab-Zozani, M, Argaw, AM, Argaw, ZG, Arshad, M, Artamonov, AA, Ashraf, T, Atlaw, D, Ausloos, F, Ausloos, M, Azadnajafabad, S, Azangou-Khyavy, M, Azari Jafari, A, Azarian, G, Bagheri, S, Bahadory, S, Baig, AA, Banach, M, Barati, N, Barrow, A, Batiha, AMM, Bejarano Ramirez, DF, Belgaumi, UI, Berhie, AY, Bhagat, DS, Bhardwaj, N, Bhardwaj, P, Bhattacharyya, K, Bhojaraja, VS, Bijani, A, Biondi, A, Bodicha, BBA, Bojia, HA, Boloor, A, Bosetti, C, Braithwaite, D, Briko, NI, Butt, ZA, Cámera, LA, Chakinala, RC, Chakraborty, PA, Charan, J, Chen, S ; https://orcid.org/0000-0002-1108-3863, Choi, JYJ, Choudhari, SG, Chowdhury, FR, Chu, DT, Chung, SC, Cortesi, PA, Cowie, BC, and Culbreth, GT
Abstract: Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 0
Published: 2022

4. The price tag of a potential cure for chronic hepatitis B infection: A cost threshold analysis for USA, China and Australia

Author: Lampertico, P, Toy, M, Hutton, D, McCulloch, K, Romero, N, Revill, PA, Penicaud, M-C, So, S, Cowie, BC, Lampertico, P, Toy, M, Hutton, D, McCulloch, K, Romero, N, Revill, PA, Penicaud, M-C, So, S, and Cowie, BC
Abstract: BACKGROUND & AIMS: We aim to capture the economic impact of a potential cure for chronic hepatitis B infection (CHB) in three countries (USA, China and Australia) with different health systems and epidemics to estimate the threshold drug prices below which a CHB cure would be cost-saving and/or highly cost-effective. METHODS: We simulated patients' hepatitis B progression, under three scenarios: current long-term suppressive antiviral therapy, functional cure defined as sustained undetectable HBsAg and HBV DNA, and partial cure defined as sustained undetectable HBV DNA only after a finite, 48-week treatment. RESULTS: Compared with current long-term antiviral therapy, a 30% effective functional cure among patients with and without cirrhosis in the USA, China and Australia would yield 17.50, 17.32 and 20.42 QALYs per patient, and 20.61, 20.42 and 20.62 QALYs per patient respectively. In financial terms, for CHB patients with and without cirrhosis, this would be cost-saving at a one-time treatment cost under US$11 944 and US$6694, respectively, in the USA, US$1744 and US$1001 in China, and US$12 063 and US$10 983 in Australia. CONCLUSION: We show that in purely economic terms, a CHB cure will be highly cost-effective even if effective in only 30% of treated patients. The threshold price for cure is largely determined by the current antiviral drug costs, since it will replace a daily antiviral pill that is inexpensive and effective, although not curative. The likely need for combination therapies to achieve cure will also present cost challenges. While cost-effectiveness is important, it cannot be the only consideration, as cure will provide many benefits in addition to reduced liver disease and HCC, including eliminating the need for a long-term daily pill and reducing stigma often associated with chronic viral infection.
Published: 2022

5. A hospital-wide response to multiple outbreaks of COVID-19 in health care workers: lessons learned from the field

Author: Buising, KL, Williamson, D, Cowie, BC, MacLachlan, J, Orr, E, MacIsaac, C, Williams, E, Bond, K, Muhi, S, McCarthy, J, Maier, AB, Irving, L, Heinjus, D, Kelly, C, Marshall, C, Buising, KL, Williamson, D, Cowie, BC, MacLachlan, J, Orr, E, MacIsaac, C, Williams, E, Bond, K, Muhi, S, McCarthy, J, Maier, AB, Irving, L, Heinjus, D, Kelly, C, and Marshall, C
Published: 2021

6. Time for universal hepatitis B screening for Australian adults

Author: Allard, NL, MacLachlan, JH, Tran, L, Yussf, N, Cowie, BC, Allard, NL, MacLachlan, JH, Tran, L, Yussf, N, and Cowie, BC
Published: 2021

7. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Sepanlou, S, Safiri, S, Bisignano, C, Ikuta, K, Merat, S, Saberifiroozi, M, Poustchi, H, Tsoi, D, Colombara, D, Abdoli, A, Adedoyin, R, Afarideh, M, Agrawal, S, Ahmad, S, Ahmadian, E, Ahmadpour, E, Akinyemiju, T, Akunna, C, Alipour, V, Almasi-Hashiani, A, Almulhim, A, Al-Raddadi, R, Alvis-Guzman, N, Anber, N, Angus, C, Anoushiravani, A, Arabloo, J, Araya, E, Asmelash, D, Ataeinia, B, Ataro, Z, Atout, M, Ausloos, F, Awasthi, A, Badawi, A, Banach, M, Bejarano Ramirez, D, Bhagavathula, A, Bhala, N, Bhattacharyya, K, Biondi, A, Bolla, S, Boloor, A, Borzì, A, Butt, Z, Cámera, L, Campos-Nonato, I, Carvalho, F, Chu, D, Chung, S, Cortesi, P, Costa, V, Cowie, B, Daryani, A, de Courten, B, Demoz, G, Desai, R, Dharmaratne, S, Djalalinia, S, Do, H, Dorostkar, F, Drake, T, Dubey, M, Duncan, B, Effiong, A, Eftekhari, A, Elsharkawy, A, Etemadi, A, Farahmand, M, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Gebremedhin, K, Geta, B, Gilani, S, Gill, P, Gutirrez, R, Haile, M, Haj-Mirzaian, A, Hamid, S, Hasankhani, M, Hasanzadeh, A, Hashemian, M, Hassen, H, Hay, S, Hayat, K, Heidari, B, Henok, A, Hoang, C, Hostiuc, M, Hostiuc, S, Hsieh, V, Igumbor, E, Ilesanmi, O, Irvani, S, Jafari Balalami, N, James, S, Jeemon, P, Jha, R, Jonas, J, Jozwiak, J, Kabir, A, Kasaeian, A, Kassaye, H, Kefale, A, Khalilov, R, Khan, M, Khan, E, Khater, A, Kim, Y, Koyanagi, A, La Vecchia, C, Lim, L, Lopez, A, Lorkowski, S, Lotufo, P, Lozano, R, Magdy Abd El Razek, M, Mai, H, Manafi, N, Manafi, A, Mansournia, M, Mantovani, L, Mazzaglia, G, Mehta, D, Mendoza, W, Menezes, R, Mengesha, M, Meretoja, T, Mestrovic, T, Miazgowski, B, Miller, T, Mirrakhimov, E, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, A, Montero-Zamora, P, Moradi, G, Naimzada, M, Nayak, V, Negoi, I, Nguyen, T, Ofori-Asenso, R, Oh, I, Olagunju, T, Padubidri, J, Pakshir, K, Pana, A, Pathak, M, Pourshams, A, Rabiee, N, Radfar, A, Rafiei, A, Ramezanzadeh, K, Rana, S, Rawaf, S, Rawaf, D, Reiner RC, J, Roever, L, Room, R, Roshandel, G, Safari, S, Samy, A, Sanabria, J, Sartorius, B, Schmidt, M, Senthilkumaran, S, Shaikh, M, Sharif, M, Sharifi, A, Shigematsu, M, Singh, J, Soheili, A, Suleria, H, Teklehaimanot, B, Tesfay, B, Vacante, M, Vahedian-Azimi, A, Valdez, P, Vasankari, T, Vu, G, Waheed, Y, Weldegwergs, K, Werdecker, A, Westerman, R, Wondafrash, D, Wondmieneh, A, Yeshitila, Y, Yonemoto, N, Yu, C, Zaidi, Z, Zarghi, A, Zelber-Sagi, S, Zewdie, K, Zhang, Z, Zhao, X, Naghavi, M, Malekzadeh, R, Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H, Tsoi D, Colombara DV, Abdoli A, Adedoyin RA, Afarideh M, Agrawal S, Ahmad S, Ahmadian E, Ahmadpour E, Akinyemiju T, Akunna CJ, Alipour V, Almasi-Hashiani A, Almulhim AM, Al-Raddadi RM, Alvis-Guzman N, Anber NH, Angus C, Anoushiravani A, Arabloo J, Araya EM, Asmelash D, Ataeinia B, Ataro Z, Atout MMW, Ausloos F, Awasthi A, Badawi A, Banach M, Bejarano Ramirez DF, Bhagavathula AS, Bhala N, Bhattacharyya K, Biondi A, Bolla SR, Boloor A, Borzì AM, Butt ZA, Cámera LA, Campos-Nonato IR, Carvalho F, Chu DT, Chung SC, Cortesi PA, Costa VM, Cowie BC, Daryani A, de Courten B, Demoz GT, Desai R, Dharmaratne SD, Djalalinia S, Do HT, Dorostkar F, Drake TM, Dubey M, Duncan BB, Effiong A, Eftekhari A, Elsharkawy A, Etemadi A, Farahmand M, Farzadfar F, Fernandes E, Filip I, Fischer F, Gebremedhin KBB, Geta B, Gilani SA, Gill PS, Gutirrez RA, Haile MT, Haj-Mirzaian A, Hamid SS, Hasankhani M, Hasanzadeh A, Hashemian M, Hassen HY, Hay SI, Hayat K, Heidari B, Henok A, Hoang CL, Hostiuc M, Hostiuc S, Hsieh VC, Igumbor EU, Ilesanmi OS, Irvani SSN, Jafari Balalami N, James SL, Jeemon P, Jha RP, Jonas JB, Jozwiak JJ, Kabir A, Kasaeian A, Kassaye HG, Kefale AT, Khalilov R, Khan MA, Khan EA, Khater A, Kim YJ, Koyanagi A, La Vecchia C, Lim LL, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Magdy Abd El Razek M, Mai HT, Manafi N, Manafi A, Mansournia MA, Mantovani LG, Mazzaglia G, Mehta D, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Mestrovic T, Miazgowski B, Miller TR, Mirrakhimov EM, Mithra P, Moazen B, Moghadaszadeh M, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Montero-Zamora PA, Moradi G, Naimzada MD, Nayak V, Negoi I, Nguyen TH, Ofori-Asenso R, Oh IH, Olagunju TO, Padubidri JR, Pakshir K, Pana A, Pathak M, Pourshams A, Rabiee N, Radfar A, Rafiei A, Ramezanzadeh K, Rana SMM, Rawaf S, Rawaf DL, Reiner RC Jr, Roever L, Room R, Roshandel G, Safari S, Samy AM, Sanabria J, Sartorius B, Schmidt MI, Senthilkumaran S, Shaikh MA, Sharif M, Sharifi A, Shigematsu M, Singh JA, Soheili A, Suleria HAR, Teklehaimanot BF, Tesfay BE, Vacante M, Vahedian-Azimi A, Valdez PR, Vasankari TJ, Vu GT, Waheed Y, Weldegwergs KG, Werdecker A, Westerman R, Wondafrash DZ, Wondmieneh AB, Yeshitila YG, Yonemoto N, Yu C, Zaidi Z, Zarghi A, Zelber-Sagi S, Zewdie KA, Zhang ZJ, Zhao XJ, Naghavi M, Malekzadeh R., Sepanlou, S, Safiri, S, Bisignano, C, Ikuta, K, Merat, S, Saberifiroozi, M, Poustchi, H, Tsoi, D, Colombara, D, Abdoli, A, Adedoyin, R, Afarideh, M, Agrawal, S, Ahmad, S, Ahmadian, E, Ahmadpour, E, Akinyemiju, T, Akunna, C, Alipour, V, Almasi-Hashiani, A, Almulhim, A, Al-Raddadi, R, Alvis-Guzman, N, Anber, N, Angus, C, Anoushiravani, A, Arabloo, J, Araya, E, Asmelash, D, Ataeinia, B, Ataro, Z, Atout, M, Ausloos, F, Awasthi, A, Badawi, A, Banach, M, Bejarano Ramirez, D, Bhagavathula, A, Bhala, N, Bhattacharyya, K, Biondi, A, Bolla, S, Boloor, A, Borzì, A, Butt, Z, Cámera, L, Campos-Nonato, I, Carvalho, F, Chu, D, Chung, S, Cortesi, P, Costa, V, Cowie, B, Daryani, A, de Courten, B, Demoz, G, Desai, R, Dharmaratne, S, Djalalinia, S, Do, H, Dorostkar, F, Drake, T, Dubey, M, Duncan, B, Effiong, A, Eftekhari, A, Elsharkawy, A, Etemadi, A, Farahmand, M, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Gebremedhin, K, Geta, B, Gilani, S, Gill, P, Gutirrez, R, Haile, M, Haj-Mirzaian, A, Hamid, S, Hasankhani, M, Hasanzadeh, A, Hashemian, M, Hassen, H, Hay, S, Hayat, K, Heidari, B, Henok, A, Hoang, C, Hostiuc, M, Hostiuc, S, Hsieh, V, Igumbor, E, Ilesanmi, O, Irvani, S, Jafari Balalami, N, James, S, Jeemon, P, Jha, R, Jonas, J, Jozwiak, J, Kabir, A, Kasaeian, A, Kassaye, H, Kefale, A, Khalilov, R, Khan, M, Khan, E, Khater, A, Kim, Y, Koyanagi, A, La Vecchia, C, Lim, L, Lopez, A, Lorkowski, S, Lotufo, P, Lozano, R, Magdy Abd El Razek, M, Mai, H, Manafi, N, Manafi, A, Mansournia, M, Mantovani, L, Mazzaglia, G, Mehta, D, Mendoza, W, Menezes, R, Mengesha, M, Meretoja, T, Mestrovic, T, Miazgowski, B, Miller, T, Mirrakhimov, E, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, A, Montero-Zamora, P, Moradi, G, Naimzada, M, Nayak, V, Negoi, I, Nguyen, T, Ofori-Asenso, R, Oh, I, Olagunju, T, Padubidri, J, Pakshir, K, Pana, A, Pathak, M, Pourshams, A, Rabiee, N, Radfar, A, Rafiei, A, Ramezanzadeh, K, Rana, S, Rawaf, S, Rawaf, D, Reiner RC, J, Roever, L, Room, R, Roshandel, G, Safari, S, Samy, A, Sanabria, J, Sartorius, B, Schmidt, M, Senthilkumaran, S, Shaikh, M, Sharif, M, Sharifi, A, Shigematsu, M, Singh, J, Soheili, A, Suleria, H, Teklehaimanot, B, Tesfay, B, Vacante, M, Vahedian-Azimi, A, Valdez, P, Vasankari, T, Vu, G, Waheed, Y, Weldegwergs, K, Werdecker, A, Westerman, R, Wondafrash, D, Wondmieneh, A, Yeshitila, Y, Yonemoto, N, Yu, C, Zaidi, Z, Zarghi, A, Zelber-Sagi, S, Zewdie, K, Zhang, Z, Zhao, X, Naghavi, M, Malekzadeh, R, Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H, Tsoi D, Colombara DV, Abdoli A, Adedoyin RA, Afarideh M, Agrawal S, Ahmad S, Ahmadian E, Ahmadpour E, Akinyemiju T, Akunna CJ, Alipour V, Almasi-Hashiani A, Almulhim AM, Al-Raddadi RM, Alvis-Guzman N, Anber NH, Angus C, Anoushiravani A, Arabloo J, Araya EM, Asmelash D, Ataeinia B, Ataro Z, Atout MMW, Ausloos F, Awasthi A, Badawi A, Banach M, Bejarano Ramirez DF, Bhagavathula AS, Bhala N, Bhattacharyya K, Biondi A, Bolla SR, Boloor A, Borzì AM, Butt ZA, Cámera LA, Campos-Nonato IR, Carvalho F, Chu DT, Chung SC, Cortesi PA, Costa VM, Cowie BC, Daryani A, de Courten B, Demoz GT, Desai R, Dharmaratne SD, Djalalinia S, Do HT, Dorostkar F, Drake TM, Dubey M, Duncan BB, Effiong A, Eftekhari A, Elsharkawy A, Etemadi A, Farahmand M, Farzadfar F, Fernandes E, Filip I, Fischer F, Gebremedhin KBB, Geta B, Gilani SA, Gill PS, Gutirrez RA, Haile MT, Haj-Mirzaian A, Hamid SS, Hasankhani M, Hasanzadeh A, Hashemian M, Hassen HY, Hay SI, Hayat K, Heidari B, Henok A, Hoang CL, Hostiuc M, Hostiuc S, Hsieh VC, Igumbor EU, Ilesanmi OS, Irvani SSN, Jafari Balalami N, James SL, Jeemon P, Jha RP, Jonas JB, Jozwiak JJ, Kabir A, Kasaeian A, Kassaye HG, Kefale AT, Khalilov R, Khan MA, Khan EA, Khater A, Kim YJ, Koyanagi A, La Vecchia C, Lim LL, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Magdy Abd El Razek M, Mai HT, Manafi N, Manafi A, Mansournia MA, Mantovani LG, Mazzaglia G, Mehta D, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Mestrovic T, Miazgowski B, Miller TR, Mirrakhimov EM, Mithra P, Moazen B, Moghadaszadeh M, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Montero-Zamora PA, Moradi G, Naimzada MD, Nayak V, Negoi I, Nguyen TH, Ofori-Asenso R, Oh IH, Olagunju TO, Padubidri JR, Pakshir K, Pana A, Pathak M, Pourshams A, Rabiee N, Radfar A, Rafiei A, Ramezanzadeh K, Rana SMM, Rawaf S, Rawaf DL, Reiner RC Jr, Roever L, Room R, Roshandel G, Safari S, Samy AM, Sanabria J, Sartorius B, Schmidt MI, Senthilkumaran S, Shaikh MA, Sharif M, Sharifi A, Shigematsu M, Singh JA, Soheili A, Suleria HAR, Teklehaimanot BF, Tesfay BE, Vacante M, Vahedian-Azimi A, Valdez PR, Vasankari TJ, Vu GT, Waheed Y, Weldegwergs KG, Werdecker A, Westerman R, Wondafrash DZ, Wondmieneh AB, Yeshitila YG, Yonemoto N, Yu C, Zaidi Z, Zarghi A, Zelber-Sagi S, Zewdie KA, Zhang ZJ, Zhao XJ, Naghavi M, and Malekzadeh R.
Abstract: Background: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. Methods: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. Findings: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions fo
Published: 2020

