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Hepatitis B Infections Among Refugees in Australia Assessment Answer

Assignment Topic: Hepatitis B Prevalence Among Refugees in Australia.

Format & word limits

Complete the assignment using the table template & headings below.

Word limit is 3000 words (excluding references & any template headings or instructions) and standard over-word limit penalties will apply. (If you use the entire template, subtract word count of 400 to account for assignment headings etc.).

(Note: subsection word limits are intended as a guide only, Word limits also indicate how marks will be distributed).

  • Use a plain font (Arial) in 11pt with either single or 1.5 spacing.


Assignments must be fully referenced in all sections using APA or Vancouver style. You should demonstrate appropriate research and synthesis of information from peer-reviewed or published literature. Relevance and accuracy of referencing is included in the marking of the assignment.

References should be in English and accessible by the markers (not local or Government reports unless available online and appropriately referenced)

Provide a brief summary of the disease you have chosen – filling in details in dot point format, or short paragraphs as appropriate in the table below

(~500 words, use cell sizes as a rough guide only to the relative amounts of detail required):

CharacteristicComments (dot points)
Infectious disease nameHepatitis B
‘Your setting’ (ie. the population you have chosen as the focus of this work)

Refuges in Australia
Causative agent(s)

(if no reservoir then this must be stated)

What is the global occurrence?
Incidence in the setting you have chosen
Prevalence in the setting you have chosen
Provide your opinion on the quality of incidence and prevalence data (give reasons for your answer)
Incubation period

What is the infectious period?
What are the transmission routes?
What other factors (e.g host or environment) may contribute to disease risk?
What is the case fatality risk?
(Give detail if the mortality risk varies according to specific situations)

Who are the people most at risk in the population?
Is the disease vaccine preventable?
What treatment is available?
(you do not need to provide detail, just identify whether there is a cure, or effective treatment to limit symptoms &/or infectious period)

  1. You learn from a public health official that there has been “an increase in cases” in your population of interest. What further questions would you need to ask this person (think of at least 5) in order to decide if this is an outbreak? Explain beside each question the exact information you are hoping to get and how you would use it. (250 words) (Eg: Q – Has this increase happened slowly over a long period of time or is it a very recent event? Reason: to learn if this is a gradual trend, or a localised outbreak that might signal the early signs of a much larger outbreak. I would use this to determine how quickly I must respond.)
  2. Briefly outline further investigations &/or analyses you might want to carry out to assess the situation (at least 4) and the specific question(s) these are designed to address. (250 words)
  3. You decide to interview some of the cases to find out more detail and to identify risk factors for this disease. List all the questions and response options you would include in a questionnaire. (Present the full questionnaire in dot point or questionnaire format, ~500 words)
  4. You decide that this increase in cases is real and requires a public health intervention. Assuming no restrictions on resources, what control measures would you recommend, and why? How would you implement them? You should use the peer-reviewed literature to support your answer. (1000 words)
  5. Discuss how successful do you think these control measures would be in your setting of interest. What would be the principle barriers to implementing these interventions in your population and how might you minimise those barriers? (500 words)


Hepatitis B infections among refugees in Australia 

  1. Brief summary of the disease 

Infectious disease name

Hepatitis B
Your setting 
Refuge in Australia
Causative agent 
Hepatitis B virus (HBV)

Source(s)It is caused by hepatitis B virus and the diseases can develop through exposure of contaminated blood, semen, or body fluids. It has been observed that unprotected sexual activity with the infected person can infect the partners. In addition, accidental transmission of the disease can result from contaminated needle or blood. Infected mothers can pass the hepatitis to their babies during childbirth.
Reservoir(s)Hepatitis B does not have any animal reservoir but it can enter in to the human body and keep asymptomatic infection for long period of time which infects others.
What is the global occurrence ?
As per the survey of World Health Organisation (WHO), the occurrence of hepatitis B is highest among the Western Pacific region and African region. It has recognised that around 6.1% adult population of Africa are infected with hepatitis B and around 6.2% adults are infected in Western Pacific region(WHO, 2019). Furthermore, approximately 2.0% adults are infected in South-East Asia Region, 3.3% adults are infected in Eastern Mediterranean Region, and only 1.6% adults are developing the illness in European Region(WHO, 2019). The rate of infection in America region is 0.7% of the total population (WHO, 2019).    

Incidence in the setting you have chosen

In 1997, around 1.5 per 100,000 people was infected in Australia. In 2001 the rate was increased to 2.2 per 100,000 in Australia(Benson & Donohue, 2007).  A study conducted in Sydney identified that almost 70% of hepatitis B cases in Australia was chronic and they were born overseas (Benson & Donohue, 2007). It is identified that hepatitis B is huge problem in refuge population of Australia.      

Prevalence in the setting you have chosen

Refuges to Australia are mainly coming from countries likes Asia, and sub- Saharan Africa where more than 10% of the population have risk of chronic hepatitis from their childhood. The poor vaccination process, infrastructural chaos, and financial constraint caused 90% of the people get infections in their first year of life and 30-50% infected in their adulthood(Benson & Donohue, 2007). When they are migrating to Australia they also bring the disease to the country and infected more people in their communities.      
Provide your opinion on the quality of incidence and prevalence data (give reasons for your answer)Refuges to Australia are coming from the countries with limited healthcare facilities and they are asymptomatic and carrying the illness to the country. The high risk groups are men and young children. Therefore, the country refuges require proper screening process and hygiene atmosphere with proper food and facilities. It would minimise the rate of infection of the in refuges and the whole country (Benson & Donohue, 2007).    
Incubation period

The average incubation period is 75 days but it can vary from 30-180 days.  
What is the infectious period?The virus can be identified within 30-60 days after the infection but it can remain silent for several years and cause chronic hepatitis and liver cancer.
What are the transmission routes?

