ORIGINAL ARTICLE B Alert: Hepatitis B virus infection in children in Victoria Gabriela Jimenez, 1,5 George Alex, 1,5 Georgia Paxton, 2,5 Thomas G Connell 2,3,5 and Winita Hardikar 1,4,5 Departments of 1 Gastroenterology and Clinical Nutrition, 2 General Medicine and 3 Infectious Diseases Unit, Royal Children’s Hospital Melbourne, 4 Department of Paediatrics, The University of Melbourne and 5 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia Aim: The aim of this study is to determine the demographic, clinical and serological patterns of hepatitis B in children in Victoria over a 17-year period. Methods: Retrospective analysis of medical records of all patients <18 years of age with positive hepatitis B surface antigen referred to the Gastroenterology, Immigrant Health and Infectious Diseases clinics between 1992 and 2009. Results: Of the 164 children identified, 76% were born overseas, with vertical transmission the most likely source in 84%. Most were asymp- tomatic, with no signs of chronic liver disease. Forty children infected with hepatitis B virus (HBV) were born in Australia prior to universal vaccination. There was poor documentation of vaccination or response to vaccination in siblings at risk within families where at least one child was infected. An increasing number of referrals was noted from 2006 to 2009 compared with the preceding 4 years (P < 0.001). Of an expected 200 follow-up visits from new referrals, 78% were attended. Conclusion: These findings suggest that the number of children with HBV in our population is increasing and that models of health care designed to integrate primary with specialist care are required to minimise the overall health care burden of this chronic infection. Key words: children; hepatitis B; immigrant health; vaccination. What is already known on this topic 1 Hepatitis B is a chronic, usually asymptomatic infection, in children. 2 Protection can be conferred by vaccination. 3 Chronic hepatitis B infection confers a risk of chronic liver disease, cirrhosis and hepatocellular carcinoma. What this paper adds 1 HBV infection should be looked for in children migrating from highly endemic areas. 2 Vaccination status and seroprotection should be confirmed in at-risk siblings of an index case. 3 Long-term follow-up is difficult to implement but important in detecting and treating complications of HBV infection. The perinatal transmission of hepatitis B virus (HBV) has sig- nificantly decreased with universal vaccination strategies in many countries that have implemented this policy. 1 Horizontal transmission may still occur in unimmunised children, particu- larly those transiting through refugee camps. Chronic HBV in children carries a risk of chronic liver disease, cirrhosis and hepatocellular carcinoma, and hence it is important that these children are identified to co-ordinate long-term follow-up care. In Australia, an estimated 160 000 people have chronic HBV infection 2 with the global burden estimated to be 350 million. 1 Recent migration patterns to Australia from highly endemic areas are believed to be the main factor associated with the increased prevalence of HBV in Australia. 3,4 In 2010, the Aus- tralian Government Department of Health and Ageing released a National Hepatitis B Strategy aimed at reducing the transmis- sion, morbidity, mortality and social impact of HBV, recognising the significant health burden of this chronic infection. Some of the key areas identified for further action included improve- ment in the level of awareness among primary care doctors and the development of models of care allowing appropriate refer- rals and management. 5 A priority action area was the need to define high-risk populations, assess their engagement with existing health-care facilities and determine methods to improve access to specialist health care, particularly for certain populations including children. There are limited data on the changing epidemiological, demographic and clinical characteristics of children infected with HBV in Australia. 2,6 We aimed to review the demographic characteristics and serological patterns of children infected with HBV infection referred to a single paediatric tertiary care centre over a 17-year period. Methods The medical records of patients less than 18 years of age with positive hepatitis B surface antigen (HBsAg) referred to the Royal Children’s Hospital (RCH) Gastroenterology, Infectious Correspondence: Dr Winita Hardikar, Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital Melbourne, Flemington Road, Parkville, Vic. 3052, Australia. Fax: +61 3 9345 6240; email: winita.hardikar@rch.org.au Conflict of interest: None declared. Accepted for publication 9 May 2012. doi:10.1111/jpc.12115 Journal of Paediatrics and Child Health 49 (2013) E213–E216 © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians) E213