8. Clinical presentation and management ofCOVID-19

Author: Thevarajan, I, Buising, KL, Cowie, BC, Thevarajan, I, Buising, KL, and Cowie, BC
Abstract: The rapid spread of severe acute respiratory syndrome coronavirus 2 led to the declaration of a global pandemic within 3 months of its emergence. The majority of patients presenting with coronavirus disease 2019 (COVID-19) experience a mild illness that can usually be managed in the community. Patients require careful monitoring and early referral to hospital if any signs of clinical deterioration occur. Increased age and the presence of comorbidities are associated with more severe disease and poorer outcomes. Treatment for COVID-19 is currently predominantly supportive care, focused on appropriate management of respiratory dysfunction. Clinical evidence is emerging for some specific therapies (including antiviral and immune-modulating agents). Investigational therapies for COVID-19 should be used in the context of approved randomised controlled trials. Australian clinicians need to be able to recognise, diagnose, manage and appropriately refer patients affected by COVID-19, with thousands of cases likely to present over the coming years.
Published: 2020

9. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Sepanlou, SG, Safiri, S, Bisignano, C, Ikuta, KS, Merat, S, Saberifiroozi, M, Poustchi, H, Tsoi, D, Colombara, DV, Abdoli, A, Adedoyin, RA, Afarideh, M, Agrawal, S, Ahmad, S, Ahmadian, E, Ahmadpour, E, Akinyemiju, T, Akunna, CJ, Alipour, V, Almasi-Hashiani, A, Almulhim, AM, Al-Raddadi, RM, Alvis-Guzman, N, Anber, NH, Angus, C, Anoushiravani, A, Arabloo, J, Araya, EM, Asmelash, D, Ataeinia, B, Ataro, Z, Atout, MMW, Ausloos, F, Awasthi, A, Badawi, A, Banach, M, Bejarano Ramirez, DF, Bhagavathula, AS, Bhala, N, Bhattacharyya, K, Biondi, A, Bolla, SR, Boloor, A, Borzi, AM, Butt, ZA, Alberto Camera, LLA, Campos-Nonato, IR, Carvalho, F, Dinh-Toi, C, Chung, S-C, Cortesi, PA, Costa, VM, Cowie, BC, Daryani, A, de Courten, B, Demoz, GT, Desai, R, Dharmaratne, SD, Djalalinia, S, Hoa, TD, Dorostkar, F, Drake, TM, Dubey, M, Duncan, BB, Effiong, A, Eftekhari, A, Elsharkawy, A, Etemadi, A, Farahmand, M, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Gebremedhin, KBB, Geta, B, Gilani, SA, Gill, PS, Alma Gutierrez, R, Haile, MT, Haj-Mirzaian, A, Hamid, SS, Hasankhani, M, Hasanzadeh, A, Hashemian, M, Hassen, HY, Hay, SI, Hayat, K, Heidari, B, Henok, A, Chi, LH, Hostiuc, M, Hostiuc, S, Hsieh, VC-R, Igumbor, EU, Ilesanmi, OS, Irvani, SSN, Balalami, NJ, James, SL, Jeemon, P, Jha, RP, Jonas, JB, Jozwiak, JJ, Kabir, A, Kasaeian, A, Kassaye, HG, Kefale, AT, Khan, RKMA, Khan, EA, Khater, A, Kim, YJ, Koyanagi, A, La Vecchia, C, Lim, L-L, Lopez, AD, Lorkowski, S, Lotufo, PA, Lozano, R, Abd El Razek, MM, Hue, TM, Manafi, N, Manafi, A, Mansournia, MA, Mantovani, LG, Mazzaglia, G, Mehta, D, Mendoza, W, Menezes, RG, Mengesha, MM, Meretoja, TJ, Mestrovic, T, Miazgowski, B, Miller, TR, Mirrakhimov, EM, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, AH, Montero-Zamora, PA, Moradi, G, Naimzada, MD, Nayak, V, Negoi, I, Trang, HN, Ofori-Asenso, R, Oh, I-H, Olagunju, TO, Padubidri, JR, Pakshir, K, Pana, A, Pathak, M, Pourshams, A, Rabiee, N, Radfar, A, Rafiei, A, Ramezanzadeh, K, Rana, SMM, Rawaf, S, Rawaf, DL, Reiner, RC, Roever, L, Room, R, Roshandel, G, Safari, S, Samy, AM, Sanabria, J, Sartorius, B, Schmidt, MI, Senthilkumaran, S, Shaikh, MA, Sharif, M, Sharifi, A, Shigematsu, M, Singh, JA, Soheili, A, Suleria, HAR, Teklehaimanot, BF, Tesfay, BE, Vacante, M, Vahedian-Azimi, A, Valdez, PR, Vasankari, TJ, Giang, TV, Waheed, Y, Weldegwergs, KG, Werdecker, A, Westerman, R, Wondafrash, DZ, Wondmieneh, AB, Yeshitila, YG, Yonemoto, N, Yu, C, Zaidi, Z, Zarghi, A, Zelber-Sagi, S, Zewdie, KA, Zhang, Z-J, Zhao, X-J, Naghavi, M, Malekzadeh, R, Sepanlou, SG, Safiri, S, Bisignano, C, Ikuta, KS, Merat, S, Saberifiroozi, M, Poustchi, H, Tsoi, D, Colombara, DV, Abdoli, A, Adedoyin, RA, Afarideh, M, Agrawal, S, Ahmad, S, Ahmadian, E, Ahmadpour, E, Akinyemiju, T, Akunna, CJ, Alipour, V, Almasi-Hashiani, A, Almulhim, AM, Al-Raddadi, RM, Alvis-Guzman, N, Anber, NH, Angus, C, Anoushiravani, A, Arabloo, J, Araya, EM, Asmelash, D, Ataeinia, B, Ataro, Z, Atout, MMW, Ausloos, F, Awasthi, A, Badawi, A, Banach, M, Bejarano Ramirez, DF, Bhagavathula, AS, Bhala, N, Bhattacharyya, K, Biondi, A, Bolla, SR, Boloor, A, Borzi, AM, Butt, ZA, Alberto Camera, LLA, Campos-Nonato, IR, Carvalho, F, Dinh-Toi, C, Chung, S-C, Cortesi, PA, Costa, VM, Cowie, BC, Daryani, A, de Courten, B, Demoz, GT, Desai, R, Dharmaratne, SD, Djalalinia, S, Hoa, TD, Dorostkar, F, Drake, TM, Dubey, M, Duncan, BB, Effiong, A, Eftekhari, A, Elsharkawy, A, Etemadi, A, Farahmand, M, Farzadfar, F, Fernandes, E, Filip, I, Fischer, F, Gebremedhin, KBB, Geta, B, Gilani, SA, Gill, PS, Alma Gutierrez, R, Haile, MT, Haj-Mirzaian, A, Hamid, SS, Hasankhani, M, Hasanzadeh, A, Hashemian, M, Hassen, HY, Hay, SI, Hayat, K, Heidari, B, Henok, A, Chi, LH, Hostiuc, M, Hostiuc, S, Hsieh, VC-R, Igumbor, EU, Ilesanmi, OS, Irvani, SSN, Balalami, NJ, James, SL, Jeemon, P, Jha, RP, Jonas, JB, Jozwiak, JJ, Kabir, A, Kasaeian, A, Kassaye, HG, Kefale, AT, Khan, RKMA, Khan, EA, Khater, A, Kim, YJ, Koyanagi, A, La Vecchia, C, Lim, L-L, Lopez, AD, Lorkowski, S, Lotufo, PA, Lozano, R, Abd El Razek, MM, Hue, TM, Manafi, N, Manafi, A, Mansournia, MA, Mantovani, LG, Mazzaglia, G, Mehta, D, Mendoza, W, Menezes, RG, Mengesha, MM, Meretoja, TJ, Mestrovic, T, Miazgowski, B, Miller, TR, Mirrakhimov, EM, Mithra, P, Moazen, B, Moghadaszadeh, M, Mohammadian-Hafshejani, A, Mohammed, S, Mokdad, AH, Montero-Zamora, PA, Moradi, G, Naimzada, MD, Nayak, V, Negoi, I, Trang, HN, Ofori-Asenso, R, Oh, I-H, Olagunju, TO, Padubidri, JR, Pakshir, K, Pana, A, Pathak, M, Pourshams, A, Rabiee, N, Radfar, A, Rafiei, A, Ramezanzadeh, K, Rana, SMM, Rawaf, S, Rawaf, DL, Reiner, RC, Roever, L, Room, R, Roshandel, G, Safari, S, Samy, AM, Sanabria, J, Sartorius, B, Schmidt, MI, Senthilkumaran, S, Shaikh, MA, Sharif, M, Sharifi, A, Shigematsu, M, Singh, JA, Soheili, A, Suleria, HAR, Teklehaimanot, BF, Tesfay, BE, Vacante, M, Vahedian-Azimi, A, Valdez, PR, Vasankari, TJ, Giang, TV, Waheed, Y, Weldegwergs, KG, Werdecker, A, Westerman, R, Wondafrash, DZ, Wondmieneh, AB, Yeshitila, YG, Yonemoto, N, Yu, C, Zaidi, Z, Zarghi, A, Zelber-Sagi, S, Zewdie, KA, Zhang, Z-J, Zhao, X-J, Naghavi, M, and Malekzadeh, R
Abstract: BACKGROUND: Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. METHODS: We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. FINDINGS: In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions fo
Published: 2020

