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A proposed mismatch between standard vaccines and the HBV\/C4 sub\u2010genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti\u2010HBs and anti\u2010HBc serology over repeated tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>100\u2009790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211\u2009802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti\u2010HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non\u2010Indigenous individuals living with CHB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross\u2010sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15069","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T14:27:07Z","timestamp":1601044027000},"page":"910-922","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-892X","authenticated-orcid":false,"given":"Ashleigh","family":"Qama","sequence":"first","affiliation":[{"name":"WHO Collaborating Centre for Viral Hepatitis Peter Doherty Institute for Infection and Immunity  Melbourne Victoria Australia"},{"name":"Department of Medicine (RMH) University of Melbourne, Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Allard","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Viral Hepatitis Peter Doherty Institute for Infection and Immunity  Melbourne Victoria Australia"},{"name":"Department of Medicine (RMH) University of Melbourne, Royal Melbourne Hospital  Parkville Victoria Australia"},{"name":"cohealth  Parkville Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Cowie","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Viral Hepatitis Peter Doherty Institute for Infection and Immunity  Melbourne Victoria Australia"},{"name":"Department of Medicine (RMH) University of Melbourne, Royal Melbourne Hospital  Parkville Victoria Australia"},{"name":"Victorian Infectious Diseases Service Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua S.","family":"Davis","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division Menzies School of Health Research  Darwin Northern Territory Australia"},{"name":"Division of Medicine John Hunter Hospital  Newcastle New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3843-837X","authenticated-orcid":false,"given":"Jane","family":"Davies","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division Menzies School of Health Research  Darwin Northern Territory Australia"},{"name":"The Infectious Diseases Department Royal Darwin Hospital  Darwin Northern Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)61412-X"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30579-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.2.36"},{"volume-title":"Viral Hepatitis Mapping Project: National Report 2017","year":"2019","author":"MacLachlan J","key":"e_1_2_7_5_1"},{"key":"e_1_2_7_6_1","first-page":"201","article-title":"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\u2010analysis","volume":"16","author":"Graham S","year":"2019","journal-title":"Sex Health"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0184082"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja13.11117"},{"key":"e_1_2_7_9_1","unstructured":"MacLachlanJ CowieBC.Hepatitis B mapping project: estimates of chronic hepatitis B prevalence and cultural and linguistic diversity by medicare local 2011\u2014National Report. 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