10. Adherence in chronic hepatitis B: associations between medication possession ratio and adverse viral outcomes

Author: Allard, NL, MacLachlan, JH, Dev, A, Dwyer, J, Srivatsa, G, Spelman, T, Thompson, AJ, Cowie, BC, Allard, NL, MacLachlan, JH, Dev, A, Dwyer, J, Srivatsa, G, Spelman, T, Thompson, AJ, and Cowie, BC
Abstract: Background Antiviral therapy for chronic hepatitis B (CHB) is effective and can substantially reduce the risk of progressive liver disease and hepatocellular carcinoma but is often administered for an indefinite duration. Adherence has been shown in clinical trials to maximize the benefit of therapy and prevent the development of resistance, however the optimal threshold for predicting clinical outcomes has not been identified. The aim of this study was to analyse adherence using the medication possession ration (MPR) and its relation to virological outcomes in a large multi-centre hospital outpatient population, and guide development of an evidence-based threshold for optimal adherence. Methods Pharmacy and pathology records of patients dispensed CHB antiviral therapy from 4 major hospitals in Melbourne between 2010 and 2013 were extracted and analysed to determine their MPR and identify instances of unfavourable viral outcomes. Viral outcomes were classified categorically, with unfavourable outcomes including HBV DNA remaining detectable after 2 years treatment or experiencing viral breakthrough. The association between MPR and unfavourable outcomes was assessed according to various thresholds using ROC analysis and time-to-event regression. Results Six hundred forty-two individuals were included in the analysis. Median age was 46.6 years, 68% were male, 77% were born in Asia, and the median time on treatment was 27.5 months. The majority had favourable viral outcomes (91.06%), with most having undetectable HBV DNA at the end of the study period. The most common unfavourable outcome was a rise of < 1 log in HBV DNA (6.54% of the total), while 2.49% of participants experienced viral breakthrough. Adherence was linearly associated with favourable outcomes, with increasing risk of virological breakthrough as MPR fell. Decreasing the value of MPR, at which a cut-point was taken, was associated with a progressively larger reduction in the rate of unfavourable event; fr
Published: 2020

11. Epidemiology of chronic hepatitis B and C in Victoria, Australia: insights and impacts from enhanced surveillance

Author: MacLachlan, JH, Romero, N, Higgins, N, Coutts, R, Chan, R, Stephens, N, Cowie, BC, MacLachlan, JH, Romero, N, Higgins, N, Coutts, R, Chan, R, Stephens, N, and Cowie, BC
Abstract: OBJECTIVE: To assess the impact of an enhanced viral hepatitis surveillance program on data completeness and on epidemiological assessment of affected populations. METHODS: Notified cases of non-acute hepatitis B and C were analysed to determine demographic characteristics and risk factors during the period prior to July 2015-June 2016, and during enhanced surveillance of the period July 2016-June 2017, during which time doctors were contacted for information about new diagnoses. RESULTS: During the enhanced period, completeness for country of birth and Indigenous status doubled for both hepatitis B and hepatitis C, from 18-37% to 48-65%. The incidence ratio of hepatitis C among Aboriginal and Torres Strait Islander people increased from eight-fold to 11.4-fold, and the proportion of hepatitis B cases reported as born in China and Vietnam relative to other countries increased. New data fields identified that 12% of hepatitis C diagnoses occurred in a correctional facility, and 2% of hepatitis B cases were healthcare workers. CONCLUSIONS: Improved data completeness highlighted the underlying epidemiology of chronic viral hepatitis, demonstrating the increased burden of infection among specific priority populations. Implications for public health: Enhanced surveillance provides greater insight into the epidemiology of chronic viral hepatitis, identifying groups at risk and opportunities for public health action.
Published: 2020

12. Towards Genotype-Specific Care for Chronic Hepatitis B: The First 6 Years Follow Up From the CHARM Cohort Study

Author: Davies, J, Smith, EL, Littlejohn, M, Edwards, R, Sozzi, V, Jackson, K, McGuire, K, Binks, P, Cowie, BC, Locarnini, S, Davis, JS, Tong, SYC, Davies, J, Smith, EL, Littlejohn, M, Edwards, R, Sozzi, V, Jackson, K, McGuire, K, Binks, P, Cowie, BC, Locarnini, S, Davis, JS, and Tong, SYC
Abstract: OBJECTIVE: There is increasing evidence to suggest that, among those with chronic hepatitis B virus infection, the natural history and rate of progression to cirrhosis and hepatocellular carcinoma is influenced by hepatitis B virus genotype. The unique hepatitis B virus genotype C4 circulates among Indigenous Australians. The aim of this work is to describe the process of establishing this cohort and review the first 6 years of available data in an effort to understand the real-world clinical care and natural history of this subgenotype. METHOD: We followed a longitudinal cohort of Indigenous Australians from the Northern Territory of Australia with established subgenotype C4 infections. We assigned phases of disease according to Gastroenterological Society of Australia and Asian Pacific Association for the Study of the Liver criteria using clinical and laboratory information that had been collected for clinical management. RESULTS: Of 193 patients followed over a median of 38 months, 58 (30%) individuals transitioned from 1 disease phase to another, 10 (5%) cleared hepatitis B e antigen, and 6 cleared hepatitis B surface antigen (3%). In this relatively young cohort (median age 40.3 years), 26 (13%) had cirrhosis by the end of the follow up period, with the majority of these being in the immune control phase of disease. CONCLUSIONS: In this cohort of hepatitis B subgenotype C4 patients, we report an aggressive and dynamic clinical phenotype. High rates of cirrhosis at a young age appear to occur in the early phases of disease.
Published: 2019

13. Chronic hepatitis B prevalence in Australian Aboriginal and Torres Strait Islander people before and after implementing a universal vaccination program: a systematic review and meta-analysis

Author: Graham, S, MacLachlan, JH, Gunaratnam, P, Cowie, BC, Graham, S, MacLachlan, JH, Gunaratnam, P, and Cowie, BC
Abstract: UNLABELLED: Background A higher prevalence of chronic hepatitis B (CHB) has been reported in Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal Australians. An Australian infant and adolescent hepatitis B virus (HBV) vaccination program was implemented in 2000. Meta-analysis methods will be used to examine if the pooled prevalence of CHB decreased after 2000 among Aboriginal Australians. METHODS: Embase, Medline and Web of Science were searched from 1 January 1981 to 29 March 2018 and all issues of the Northern Territory and New South Wales Public Health Bulletins. Studies needed to report the number of individuals who were tested and tested positive for hepatitis B surface antigen (HBsAg). RESULTS: There were 36 studies; 16 before and 20 after 2000; reporting 84 prevalence estimates. Population groups included: adults (14 studies), pregnant women (13 studies), prisoners (five studies) children or teenagers (10 studies) and infants (two studies). The pooled prevalence of HBsAg decreased overall (from 10.8% before 2000 vs 3.5% after 2000), in women (4.2% vs 2.2%), in males (17.5% vs 3.5%), in regional (7.8% vs 3.9%) and remote (14.4% vs 5.7%) areas, in New South Wales (12.3% vs 3.0%), in the Northern Territory (6.1% vs 5.1%), in adults (15.3% vs 4.3%) and in pregnant women (3.6% vs 2.6%). CONCLUSION: The prevalence of HBsAg decreased among Aboriginal people after 2000.
Published: 2019

14. Influenza and pertussis vaccination of women during pregnancy in Victoria, 2015-2017

Author: Rowe, SL, Perrett, KP, Morey, R, Stephens, N, Cowie, BC, Nolan, TM, Leder, K, Pitcher, H, Sutton, B, Cheng, AC, Rowe, SL, Perrett, KP, Morey, R, Stephens, N, Cowie, BC, Nolan, TM, Leder, K, Pitcher, H, Sutton, B, and Cheng, AC
Abstract: OBJECTIVES: To assess variations by time of year and hospital in the uptake of influenza and pertussis vaccinations by pregnant women in Victoria; to identify factors associated with vaccination uptake. DESIGN, SETTING: Retrospective analysis of data in the Victorian Perinatal Data Collection (VPDC), a population surveillance system for obstetric conditions, procedures, and pregnancy and birth outcomes. PARTICIPANTS: Women whose pregnancies ended in a live or stillbirth during July 2015 - June 2017. MAIN OUTCOME MEASURES: Influenza and pertussis vaccinations during pregnancy. RESULTS: 153 980 pregnancies in 67 hospitals ended during July 2015 - June 2017; 59 968 pregnant women (39.0%) were vaccinated against influenza and 98 583 (64.0%) against pertussis. Coverage varied by pregnancy end date, rising for influenza during winter and spring, but for pertussis rising continuously across the two years from 37.5% to 82.2%. Differences between hospitals in coverage were marked. Factors associated with vaccination included greater maternal age, primigravidity, early antenatal care, and GP-led care. The odds of vaccination were statistically significantly lower for women born overseas and those who smoked during pregnancy; the odds of vaccination were also lower for Aboriginal and Torres Strait Islander women. CONCLUSIONS: Pertussis vaccination of pregnant women in Victoria has increased, but influenza vaccination rates remain moderate and variable. Structural changes at the system level may improve maternal vaccination rates. Embedding the delivery of maternal vaccination programs in antenatal care pathways should be a priority.
Published: 2019

15. Bridging the access gap: Medicare ineligibility in people living with chronic hepatitis B

Author: MacLachlan, JH, Cowie, BC, MacLachlan, JH, and Cowie, BC
Abstract: People living in Australia on temporary student or work visas are excluded from Medicare access and can face barriers to adequate healthcare, even if they are privately insured. This analysis aimed to quantify this issue in relation to people living with chronic hepatitis B, the majority of whom in Australia were born overseas. The data suggest that an estimated 25 000 people living with chronic hepatitis B in Australia are ineligible for Medicare, 10% of the total number affected, with considerable potential impact in access to effective healthcare and prevention of adverse outcomes.
Published: 2019

16. Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030

Author: Howell, J, Pedrana, A, Cowie, BC, Doyle, J, Getahun, A, Ward, J, Gane, E, Cunningham, C, Wallace, J, Lee, A, Malani, J, Thompson, A, Hellard, ME, Howell, J, Pedrana, A, Cowie, BC, Doyle, J, Getahun, A, Ward, J, Gane, E, Cunningham, C, Wallace, J, Lee, A, Malani, J, Thompson, A, and Hellard, ME
Abstract: Viral hepatitis affects more than 320 million people globally, leading to significant morbidity and mortality due to liver failure and hepatocellular carcinoma (HCC). More than 248 million people (3.2% globally) are chronically infected with hepatitis B virus (HBV), and an estimated 80 million people (1.1% globally) are chronically infected with hepatitis C virus (HCV). In 2015, more than 700 000 deaths were directly attributable to HBV, and nearly 500 000 deaths were attributable to HCV infection; 2-5% of HBV-infected people develop HCC per annum irrespective of the presence of cirrhosis, whereas 1-5% HCV-infected people with advanced fibrosis develop HCC per annum. The rapidly escalating global mortality related to HBV and HCV related viral hepatitis to be the 7th leading cause of death worldwide in 2013, from 10th leading cause in 1990. Australia, New Zealand, and Pacific Island Countries and Territories fall within the World Health Organization Western Pacific Region, which has a high prevalence of viral hepatitis and related morbidity, particularly HBV. Remarkably, in this region, HBV-related mortality is greater than for tuberculosis, HIV infection, and malaria combined. The region provides a unique contrast in viral hepatitis prevalence, health system resources, and approaches taken to achieve World Health Organization global elimination targets for HBV and HCV infection. This review highlights the latest evidence in viral hepatitis epidemiology and explores the health resources available to combat viral hepatitis, focusing on the major challenges and critical needs to achieve elimination in Australia, New Zealand, and Pacific Island Countries and Territories.
Published: 2019

17. Hepatocellular carcinoma over three decades in Victoria, Australia: epidemiology, diagnosis and trends, 1984-2013

Author: Carville, KS, MacLachlan, JH, Thursfield, V, Cowie, BC, Carville, KS, MacLachlan, JH, Thursfield, V, and Cowie, BC
Abstract: BACKGROUND: Liver cancer continues to be a health priority in Australia, with the majority attributable to preventable causes, and certain populations at higher risk. AIMS: Epidemiological assessment of incidence, trends and distribution to inform prevention, and reassessment of data in light of recent changes to registry case definitions. METHODS: Reported cases of hepatocellular carcinoma (HCC) in Victoria, Australia, 1984-2013, were obtained from the Victorian Cancer Registry. Demographic characteristics were examined, incidence and survival assessed using Poisson and Cox regression, and geographic distribution mapped. Incidence was compared before and after inclusion of non-histologically confirmed cases in Registry data to assess impacts on incidence trends. RESULTS: Diagnoses of HCC rose substantially between 1984 and 2013, increasing sixfold from 0.9 to 5.9 per 100 000. The rate of increase per year accelerated from 5.3% between 1984 and 2003 to 9.5% between 2004 and 2013. Cases were disproportionately male (80%), median age at diagnosis was 66 years and 53% were born overseas. Even during 2004-2013, 5-year survival was only 16%, although higher among younger people, metropolitan residents and people born overseas. Incidence showed strong geographic clustering. The proportion of cases diagnosed clinically increased from 1% during 1984-2004 to 43% in 2009-2013. The revised case definition added 993 cases (27.3% of total). CONCLUSION: Cases of HCC are becoming increasingly common, and revised incidence estimates highlight the impact of case definitions in the context of changing diagnostic approaches. The ongoing burden, disproportionate population distribution and low survival emphasise the importance of prevention and early detection as a public health imperative.
Published: 2018

18. Deaths from liver cancer continue to rise in Australia: is elimination by 2030 possible?

Author: Brown, CR, Allard, NL, MacLachlan, JH, Cowie, BC, Brown, CR, Allard, NL, MacLachlan, JH, and Cowie, BC
Published: 2017

19. Establishing contemporary trends in hepatitis B sero-epidemiology in an Indigenous population

Author: Blackard, J, Davies, J, Li, SQ, Tong, SY, Baird, RW, Beaman, M, Higgins, G, Cowie, BC, Condon, JR, Davis, JS, Blackard, J, Davies, J, Li, SQ, Tong, SY, Baird, RW, Beaman, M, Higgins, G, Cowie, BC, Condon, JR, and Davis, JS
Abstract: BACKGROUND: Indigenous populations globally are disproportionately affected by chronic hepatitis B virus (HBV) infection however contemporary sero-prevalence data are often absent. In the Indigenous population of the Northern Territory (NT) of Australia the unique C4 sub-genotype of HBV universally circulates. There are no studies of the sero-prevalence, nor the impact of the vaccination program (which has a serotype mismatch compared to C4), at a population-wide level. METHODS: We examined all available HBV serology results obtained from the three main laboratories serving NT residents between 1991 and 2011. Data were linked with a NT government database to determine Indigenous status and the most recent test results for each individual were extracted as a cross-sectional database including 88,112 unique individuals. The primary aim was to obtain a contemporary estimate of HBsAg positivity for the NT by Indigenous status. RESULTS: Based on all tests from 2007-2011 (35,633 individuals), hepatitis B surface antigen (HBsAg) positivity was 3·40% (95%CI 3·19-3·61), being higher in Indigenous (6·08%[5·65%-6·53%]) than non-Indigenous (1·56%[1·38%-1·76%]) Australians, p<0·0001. Birth cohort analysis showed HBsAg positivity fell over time for Indigenous people, with this decrease commencing prior to universal infant vaccination (which commenced in 1990), with an ongoing but slower rate of decline since 1990, (0·23% decrease per year versus 0·17%). CONCLUSIONS: HBsAg positivity is high in the NT, particularly in the Indigenous population. HBsAg positivity has fallen over time but a substantial part of this decrease is due to factors other than the universal vaccination program.
Published: 2017

20. Observation of active sites for oxygen reduction reaction on nitrogen-doped multilayer graphene

Author: Xing,T, Zheng,Y, Li,LH, Cowie,BC, Gunzelmann,D, Qiao,SZ, Huang,S, Chen,Y, Xing,T, Zheng,Y, Li,LH, Cowie,BC, Gunzelmann,D, Qiao,SZ, Huang,S, and Chen,Y
Abstract: Active sites and the catalytic mechanism of nitrogen-doped graphene in an oxygen reduction reaction (ORR) have been extensively studied but are still inconclusive, partly due to the lack of an experimental method that can detect the active sites. It is proposed in this report that the active sites on nitrogen-doped graphene can be determined via the examination of its chemical composition change before and after ORR. Synchrotron-based X-ray photoelectron spectroscopy analyses of three nitrogen-doped multilayer graphene samples reveal that oxygen reduction intermediate OH(ads), which should chemically attach to the active sites, remains on the carbon atoms neighboring pyridinic nitrogen after ORR. In addition, a high amount of the OH(ads) attachment after ORR corresponds to a high catalytic efficiency and vice versa. These pinpoint that the carbon atoms close to pyridinic nitrogen are the main active sites among the different nitrogen doping configurations.
Published: 2014

21. Health literacy in patients with chronic hepatitis B attending a tertiary hospital in Melbourne: a questionnaire based survey

Author: Dahl, TFM, Cowie, BC, Biggs, B-A, Leder, K, MacLachlan, JH, Marshall, C, Dahl, TFM, Cowie, BC, Biggs, B-A, Leder, K, MacLachlan, JH, and Marshall, C
Abstract: BACKGROUND: Current estimates suggest over 218,000 individuals in Australia are chronically infected with hepatitis B virus. The majority of these people are migrants and refugees born in hepatitis B endemic countries, where attitudes towards health, levels of education, and English proficiency can be a barrier to accessing the Australian health care system, and best managing chronic hepatitis B. This study aimed to assess the knowledge of transmission and consequences of chronic hepatitis B among these patients. METHOD: A prospective study was conducted between May and August 2012. Patients with chronic hepatitis B were recruited from three Royal Melbourne Hospital outpatient clinics. Two questionnaires were administered. Questionnaire 1, completed during observation of a prospective participants' consultation, documented information given to the patient by their clinician. After the consultation, Questionnaire 2 was administered to assess patient demographics, and overall knowledge of the effect, transmission and treatment of hepatitis B. RESULTS: 55 participants were recruited. 93% of them were born overseas, 17% used an interpreter, and the average time since diagnosis was 9.7 years.Results from Questionnaire 1 showed that the clinician rarely discussed many concepts. Questionnaire 2 exposed considerable gaps in hepatitis B knowledge. Few participants reported a risk of cirrhosis (11%) or liver cancer (18%). There was a high awareness of transmission routes, with 89% correctly identifying sexual transmission, 93% infected blood, and 85% perinatal transmission. However, 25% of participants believed hepatitis B could be spread by sharing food, and over 50% by kissing and via mosquitoes. A knowledge score out of 12 was assessed for each participant. The average score was 7.5. Multivariate analysis found higher knowledge scores among those with a family member also diagnosed with chronic hepatitis B and those routinely seeing the same clinician (p = 0.009 and p = 0.
Published: 2014

22. The Perpetual Challenge of Infectious Diseases

Author: Cowie, BC, Dore, GJ ; https://orcid.org/0000-0002-4741-2622, Cowie, BC, and Dore, GJ ; https://orcid.org/0000-0002-4741-2622
Published: 2012

23. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Author: Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basanez, M-G, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabe, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, SA, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, GR, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT-A, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fevre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FGR, Franklin, R, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gosselin, R, Grainger, R, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Maria Haro, J, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, J-P, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Ma, J, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Elena Medina-Mora, M, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, A-C, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KMV, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Perez Padilla, R, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leon, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJC, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JRA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, MJ, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SRM, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, P-H, Zaidi, AKM, Zheng, Z-J, Zonies, D, Lopez, AD, Murray, CJL, Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basanez, M-G, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabe, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, SA, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, GR, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT-A, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fevre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FGR, Franklin, R, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gosselin, R, Grainger, R, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Maria Haro, J, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, J-P, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Ma, J, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Elena Medina-Mora, M, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, A-C, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KMV, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Perez Padilla, R, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leon, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJC, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JRA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, MJ, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SRM, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, P-H, Zaidi, AKM, Zheng, Z-J, Zonies, D, Lopez, AD, and Murray, CJL
Abstract: BACKGROUND: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). METHODS: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. FINDINGS: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350,000 cases per 1 million people. Prevalence and severity of health loss were weakly cor
Published: 2012

24. Effect of Latitude on Seasonality of Tuberculosis, Australia, 2002-2011

Author: MacLachlan, JH, Lavender, CJ, Cowie, BC, MacLachlan, JH, Lavender, CJ, and Cowie, BC
Abstract: Seasonal variation in tuberculosis diagnoses recently has been reported in various populations. In Australia, seasonality of tuberculosis diagnoses was more pronounced in areas where UV exposure is reduced and vitamin D deficiency is more prevalent. Our findings suggest vitamin D deficiency as a factor in disease activation.
Published: 2012

25. Hepatitis E infections, Victoria, Australia

Author: Cowie, BC, Adamopoulos, J, Carter, K, Kelly, H, Cowie, BC, Adamopoulos, J, Carter, K, and Kelly, H
Abstract: In the first half of 2004, acute hepatitis E virus infections diagnosed in Victoria, Australia, increased 7-fold. Of the interviewed patients with highly reactive serologic results, 90% reported recent clinically compatible illness and overseas travel. The increase is compared with a background of exposure in countries in which hepatitis E is endemic.
Published: 2005

26. The perpetual challenge of infectious diseases.

Author: Cowie BC, Dore GJ, Cowie, Benjamin C, and Dore, Gregory J
Published: 2012
Full Text: View/download PDF

27. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Roth, Gregory A., Collaborotors, G. B. D.Causes Death, Abate, Degu, Abate, Kalkidan Hassen, Abay, Solomon M., Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Load, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Haftom Temesgen, Abebe, Molla, Abebe, Zegeye, Abejie, Ayenew Negesse, Abera, Semaw F., Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Adamu, Abdu A., Adebayo, Oladimeji, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Adookunboh, Olatunii, Adhena, Beyene Meressa, Adib, Mina G., Admasie, Aniha, Afshin, Ashkan, Agarwal, Gina, Agesa, Karelia M., Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Melidi, Ahmed, Muktar Beshir, Ahmed, Sayent, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Fddine, Akbari, Mohammad Esmaeil, Akinyeniti, Rufus Olusola, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Raddadi, Rajaa M., Alandab, Fares, Alam, Khurshid, Alam, Tahiya, Alebel, Animut, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, Francois, Allebeck, Peter, Alonso, Jordi, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T., Aminde, Leopold N., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampern, Anber, Nahla Hamed, Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansari, Hossein, Aniha, Mustafa Geleto, Antonio, Carl Abelardo T., Anwari, Palwasha, Aremu, Olatunde, Arnlov, Johan, Arora, Amit, Arora, Monika, Artaman, Al, Aryal, Krishna K., Asayesh, Hamid, Asfaw, Ephremi Tsegay, Ataro, Zerihun, Atique, Suleman, Atre, Sachin R., Ausloos, Marcel, Avokpaho, Euripide F. G. A., Awasthi, Ashish, Quintattilla, Beatriz Paulina Ayala, Ayele, Yohanes, Ayer, Rakesh, Azzopardi, Peter S., Babazadeh, Arefeh, Bacha, Umar, Badali, Hamid, Badawi, Alaa, Bali, Ayele Geleto, Ballesteros, Katherine E., Banach, Maciej, Banerjee, Kajori, Bannick, Marlena S., Banoub, Joseph Adel Mattar, Barboza, Miguel A., Barker-Collo, Suzanne Lyu, Barnighausen, Till Winfried, Barquera, Simon, Barrero, Lope, Bassat, Quique, Base, Sanjay, Baune, Bernhard T., Baynes, Habtamu Wondifraw, Bazargan-Hejazi, Shahrzad, Beth, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Mcysam, Bejot, Yannick, Bekele, Bayu Begashaw, Belacliew, Abate Bekele, Belay, Ezra, Belay, Yihalem Abebe, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bensenor, Isabela M., Berman, Adam F., Bernabe, Eduardo, Bernstein, Robert S., Bertolacci, Gregory J., Beuran, Mircea, Beyranvand, Tina, Bhalla, Ashish, Bhattarai, Suraj, Bhaumik, Sounayadeeep, Bhutta, Zulfiqar A., Biadgo, Belete, Biehl, Molly H., Bijani, Ali, Bikbov, Boris, Bilano, Ver, Bililign, Nigus, Bin Sayeed, Muhammad Shandaat, Bisanzio, Donal, Biswas, Tuhin, Blacker, Brigitte F., Basara, Berrak Bora, Borschmann, Rohan, Bosetti, Cristina, Bozorgmehr, Kayvan, Brady, Oliver J., Brant, Luisa C., Brayne, Carol, Brazinova, Alexandra, Breitborde, Nicholas J. K., Brenner, Hermann, Briant, Paul Svitil, Britton, Gabrielle, Brugha, Traolach, Busse, Reinhard, Butt, Zahid A., Callender, Charlton S. K. H., Campos-Nonato, Ismael R., Rincon, Julio Cesar Canapuzano, Cano, Jorge, Car, Mate, Cardenas, Rosario, Carreras, Giulia, Carrero, Juan J., Carter, Austin, Carvalho, Felix, Castaneda-Orjuela, Carlos A., Rivas, Jacqueline Castillo, Castle, Chris D., Castro, Clara, Castro, Franz, Catala-Lopez, Ferran, Cerin, Ester, Chaiah, Yazan, Chang, Jung -Chen, Chanson, Fiona J., Chaturvedi, Pankaj, Chiang, Peggy Pei-Chia, Chimed-Ochir, Odgerel, Chisumpa, Vesper Hichilombwe, Chitheet, Abdulaal, Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam J., Chiang, Sheng-Chia, Cicuttini, Flavia M., Ciobanu, Liliana G., Cirillo, Massimo, Cohen, Aaron J., Cooper, Leslie Trumbull, Cortesi, Paolo Angelo, Cortinovis, Monica, Cousin, Ewerton, Cowie, Benjamin C., Criqui, Michael H., Cromwell, Elizabeth A., Crowe, Christopher Stephen, Crump, John A., Cunningham, Matthew, Daba, Alemneh Kabeta, Dadi, Abel Fekadu, Dandona, Lalit, Dandona, Rakhi, Dang, Anh Kim, Dargan, Paul I., Daryani, Ahmad, Das, Siddharth K., Das Gupta, Rajat, Das Neves, Jose, Dasa, Tamirat Tesfaye, Dash, Aditya Prasad, Davis, Adrian C., Weaver, Nicole Davis, Davitoiu, Dragos Virgil, Davletov, Kairat, De La Hoz, Fernando Pio, De Neve, Jan-Walter, Degefa, Meaza Girma, Degenhardt, Louisa, Degfie, Tizta T., Deiparine, Selina, Demoz, Gebre Teklemariam, Demtsu, Baleen Betsu, Denova-Gutierrez, Edgar, Deribe, Kebede, Dervenis, Nikolaos, Jarlais, Don C. 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Jc, Ferrari, Aj, Feyissa, Gt, Foigt, Na, Foreman, Kj, Frank, Td, Fuller, Je, Fürst, T, Furtado, Jm, Futran, Nd, Garcia-Basteiro, Al, Garcia-Gordillo, Ma, Gardner, Wm, Gebre, Ak, Gebrehiwot, Tt, Gebremedhin, At, Gebremichael, Tg, Gelano, Tf, Geleijnse, Jm, Geramo, Ycd, Gething, Pw, Gezae, Ke, Ghadami, Mr, Gibney, Kb, Gill, Tk, Gillum, Rf, Ginawi, Ia, Goldberg, Em, Gómez-Dantés, H, Gona, Pn, Gopalani, Sv, Gorman, Tm, Goulart, Ac, Gnedovskaya, Ev, Gugnani, Hc, Guimaraes, Al, Gupta, Pc, Gutiérrez, Ra, Haagsma, Ja, Hagos, Tb, Hailegiyorgis, Tt, Hailu, Gb, Hamadeh, Rr, Handal, Aj, Hankey, Gj, Harb, Hl, Haro, Jm, Hassen, Hy, Hay, Rj, Hay, Si, Hegazy, Mi, Henry, Nj, Hibstu, Dt, Hoek, Hw, Hole, Mk, Hosgood, Hd, Hosseini, Sm, Hotez, Pj, Hoy, Dg, Huang, Jj, Hussen, Mm, Irvani, Ssn, Irvine, Cm, Islam, Sm, Jacobsen, Kh, Jain, Sk, Jalu, Mt, James, Sl, Jayatilleke, Au, Jenkins, Kj, Jha, Rp, Johnson, Co, Johnson, Sc, Jonas, Jb, Jozwiak, Jj, Jungari, Sb, Jürisson, M, Kassa, Dh, Kassa, Gm, Kassa, Td, Kassebaum, Nj, Katikireddi, Sv, Karyani, Ak, Kefale, At, Keiyoro, Pn, Kemp, Gr, Kengne, Ap, Kesavachandran, Cn, Khafaie, Ma, Khalil, Ia, Khan, Ea, Khan, Ma, Khang, Yh, Khater, Mm, Khoja, At, Khosravi, Mh, Kiadaliri, Aa, Kibret, Gd, Kidanemariam, Zt, Kiirithio, Dn, Kim, Ye, Kim, Yj, Kimokoti, Rw, Kivimäki, M, Knudsen, Ak, Kocarnik, Jm, Kopec, Ja, Koul, Pa, Kravchenko, Ma, Kumar, Ga, Kutz, Mj, Kyu, Hh, Lad, Dp, Lad, Sd, Lal, Dk, Lam, Jo, Lami, Fh, Lansingh, Vc, Larson, Hj, Lau, Km, Lazarus, Jv, Lee, Ph, Leshargie, Ct, Lim, Ll, Limenih, Ma, Lopez, Ad, Lotufo, Pa, Macarayan, Erk, Mackay, Mt, Maclachlan, Jh, Maddison, Er, Maghavani, Dp, Malta, Dc, Manda, Al, Mandarano-Filho, Lg, Mansournia, Ma, Mapoma, Cc, Maravilla, Jc, Marks, Gb, Martins-Melo, Fr, März, W, Marzan, Mb, Masci, Jr, Massenburg, Bb, Mathur, Mr, Maulik, Pk, Mcgrath, Jj, Mcmahon, Bj, Mehndiratta, Mm, Mehta, Km, Mekonnen, Tc, Memiah, Ptn, Memish, Za, Mengistu, Dt, Mensah, Ga, Mereta, St, Meretoja, Tj, Mezgebe, Hb, Millear, Ai, Miller, Tr, Miller-Petrie, Mk, Mini, Gk, Mirrakhimov, Em, Misganaw, At, Mohammad, Ka, Mohammed, Ma, Mokdad, Ah, Moreno Velásquez, I, Morrison, Sd, Moschos, Mm, Mousavi, Sm, Muchie, Kf, Mueller, Uo, Mumford, Je, Musa, Ki, Nachega, Jb, Nansseu, Jr, Nascimento, Br, Negoi, Ri, Newton, Crj, Ngalesoni, Fn, Ngunjiri, Jw, Nguyen, Aq, Nguyen, Ht, Nguyen, Lh, Nguyen, Th, Ningrum, Dna, Nirayo, Yl, Nixon, Mr, Norheim, Of, Noubiap, Jj, Nouri, Hr, Nourollahpour Shiadeh, M, Nowroozi, Mr, Odell, Cm, Ogbo, Fa, Oh, Ih, Olagunju, At, Olivares, Pr, Olsen, He, Olusanya, Bo, Olusanya, Jo, Ong, Kl, Ong, Sk, Orpana, Hm, Ortiz, Jr, Øverland, S, Owolabi, Mo, Özdemir, R, P A, M, Pakhare, Ap, Pakpour, Ah, Pandian, Jd, Park, Ek, Parry, Cdh, Patton, Gc, Paturi, Vr, Paulson, Kr, Pereira, Dm, Phillips, Mr, Piel, Fb, Pigott, Dm, Pillay, Jd, Postma, Mj, Purcell, Ca, Quistberg, Da, Rade, Kw, Radfar, A, Rafay, A, Rafiei, A, Rahim, F, Rahman, Mhu, Rahman, Ma, Rai, Rk, Ranabhat, Cl, Rao, Pc, Rawaf, Dl, Razo-García, C, Reiner, Rc, Reitsma, Mb, Renzaho, Amn, Riahi, Sm, Ribeiro, Alp, Rios-Blancas, Mj, Roba, Kt, Roberts, Nl, Robinson, Sr, Sahraian, Ma, Saldanha, Rf, Sambala, Ez, Samy, Am, Sanchez-Niño, Md, Santomauro, Df, Santos, Jv, Milicevic, Mm, Sao Jose, Bp, Sarker, Ar, Sarmiento-Suárez, R, Sawant, Ar, Schmidt, Mi, Schneider, Ijc, Schöttker, B, Schutte, Ae, Schwebel, Dc, Scott, Jg, Sepanlou, Sg, Serván-Mori, E, Shackelford, Ka, Shaheen, Aa, Shaikh, Ma, Shrime, Mg, Siddiqi, Tj, Sigfusdottir, Id, Silberberg, Dh, Silva, Da, Silva, Jp, Silva, Ntd, Silveira, Dga, Singh, Ja, Singh, Np, Singh, Pk, Sinha, Dn, Sobaih, Bh, Sorensen, Rjd, Soriano, Jb, Soyiri, In, Sposato, La, Sreeramareddy, Ct, Stanaway, Jd, Starodubov, Vi, Stein, Dj, Stewart, Lg, Stokes, Ma, Subart, Ml, Sufiyan, Mb, Sur, Pj, Sykes, Bl, Sylaja, Pn, Sylte, Do, Szoeke, Cei, Tabarés-Seisdedos, R, Tadakamadla, Sk, Tassew, Sg, Tekalign, Tg, Tekle, Mg, Temsah, Mh, Teshale, My, Tessema, Ga, Thankappan, Kr, Thrift, Ag, Thurston, Gd, To, Qg, Torre, Ae, Tortajada-Girbés, M, Tovani-Palone, Mr, Tran, Bx, Tran, Kb, Troeger, Ce, Truelsen, Tc, Truong, Nt, Tsadik, Ag, Tuzcu, Em, Ukwaja, Kn, Undurraga, Ea, Updike, Rl, Uthman, Oa, Uzun, Sb, Valdez, Pr, Vasankari, Tj, Vladimirov, Sk, Vollset, Se, Wagner, Gr, Wallin, Mt, Walson, Jl, Wang, Yp, Wassie, Mm, Weintraub, Rg, Weldegwergs, Kg, Werkneh, Aa, West, Te, Whiteford, Ha, Wilner, Lb, Wolfe, Cda, Wu, Yc, Wyper, Gma, Yahyazadeh Jabbari, Sh, Yan, Ll, Yasin, Yj, Yentür, Gk, Yimer, Em, Yirsaw, Bd, Yoon, Sj, Younis, Mz, Zaman, Sb, Zeleke, Aj, Zenebe, Zm, Zhang, Al, Zuhlke, Lj, and Murray, Cjl.
Subjects: Adult, Male, Adolescent, national age-sex-specific mortality, UNITED-STATES, Global Health, Socioeconomic Factor, Global Burden of Disease, GBD, causes of death, Young Adult, Age Distribution, Life Expectancy, General & Internal Medicine, Cause of Death, PUBLIC-HEALTH PROBLEM, mortality, 282 causes global burden of disease, Sex Distribution, Child, Aged, Aged, 80 and over, BARRIERS, DEMENTIA, Medicine (all), Infant, Newborn, Infant, 11 Medical And Health Sciences, Middle Aged, TRENDS, PREVENTION, PREVALENCE, ALZHEIMERS-DISEASE, INDIVIDUALS, 3121 General medicine, internal medicine and other clinical medicine, Child, Preschool, REGISTRATION, Female, Human medicine, Human
Abstract: Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.
Published: 2018

28. Pathogens don't respect politicians: US federal disruption poses a new threat to global public health.

Author: Wang S, Harrington M, Graham CS, Downs LO, Kagwanja N, Etyang AO, Iwuji C, Ndung'u T, Cowie BC, Kabagambe K, and Matthews PC
Abstract: Competing Interests: We write this statement in a personal capacity and not on behalf of our institutes. PCM receives core funding from The Francis Crick Institute (ref CC2223) and University College London Biomedical Research Centre, and has received previous funding for a student in her group from GSK, which is unrelated to this current work, reimbursement for expenses from WHO to attend advisory board meetings, and publishing royalties from Oxford University Press. KK declares funding support for the National Organisation for People Living with Hepatitis B from Abbott, GSK, Gilead Sciences, and the Hepatitis B Foundation. SW has received grant support from Gilead paid to her institution, speaking honorarium from PRIME and Peerview paid to her institution, and has received reimbursement from WHO for expenses to attend committee meetings. CI has received funding from Gilead for investigator-sponsored research paid to his institution. TN has received Gilead funding and honoraria from Gilead for investigator-sponsored research and presentations and sits on the HIV cure advisory board for Gilead Sciences and a scientific advisory panel for MATRIX. BCC has received reimbursement from WHO for travel provided to attend official WHO committee and advisory group meetings, and funding from The Royal Melbourne Hospital to attend conferences, and is an unpaid member of the board of directors of ASHM Health (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine). All other authors declare no competing interests.
Published: 2025
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29. Uptake of guideline-based testing for chronic viral hepatitis in Australian primary care: retrospective analysis of electronic medical record data.

Author: MacLachlan JH, Allard N, Tran L, Savage A, Adamson E, Price V, Pearce C, Dore GJ, and Cowie BC
Subjects: Humans, Retrospective Studies, Female, Male, Middle Aged, Adult, Victoria epidemiology, Hepatitis C, Chronic diagnosis, Hepatitis C, Chronic epidemiology, Aged, Practice Guidelines as Topic, Adolescent, Risk Factors, Guideline Adherence statistics & numerical data, Young Adult, Mass Screening methods, Primary Health Care statistics & numerical data, Electronic Health Records, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic epidemiology
Abstract: Background Diagnosis is essential for engagement in care for chronic hepatitis B (CHB) and chronic hepatitis C (CHC), however, many Australians remain undiagnosed, especially for CHB. Primary care represents an important setting for testing, and this study sought to examine coverage in a large representative cohort of patients. Methods We analysed retrospective data from the electronic medical records of active patients visiting 566 primary care clinics in Victoria, Australia. Pathology records were assessed to identify the proportion of patients with a record of CHB/CHC serology testing based on risk factors identified in national guidelines (ethnicity, Indigenous status, history of injecting drug use, diagnosed HIV, and/or indications of liver disease). Results Of 1,593,774 patients, 393,948 (24.7%) had an indication for testing for CHB and/or CHC, of which 150,821 (38.3%) had evidence of testing. This proportion was highest in patients with HIV (65.6%) or injecting drug use history (60.0%), and lowest for those whose Indigenous status/ethnicity indicated testing (38.2%) or with elevated liver enzymes (39.1%). The proportion with evidence of testing was only moderate among those with a cirrhosis diagnosis (48.6%) or probable cirrhosis based on laboratory testing (50.6%). Conclusions This analysis demonstrated considerable gaps in testing for CHB and CHC in a large population of patients, including many with evidence of cirrhosis, suggesting higher risk of adverse outcomes. Primary care practices should be supported to comprehensively offer testing for viral hepatitis, particularly where there is evidence of liver disease, and these findings should be used to guide future interventions.
Published: 2024
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30. Hepatitis B clinical care provision in pregnancy: A whole-of-population linkage study in Victoria, Australia.

Author: MacLachlan JH, Romero N, Allard N, Rowe SL, and Cowie BC
Subjects: Humans, Female, Pregnancy, Adult, Victoria epidemiology, Antiviral Agents therapeutic use, Young Adult, Infectious Disease Transmission, Vertical prevention & control, Infectious Disease Transmission, Vertical statistics & numerical data, Cohort Studies, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious diagnosis, Viral Load, Hepatitis B, Chronic epidemiology, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic drug therapy, Hepatitis B, Chronic transmission
Abstract: Background and Aim: Pregnancy is a key setting for engagement in chronic hepatitis B (CHB) care, due to the implications for transmission to the infant and antenatal diagnosis representing an opportunity for ongoing follow-up. This study aimed to identify the coverage and predictors of clinical care for women with CHB during and after pregnancy in a population-level cohort., Methods: Notified CHB cases in Victoria, Australia, were linked with hospitalizations, medical services, and prescribing data, covering the period 1991-2018. Women with an admission for a live birth were identified and services provided during pregnancy were assessed, including general practitioner (GP) or specialist visits, viral load and serology testing, and antiviral treatment. Viral load and serology testing coverage ware also assessed for the 2-year period following pregnancy. Demographic and clinical predictors of viral load testing during pregnancy were assessed., Results: A total of 11 015 birth events occurred for 6090 women with CHB. During pregnancy most had a GP consultation (91.6%); however, only 39.5% had viral load testing and 41.4% had a gastroenterology or infectious diseases specialist consultation. Viral load testing and serology testing in the 2 years after pregnancy occurred in approximately half (47.9% and 52.2%, respectively) with increases over time. Viral load testing was more likely in those born overseas, those with more than one previous birth, and those living in Melbourne., Conclusions: Despite improvements over time, key gaps were identified in the provision of CHB clinical care during and after pregnancy, with implications for ongoing transmission and adverse outcomes., (© 2024 The Author(s). Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Published: 2024
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31. A pilot project harnessing surveillance systems to support clinicians providing clinical care for people diagnosed with hepatitis C in Victoria, Australia, September 2021 to 31 March 2022.

Author: Abbott M, MacLachlan JH, Romero N, Matthews N, Higgins N, Lee A, Stoove M, Marukutira T, Quinn B, Allard NL, and Cowie BC
Subjects: Humans, Pilot Projects, Male, Female, Middle Aged, Adult, Victoria, Disease Notification, Aged, Hepacivirus isolation & purification, Hepacivirus genetics, Population Surveillance methods, Contact Tracing methods, Hepatitis C, Chronic diagnosis, Hepatitis C diagnosis
Abstract: BackgroundActive follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination.AimThis pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification.MethodsFor notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand.ResultsOf 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians.ConclusionsMost doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.
Published: 2024
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32. The cascade of care for hepatitis C in Victoria, Australia: a data linkage cohort study.

Author: Snow K, MacLachlan JH, Rowe S, Higgins N, and Cowie BC
Subjects: Humans, Female, Male, Middle Aged, Victoria epidemiology, Adult, Aged, Cohort Studies, Longitudinal Studies, Registries, Young Adult, Information Storage and Retrieval, Antiviral Agents therapeutic use, Adolescent, Hepatitis C, Chronic epidemiology, Hepatitis C, Chronic drug therapy, Health Services Accessibility, Hepatitis C epidemiology, Hepatitis C therapy, Hepatitis C drug therapy
Abstract: Background: Highly effective hepatitis C therapies are available in Australia. However, people living with hepatitis C face various barriers to accessing care and treatment., Aims: To identify gaps in the cascade of care for hepatitis C and generate estimates of the number living with untreated infection according to population group, using a representative longitudinal study population., Methods: We linked hepatitis C notification data from Victoria to national pathology, prescribing and death registry data. We assessed receipt of key clinical services in a large cohort who tested positive for hepatitis C from 1 January 2000 to 31 December 2016, with follow-up to 30 June 2018. We estimated the number still living with hepatitis C, adjusting for spontaneous clearance and mortality., Results: The cohort comprised 45 391 people positive for hepatitis C. Of these, 13 346 (29%) received treatment and an estimated 28% (95% confidence interval (CI): 26-30%) were still living with chronic infection at 30 June 2018, with the remainder still living following spontaneous clearance (30%, 95% CI: 29-32%) or having died (12%, 95% CI: 12-12%). Half (50%) of those still living with hepatitis C were born from 1965 to 1980, and 74% first tested positive before 2011., Conclusions: Despite an enabling policy environment and subsidised therapy, many people in this cohort were not treated. Increased measures may be needed to engage people in care, including those who acquired hepatitis C more than 10 years ago., (© 2024 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)
Published: 2024
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33. Australian vaccine preventable disease epidemiological review series: Hepatitis B, 2000-2019.

Author: Sonneveld N, Jackson J, Dey A, Lambert SB, Clark KK, Cowie BC, Macartney K, and Beard F
Subjects: Adult, Australia epidemiology, Disease Notification statistics & numerical data, Child, Preschool, Humans, Australasian People, Vaccination statistics & numerical data, Middle Aged, Hospitalization statistics & numerical data, Male, Young Adult, Adolescent, Immunization Programs, Infant, Newborn, Infant, Child, Female, Australian Aboriginal and Torres Strait Islander Peoples, Aged, Hepatitis B epidemiology, Hepatitis B prevention & control, Hepatitis B Vaccines administration & dosage
Abstract: Introduction: Hepatitis B vaccination was nationally funded for adolescents in 1996, with inclusion of universal infant immunisation under the National Immunisation Program (NIP) in May 2000. This study describes hepatitis B epidemiology in Australia in the two decades since 2000., Methods: This article analyses newly-acquired (within the prior 24 months) and unspecified (all other) hepatitis B notifications (2000-2019) from the National Notifiable Diseases Surveillance System; acute hepatitis B hospitalisations (2001-2019) from the National Hospital Morbidity Database; and acute (2000-2019) and chronic (2006-2019) hepatitis B deaths from the Australian Bureau of Statistics and Australian Coordinating Registry. Rates over the reporting period were described overall, and by age group, sex, and Aboriginal and Torres Strait Islander status (Aboriginal and/or Torres Strait Islander versus other [neither Aboriginal nor Torres Strait Islander, unknown or not stated]). Trend analyses were performed using Poisson or negative binomial regression. Additional analyses were performed for the cohort born after May 2000., Results and Discussion: The annual all-age notification rate per 100,000 per year declined (p < 0.001) from 2.13 in 2000 to 0.65 in 2019 for newly-acquired hepatitis B and from 38.3 to 22.3 for unspecified hepatitis B (likely to predominantly represent chronic hepatitis B). Newly-acquired and unspecified hepatitis B notification rates were lowest among children aged < 15 years. The most substantial reductions in notification rates of newly-acquired hepatitis B were among adolescents aged 15-19 years and young adults aged 20-24 and 25-29 years (respectively 17-, 11-, and 7-fold); these age groups also recorded the most substantial reductions in unspecified hepatitis B notifications (respectively 5-, 3.5-, and 2-fold). Newly-acquired hepatitis B notification and acute hepatitis B mortality rates were two- to threefold higher in males than females. The all-age newly-acquired hepatitis B notification rate in Aboriginal and Torres Strait Islander people decreased twofold between 2000 and 2019, but remained threefold higher than in other people. Acute hepatitis B hospitalisations also declined over the study period (p < 0.001) and followed similar patterns. There were no acute or chronic hepatitis B deaths among people born after May 2000; this cohort featured 52 newly-acquired and 887 unspecified hepatitis B notifications. Due to lack of data on country of birth (and hence eligibility for infant vaccination under the NIP or overseas programs), vaccination status and likely transmission routes, we were unable to assess factors contributing to these potentially preventable infections., Conclusion: Adolescent and infant immunisation under the NIP has led to significant reductions in notification rates of newly-acquired hepatitis B, and in acute hepatitis B hospitalisation rates, both overall and in Aboriginal and Torres Strait Islander people. Unspecified hepatitis B notification rates have also greatly decreased in children and young adults, likely largely due to the impact of overseas infant immunisation programs on prevalence in child and adolescent migrants. Work to improve completeness of variables within national datasets is crucial, along with enhanced surveillance of both newly-acquired and unspecified hepatitis B cases to investigate transmission routes, vaccination status and factors contributing to acquisition of hepatitis B, in order to optimise the impact of immunisation programs and ensure linkage with care., (© Commonwealth of Australia CC BY-NC-ND.)
Published: 2024
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34. Vaccination coverage among people who inject drugs: A systematic review.

Author: Price O, Swanton R, Grebely J, Hajarizadeh B, Webb P, Peacock A, Dore GJ, Cowie BC, Vickerman P, and Degenhardt L
Subjects: Humans, Vaccination statistics & numerical data, COVID-19 prevention & control, Global Health, Vaccination Coverage statistics & numerical data, Substance Abuse, Intravenous
Abstract: Background: People who inject drugs may be at excess risk of acquiring vaccine-preventable diseases and negative associated health outcomes, but experience barriers to vaccination. We aimed to determine vaccination coverage among people who inject drugs globally., Methodology: We conducted systematic searches of the peer-reviewed and grey literature, date limited from January 2008 to August 2023, focusing on diseases for which people who inject drugs are at elevated risk for and for which an adult vaccination dose is recommended (COVID-19, hepatitis A, hepatitis B, human papillomavirus, influenza, pneumococcal disease, tetanus). To summarise available data, we conducted a narrative synthesis., Results: We included 78 studies/reports comprising 117 estimates of vaccination coverage across 36 countries. Most estimates were obtained from high income countries (80%, n=94). We located estimates for hepatitis B vaccination in 33 countries, which included 18 countries with data on serological evidence of vaccine-derived hepatitis B immunity (range: 6-53%) and 22 countries with self-report data for vaccine uptake (<1-96%). Data for other vaccines were scarcer: reported hepatitis A vaccination coverage ranged 3-89% (five countries), COVID-19 ranged 4-84% (five countries), while we located estimates from fewer than five countries for influenza, tetanus, pneumococcal disease, and human papillomavirus., Conclusion: Estimates were sparse but where available indicative of suboptimal vaccination coverage among people who inject drugs. Improving the consistency, timeliness, and geographic coverage of vaccine uptake data among this population is essential to inform efforts to increase uptake., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: In the past 3 years, LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior and Seqirus. AP has received investigator-initiated untied educational grants from Seqirus. JG is a consultant or advisor and has received research grants from AbbVie, Abbott, bioLytical, Camurus, Cepheid, Gilead Sciences, Hologic, Indivior, and Roche. GJD has received research grants from AbbVie and Gilead Sciences. These companies and organisations had no knowledge of or role in the design, conduct, interpretation, or publication of these findings. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Published: 2024
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35. Effectiveness of community-based oral antiviral treatments against severe COVID-19 outcomes in people 70 years and over in Victoria, Australia, 2022: an observational study.

Author: Van Heer C, Majumdar SS, Parta I, Martinie M, Dawson R, West D, Hewett L, Lister D, Sutton B, O'Brien DP, and Cowie BC
Abstract: Background: Oral Antiviral (OAV) COVID-19 treatments are widely used, but evidence for their effectiveness against the Omicron variant in higher risk, vaccinated individuals is limited., Methods: Retrospective study of two vaccinated cohorts of COVID-19 cases aged ≥70 years diagnosed during a BA.4/5 Omicron wave in Victoria, Australia. Cases received either nirmatrelvir-ritonavir or molnupiravir as their only treatment. Data linkage and logistic regression modelling was used to evaluate the association between treatment and death and hospitalisation and compared with no treatment., Findings: Of 38,933 individuals in the mortality study population, 13.5% (n = 5250) received nirmatrelvir-ritonavir, 51.3% (n = 19,962) received molnupiravir and 35.2% (n = 13,721) were untreated. Treatment was associated with a 57% (OR = 0.43, 95% CI 0.36-0.51) reduction in the odds of death, 73% (OR = 0.27, 95% CI 0.17-0.40) for nirmatrelvir-ritonavir and 55% (OR = 0.45, 95% CI 0.38-0.54) for molnupiravir. Treatment was associated with a 31% (OR = 0.69, 95% CI 0.55-0.86) reduction in the odds of hospitalisation, 40% (OR = 0.60, 95% CI 0.43-0.83) for nirmatrelvir-ritonavir and 29% (OR = 0.71, 95% CI 0.58-0.87) for molnupiravir. Cases treated within 1 day of diagnosis had a 61% reduction in the odds of death (OR = 0.39, 95% CI 0.33-0.46) compared with 33% reduction for a delay of 4 or more days (OR = 0.67, 95% CI 0.44-0.97)., Interpretation: Treatment with both nirmatrelvir-ritonavir or molnupiravir was associated with a reduction in death and hospitalisation in vaccinated ≥70 years individuals during the Omicron era. Timely, equitable treatment with OAVs is an important tool in the fight against COVID-19., Funding: There was no funding for this study., Competing Interests: No conflicts of interest or relevant disclosures existed for the authors., (Crown Copyright © 2023 Published by Elsevier Ltd.)
Published: 2023
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36. Excess mortality among people with communicable diseases over a 30-year period, Victoria, Australia: a whole of population cohort study.

Author: Rowe SL, Leder K, Sundaresan L, Wollersheim D, Lawrie J, Stephens N, Cowie BC, Nolan TM, and Cheng AC
Abstract: Background: Understanding mortality burden associated with communicable diseases is key to informing resource allocation, disease prevention and control efforts, and evaluating public health interventions. We quantified excess mortality among people notified with communicable diseases in Victoria, Australia., Methods: Cases of communicable disease notified in Victoria between 1 January 1991 and 31 December 2021 were linked to the death registry. Informational gain obtained through linkage and 30-day case fatality rates were calculated for each disease. Standardised mortality ratios (SMR) and 95% confidence intervals were calculated up to a year following illness onset., Findings: There were 1,032,619 cases and 5985 (0.58%) died ≤30 days of illness onset. Following linkage, the 30-day case fatality rate increased more than 2-fold. Diseases with high 7-day SMR signifying excess mortality included invasive pneumococcal disease (167.7, 95% CI 153.4-182.7); listeriosis (166.2, 95% CI 121.2-218.3); invasive meningococcal disease (145.9, 95% CI 116.7-178.3); legionellosis (43.3, 95% CI 28.0-62.0); and COVID-19 (21.9, 95% CI 19.7-24.3). Most diseases exhibited a strong negative gradient, with high SMRs in the first 7-days of illness onset that reduced over time., Interpretation: We demonstrated that the rate of death in Victoria's notifiable disease surveillance dataset is underestimated. Further, compared to a general population, there is evidence of elevated all-cause mortality among people notified with communicable diseases often up to one year following illness onset. Not all elevated risk is likely directly attributable to the communicable diseases of interest, rather, it may reflect underlying comorbidities or behaviours in these individuals. Regardless of attribution, infection with communicable diseases may represent a marker of mortality. Key to preventing deaths may be through timely and appropriate transition to primary and preventive healthcare following diagnosis., Funding: No funding was provided for this study., Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. TN has clinical trial contracts that provide institutional (not personal) payments to the Murdoch Childrens Research Institute and the University of Melbourne outside submitted work relating to sponsored vaccine trials of several different vaccines by Moderna, Sanofi, Seqirus, Iliad, Dynavax, and GSK. TN is a member of COVID-19, Respiratory Syncytial Virus and influenza vaccines clinical trial committees conducted by Moderna, SKBio Korea, Clover (PRC), and Emergent Biotech, outside submitted work., (© 2023 The Authors.)
Published: 2023
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37. Access to oral COVID-19 antivirals in the community: are eligibility criteria and systems ensuring equity?

Author: Allard NL, Canevari J, Haslett N, and Cowie BC
Subjects: Humans, Antiviral Agents therapeutic use, Health Services Accessibility, COVID-19, Health Equity
Published: 2023
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38. Missed opportunities for diagnosis of hepatitis B and C in individuals diagnosed with decompensated cirrhosis or hepatocellular carcinoma.

Author: Mnatzaganian G, MacLachlan JH, Allard N, Brown C, Rowe S, and Cowie BC
Subjects: Humans, Hepatitis B virus, Hepacivirus, Liver Cirrhosis diagnosis, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular etiology, Carcinoma, Hepatocellular pathology, Liver Neoplasms diagnosis, Liver Neoplasms etiology, Liver Neoplasms pathology, Hepatitis B complications, Hepatitis B diagnosis, Hepatitis C complications, Hepatitis C diagnosis
Abstract: Background and Aim: This study aimed to assess utilization of health-care services in people with decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) and a "late diagnosis" of hepatitis B or hepatitis C., Methods: Hepatitis B and C cases during 1997-2016 in Victoria, Australia, were linked with hospitalizations, deaths, liver cancer diagnoses, and medical services. A late diagnosis was defined as hepatitis B or hepatitis C notification occurring after, at the same time, or within 2 years preceding an HCC/DC diagnosis. Services provided during the 10-year period before HCC/DC diagnosis were assessed, including general practitioner (GP) or specialist visits, emergency department presentations, hospital admissions, and blood tests., Results: Of the 25 766 notified cases of hepatitis B, 751 (2.9%) were diagnosed with HCC/DC, and hepatitis B was diagnosed late in 385 (51.3%). Of 44 317 cases of hepatitis C, 2576 (5.8%) were diagnosed with HCC/DC, and hepatitis C was diagnosed late in 857 (33.3%). Although late diagnosis dropped over time, missed opportunities for timely diagnosis were observed. Most people diagnosed late had visited a GP (97.4% for hepatitis B, 98.9% for hepatitis C) or had a blood test (90.9% for hepatitis B, 88.6% for hepatitis C) during the 10 years before HCC/DC diagnosis. The median number of GP visits was 24 and 32, and blood tests 7 and 8, for hepatitis B and C, respectively., Conclusions: Late diagnosis of viral hepatitis remains a concern, with the majority having frequent health-care service provision in the preceding period, indicating missed opportunities for diagnosis., (© 2023 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Published: 2023
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39. Universal testing for hepatitis B must be accompanied by better linkage with care.

Author: Tran L and Cowie BC
Subjects: Humans, Hepatitis B virus, Hepatitis B
Published: 2023
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40. Modelling jurisdictional disparities in the cascade of care for chronic hepatitis B in Australia: impact of treatment uptake on mortality.

Author: McCulloch K, Romero N, Allard N, MacLachlan JH, and Cowie BC
Subjects: Aged, Humans, National Health Programs, New South Wales, Northern Territory, Tasmania, Hepatitis B, Chronic epidemiology, Hepatitis B, Chronic therapy, Hepatitis B, Chronic diagnosis
Abstract: Objective: Investigate the cascade of care for chronic hepatitis B (CHB) and estimate impacts of increasing treatment uptake on attributable burden, according to jurisdiction., Methods: A mathematical model of CHB in Australia was utilised, combined with notifiable disease and Medicare data. We estimated the proportion with CHB who were diagnosed, engaged in care and receiving treatment in each state/territory, and projected future mortality., Results: The highest uptake of all measures was in New South Wales, however, the largest increase over time occurred in Northern Territory. No jurisdiction is due to meet 2022 targets of treatment uptake or mortality reduction. Previously declining mortality is predicted to plateau or increase in all jurisdictions except Northern Territory. The largest gap in the cascade of care was most commonly diagnosed individuals not engaged in care; however, in Victoria and Tasmania it was lack of diagnosis., Conclusions: Measures of the cascade of care varied substantially between jurisdictions; while all require improvements to reduce mortality, the specific gaps vary, as do potential impacts., Implications for Public Health: Improving the cascade of care for CHB will require jurisdictionally tailored approaches. If improvements are not made, more deaths will occur due to CHB in most states and territories., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
Published: 2023
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41. Associations between COVID-19 and hospitalisation with respiratory and non-respiratory conditions: a record linkage study.

Author: Rowe SL, Leder K, Dyson K, Sundaresan L, Wollersheim D, Lynch B, Abdullahi I, Cowie BC, Stephens N, Nolan TM, Sullivan SG, Sutton B, and Cheng AC
Subjects: Humans, COVID-19 Vaccines, SARS-CoV-2, Hospitalization, COVID-19 epidemiology, Myocardial Infarction
Abstract: Objectives: To assess associations between SARS-CoV-2 infection and the incidence of hospitalisation with selected respiratory and non-respiratory conditions in a largely SARS-CoV-2 vaccine-naïve population ., Design, Setting, Participants: Self-control case series; analysis of population-wide surveillance and administrative data for all laboratory-confirmed COVID-19 cases notified to the Victorian Department of Health (onset, 23 January 2020 - 31 May 2021; ie, prior to widespread vaccination rollout) and linked hospital admissions data (admission dates to 30 September 2021)., Main Outcome Measures: Hospitalisation of people with acute COVID-19; incidence rate ratios (IRRs) comparing incidence of hospitalisations with defined conditions (including cardiac, cerebrovascular, venous thrombo-embolic, coagulative, and renal disorders) from three days before to within 89 days of onset of COVID-19 with incidence during baseline period (60-365 days prior to COVID-19 onset)., Results: A total of 20 594 COVID-19 cases were notified; 2992 people (14.5%) were hospitalised with COVID-19. The incidence of hospitalisation within 89 days of onset of COVID-19 was higher than during the baseline period for several conditions, including myocarditis and pericarditis (IRR, 14.8; 95% CI, 3.2-68.3), thrombocytopenia (IRR, 7.4; 95% CI, 4.4-12.5), pulmonary embolism (IRR, 6.4; 95% CI, 3.6-11.4), acute myocardial infarction (IRR, 3.9; 95% CI, 2.6-5.8), and cerebral infarction (IRR, 2.3; 95% CI, 1.4-3.9)., Conclusion: SARS-CoV-2 infection is associated with higher incidence of hospitalisation with several respiratory and non-respiratory conditions. Our findings reinforce the value of COVID-19 mitigation measures such as vaccination, and awareness of these associations should assist the clinical management of people with histories of SARS-CoV-2 infection., (© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)
Published: 2023
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42. Australian consensus recommendations for the management of hepatitis B.

Author: Lubel JS, Strasser SI, Thompson AJ, Cowie BC, MacLachlan J, Allard NL, Holmes J, Kemp WW, Majumdar A, Iser D, Howell J, and Matthews GV
Subjects: Antiviral Agents therapeutic use, Australia epidemiology, Consensus, Female, Hepatitis B virus, Humans, Infectious Disease Transmission, Vertical prevention & control, Liver Cirrhosis diagnosis, Liver Cirrhosis etiology, Liver Cirrhosis prevention & control, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular epidemiology, Carcinoma, Hepatocellular etiology, Hepatitis B diagnosis, Hepatitis B drug therapy, Hepatitis B epidemiology, Hepatitis B, Chronic diagnosis, Hepatitis B, Chronic drug therapy, Hepatitis B, Chronic epidemiology, Liver Neoplasms diagnosis, Liver Neoplasms epidemiology, Liver Neoplasms prevention & control
Abstract: Introduction: The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC)., Main Recommendations: This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis., Change in Management as a Result of This Guideline: These recommendations aim to raise awareness of the current management of hepatitis B in Australia. Critically, the timely identification of individuals living with hepatitis B, and where appropriate, commencement of antiviral therapy, can prevent the development of cirrhosis, HCC and mother-to-child transmission as well as hepatitis B reactivation in immunocompromised individuals. Recognising patient and viral factors that predispose to the development of cirrhosis and HCC will enable clinicians to risk-stratify and appropriately implement surveillance strategies to prevent these complications of hepatitis B., (© 2022 AMPCo Pty Ltd.)
Published: 2022
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43. The COVID Positive Pathway: a collaboration between public health agencies, primary care, and metropolitan hospitals in Melbourne.

Author: Lim SM, Allard NL, Devereux J, Cowie BC, Tydeman M, Miller A, Ho K, Cleveland B, Singleton L, Aarons K, Eleftheriou P, Chan T, Braitberg G, and Maier A
Subjects: Adult, Cohort Studies, Hospitals, Urban, Humans, Primary Health Care, Public Health, COVID-19 epidemiology, COVID-19 therapy
Abstract: Objectives: To assess the capacity of the COVID Positive Pathway, a collaborative model of care involving the Victorian public health unit, hospital services, primary care, community organisations, and the North Western Melbourne Primary Health Network, to support people with coronavirus disease 2019 (COVID-19) isolating at home., Design, Setting, Participants: Cohort study of adults in northwest Melbourne with COVID-19, 3 August - 31 December 2020., Main Outcome Measures: Demographic and clinical characteristics, and social and welfare needs of people cared for in the Pathway, by care tier level., Results: Of 1392 people referred to the Pathway by the public health unit, 858 were eligible for enrolment, and 711 consented to participation; 647 (91%) remained in the Pathway until they had recovered and isolation was no longer required. A total of 575 participants (81%) received care in primary care, mostly from their usual general practitioners; 155 people (22%) received care from hospital outreach services, and 64 (9%) needed high tier care (hospitalisation). Assistance with food and other basic supplies was required by 239 people in the Pathway (34%)., Conclusions: The COVID Positive Pathway is a feasible multidisciplinary, tiered model of care for people with COVID-19. About 80% of participants could be adequately supported by primary care and community organisations, allowing hospital services to be reserved for people with more severe illness or with risk factors for disease progression. The principles of this model could be applied to other health conditions if regulatory and funding barriers to information-sharing and care delivery by health care providers can be overcome., (© 2022 AMPCo Pty Ltd.)
Published: 2022
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44. Performance of hospital-based contact tracing for COVID-19 during Australia's second wave.

Author: Bailie CR, Leung VK, Orr E, Singleton E, Kelly C, Buising KL, Cowie BC, Kirk MD, Sullivan SG, and Marshall C
Subjects: Hospitals, Humans, Quarantine, SARS-CoV-2, COVID-19, Contact Tracing
Abstract: Background: Hospital-based contact tracing aims to limit spread of COVID-19 within healthcare facilities. In large outbreaks, this can stretch resources and workforce due to quarantine of uninfected staff. We analysed the performance of a manual contact tracing system for healthcare workers (HCW) at a multi-site healthcare facility in Melbourne, Australia, from June-September 2020, during an epidemic of COVID-19., Methods: All HCW close contacts were quarantined for 14 days, and tested around day 11, if not already diagnosed with COVID-19. We examined the prevalence and timing of symptoms in cases detected during quarantine, described this group as proportions of all close contacts and of all cases, and used logistic regression to assess factors associated with infection., Results: COVID-19 was diagnosed during quarantine in 52 furloughed HCWs, from 483 quarantine episodes (11%), accounting for 19% (52/270) of total HCW cases. In 361 exposures to a clear index case, odds of infection were higher after contact with an infectious patient compared to an infectious HCW (aOR: 4.69, 95% CI: 1.98-12.14). Contact with cases outside the workplace increased odds of infection compared to workplace contact only (aOR: 7.70, 95% CI: 2.63-23.05). We estimated 30%, 78% and 95% of symptomatic cases would develop symptoms by days 3, 7, and 11 of quarantine, respectively., Conclusion: In our setting, hospital-based contact tracing detected and contained a significant proportion of HCW cases, without excessive quarantine of uninfected staff. Effectiveness of contact tracing is determined by a range of dynamic factors, so system performance should be monitored in real-time., (Copyright © 2021 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)
Published: 2022
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45. The price tag of a potential cure for chronic hepatitis B infection: A cost threshold analysis for USA, China and Australia.

Author: Toy M, Hutton D, McCulloch K, Romero N, Revill PA, Penicaud MC, So S, and Cowie BC
Subjects: Antiviral Agents, Australia, China epidemiology, Cost-Benefit Analysis, Humans, Carcinoma, Hepatocellular drug therapy, Hepatitis B drug therapy, Hepatitis B, Chronic drug therapy, Liver Neoplasms drug therapy
Abstract: Background & Aims: We aim to capture the economic impact of a potential cure for chronic hepatitis B infection (CHB) in three countries (USA, China and Australia) with different health systems and epidemics to estimate the threshold drug prices below which a CHB cure would be cost-saving and/or highly cost-effective., Methods: We simulated patients' hepatitis B progression, under three scenarios: current long-term suppressive antiviral therapy, functional cure defined as sustained undetectable HBsAg and HBV DNA, and partial cure defined as sustained undetectable HBV DNA only after a finite, 48-week treatment., Results: Compared with current long-term antiviral therapy, a 30% effective functional cure among patients with and without cirrhosis in the USA, China and Australia would yield 17.50, 17.32 and 20.42 QALYs per patient, and 20.61, 20.42 and 20.62 QALYs per patient respectively. In financial terms, for CHB patients with and without cirrhosis, this would be cost-saving at a one-time treatment cost under US$11 944 and US$6694, respectively, in the USA, US$1744 and US$1001 in China, and US$12 063 and US$10 983 in Australia., Conclusion: We show that in purely economic terms, a CHB cure will be highly cost-effective even if effective in only 30% of treated patients. The threshold price for cure is largely determined by the current antiviral drug costs, since it will replace a daily antiviral pill that is inexpensive and effective, although not curative. The likely need for combination therapies to achieve cure will also present cost challenges. While cost-effectiveness is important, it cannot be the only consideration, as cure will provide many benefits in addition to reduced liver disease and HCC, including eliminating the need for a long-term daily pill and reducing stigma often associated with chronic viral infection., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Published: 2022
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46. Maternal Vaccination and Infant Influenza and Pertussis.

Author: Rowe SL, Leder K, Perrett KP, Romero N, Nolan TM, Stephens N, Cowie BC, and Cheng AC
Subjects: Adult, Cohort Studies, Diphtheria-Tetanus-acellular Pertussis Vaccines, Female, Humans, Infant, Infant, Newborn, Influenza Vaccines, Parturition, Pregnancy, Pregnancy Complications, Infectious prevention & control, Pregnant People, Vaccination statistics & numerical data, Victoria, Whooping Cough prevention & control, Influenza, Human prevention & control, Pertussis Vaccine immunology
Abstract: Background and Objectives: Infant influenza and pertussis disease causes considerable morbidity and mortality worldwide. We examined the effectiveness of maternal influenza and pertussis vaccines in preventing these diseases in infants., Methods: This inception cohort study comprised women whose pregnancies ended between September 1, 2015, and December 31, 2017, in Victoria, Australia. Maternal vaccination status was sourced from the Victorian Perinatal Data Collection and linked to 5 data sets to ascertain infant outcomes and vaccination. The primary outcome of interest was laboratory-confirmed influenza or pertussis disease in infants aged <2 months, 2 to <6 months, and <6 months combined. Secondary outcomes included infant hospitalization (emergency presentation or admission) and death. Risk ratios and 95% confidence intervals (CIs) were estimated by Poisson regression. Vaccine effectiveness (VE) was estimated as (1 minus the risk ratio) x 100%., Results: Among 186 962 pregnant women, 85 830 (45.9%) and 128 060 (68.5%) were vaccinated against influenza and pertussis, respectively. There were 175 and 51 infants with laboratory-confirmed influenza and pertussis disease, respectively. Influenza VE was 56.1% (95% CI, 23.3% to 74.9%) for infants aged <2 months and 35.7% (2.2% to 57.7%) for infants aged 2 to <6 months. Pertussis VE was 80.1% (95% CI, 37.1% to 93.7%) for infants aged <2 months and 31.8% (95% CI, -39.1% to 66.6%) for infants aged 2 to <6 months., Conclusions: Our study provides evidence of the direct effectiveness of maternal influenza and pertussis vaccination in preventing these diseases in infants aged <2 months. The findings strengthen the importance of maternal vaccination to prevent these diseases in infants., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)
Published: 2021
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47. Time for universal hepatitis B screening for Australian adults.

Author: Allard NL, MacLachlan JH, Tran L, Yussf N, and Cowie BC
Subjects: Adult, Aged, Antiviral Agents administration & dosage, Antiviral Agents economics, Antiviral Agents therapeutic use, Australia epidemiology, Cost of Illness, Cost-Benefit Analysis, Fibrosis economics, Fibrosis epidemiology, Fibrosis prevention & control, Health Services Accessibility standards, Hepatitis B epidemiology, Hepatitis B prevention & control, Hepatitis B Vaccines administration & dosage, Hepatitis B Vaccines therapeutic use, Humans, Liver Neoplasms economics, Liver Neoplasms epidemiology, Liver Neoplasms prevention & control, Mass Screening standards, Mass Screening statistics & numerical data, Middle Aged, Practice Guidelines as Topic, Prevalence, Health Services Accessibility legislation & jurisprudence, Hepatitis B diagnosis, Mass Screening methods
Published: 2021
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48. A hospital-wide response to multiple outbreaks of COVID-19 in health care workers: lessons learned from the field.

Author: Buising KL, Williamson D, Cowie BC, MacLachlan J, Orr E, MacIsaac C, Williams E, Bond K, Muhi S, McCarthy J, Maier AB, Irving L, Heinjus D, Kelly C, and Marshall C
Subjects: Adult, Australia epidemiology, COVID-19 prevention & control, Cross Infection epidemiology, Cross Infection prevention & control, Female, Hospital Departments, Hospitals, University, Humans, Infection Control methods, Infectious Disease Transmission, Patient-to-Professional prevention & control, Male, Occupational Diseases prevention & control, SARS-CoV-2, COVID-19 transmission, Infectious Disease Transmission, Patient-to-Professional statistics & numerical data, Occupational Diseases epidemiology, Personnel, Hospital
Published: 2021
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49. Early Spread of SARS-CoV-2 in the Icelandic Population.

Author: Cowie BC and MacLachlan JH
Subjects: Humans, Iceland epidemiology, Pandemics, SARS-CoV-2, COVID-19, Coronavirus Infections epidemiology, Pneumonia, Viral epidemiology
Published: 2020
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50. Clinical presentation and management of COVID-19.

Author: Thevarajan I, Buising KL, and Cowie BC
Subjects: Age Factors, Antiviral Agents therapeutic use, Australia epidemiology, Betacoronavirus, COVID-19, Coronavirus Infections epidemiology, Humans, Immunologic Factors therapeutic use, Oxygen Inhalation Therapy, Pandemics, Pneumonia, Viral epidemiology, Risk Factors, SARS-CoV-2, Severity of Illness Index, Coronavirus Infections diagnosis, Coronavirus Infections therapy, Pneumonia, Viral diagnosis, Pneumonia, Viral therapy
Abstract: The rapid spread of severe acute respiratory syndrome coronavirus 2 led to the declaration of a global pandemic within 3 months of its emergence. The majority of patients presenting with coronavirus disease 2019 (COVID-19) experience a mild illness that can usually be managed in the community. Patients require careful monitoring and early referral to hospital if any signs of clinical deterioration occur. Increased age and the presence of comorbidities are associated with more severe disease and poorer outcomes. Treatment for COVID-19 is currently predominantly supportive care, focused on appropriate management of respiratory dysfunction. Clinical evidence is emerging for some specific therapies (including antiviral and immune-modulating agents). Investigational therapies for COVID-19 should be used in the context of approved randomised controlled trials. Australian clinicians need to be able to recognise, diagnose, manage and appropriately refer patients affected by COVID-19, with thousands of cases likely to present over the coming years., (© 2020 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)
Published: 2020
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