In highly endemic area the virus is spread from mother to baby during birth or exposure to infected blood is caused the disease transmission in new born children.  It can increase the risk of chronic hepatitis B in children infected from their mother before 5 years of age. 
The disease can spread in adults through needle stick injury, practicing tattooing or piercing. In addition, contamination can result from infected saliva, vaginal secretion, and semen. Infection in adulthood can lead to chronic illness in less than 5% of cases whereas infection in infancy can lead to chronic hepatitis B in 95% of the cases(Mayo Clinic, 2020). In healthcare setting, use of unsterilized needles and surgical tools can help in diseases transmission.  The virus can able to survive outside the body for at least 7 days and during this time virus can cause infections. 
What other factors (e.g host or
environment) may contribute to disease
The risk factors for the disease includes unprotected sex, living with family members infected with virus, travelling to the region with high infection rate, and touching the contaminated surface(Mayo Clinic, 2020).  
What is the case fatality risk?
(Give detail if the mortality risk varies
according to specific situations)
It can be cured if early interventions take place. But in case of chronic hepatitis B the mortality chance are increased. In 2005-2006 in Australia 39 deaths occurred from hepatitis B. Among the deaths male mortality rate was high compared to women. However, in 2017 no death recorded from hepatitis B(Department of Health, 2010).      

Who are the people most at risk in the
Infants and children between the age of 0-6 years and  adults male living in poor socioeconomic conditions are vulnerable to develop the illness(Mayo Clinic, 2020)
Is the disease vaccine preventable?Yes. In May, 2000, hepatitis B immunisation was invented which needs three doses to eliminate the risk factors(Mayo Clinic, 2020).
What treatment is available?
(you do not need to provide detail, just
identify whether there is a cure, or
effective treatment to limit symptoms
&/or infectious period)
  • Vaccination to prevent the illness
  • Medicines (oral antiviral agents) to treat the chronic hepatitis B

2.  Questioning for explanation 

Q. Are only refugees affected by hepatitis B in Australia or it is affecting the native people also?

Reason: it would help us to recognise the trends of the diseases in Australia. If it has been observed that only refugees in Australia has higher prevalence of diseases then need to upgrade the healthcare facilities for the refugees.  

Q. Can vaccination minimise the risk of spread or occurrence of the disease and what is the effectiveness of the vaccination?

Reason: the information and effectiveness of vaccination can help us to understand the preventive measures which can be utilised vigorously for better results in diminishing the rate of incident.  

Q. Who is more (children or male or female) affected by the disease and why are the more vulnerable to hepatitis B?

Reason: the identification of vulnerable group can help in quick response and proper attention towards the prevention of the disease. The mostly affected groups get proper attention and intervention in future.    

Q. What are the risk factors behind the increase of hepatitis B in refugees?

Reason: the identification or information about the potential risk factors for the disease can help in prevention measures. The risk factors should be minimised and replaced with prompt intervention process.  

Q. What are the clinical procedures followed to identify the hepatitis B in refugees? Is this appropriate for the identification process or not?

Reason: if it has been isolated that the present clinical procedure like screening of the disease is not sufficient and increasing the number of cases in refugees then it should be modified for better results. 

3.  Further questioning for more explanations  

Q. Which countries emigrants are more affected by the hepatitis B? Is they are coming from high endemic areas?

Reason: it would help to identify the specific countries those have high incident of hepatitis B and spreading the disease in Australia. The people emigrates from endemic countries need more proper attention and screening procedure. It will also important for identification of chronic hepatitis B in emigrants and restrict them from spreading.     

Q. Are the refugees suffering from chronic hepatitis B or acute hepatitis B?

Reason: the type of hepatitis B found in refugees has special impact on prevention and intervention process. The information about the type of hepatitis B can help us to improve the screening process and prompt action against the infections.   

Q. What is the mortality rate in refugees due to hepatitis B?

Reason: the information about the mortality rate in the refugees due to hepatitis B infection can signify the seriousness of the illness and proper intervention can be taken. In addition, low mortality rate can be considered as positive treatment process and screening process.

Q.  Are the refuges spreading the illness within their communities or outside the communities?  

Reason: it is essential to understand the trend of the outbreaks. The spreading outside the refugee communities can be indicating the transmission of the disease which needs to be suppressed for prevent the endemic. If the spreading occurred within the communities then the communities requires proper medical attention and intervention.

4. Interviewing for identifying the risk factors

 a. What country are you from? 

  • Mention the country name………………………..

b. Are you born in that country?

  • Yes
  • No
  • Country name………….

(If no, then mention the country name where you born. )

c. Do your parents have ever detected this disease?

  • Yes
  • No

d. Does anyone in your relatives have this disease?

  • Yes
  • No

(If yes, then) 

Did you directly associated with him/her during the infection period?

  • Yes
  • No

e. Did you have ever unprotected sex with unknown person?

  • Yes
  • No

f. Have you ever had going through any organ or tissue transplant?

  • Yes
  • No

g. Have you ever had an injury in accident? 

  • Yes
  • No

(If yes, then)

And had needed to take blood in the hospital?

  • Yes
  • No

h. What is your primary occupation?

  • Mention your occupation here ……………………..

i. Do you think that your professions can cause the disease?

  • Yes
  • No

j. Did you have any kind of addiction related to needle or saliva? 

  • Yes
  • No

k. Did you ever inject drugs without medical prescriptions or through unsterilized needle?

  • Yes
  • No

l. Can you remember that you ever came in contact with someone who had this illness?

  • Yes
  • No

5.  Control and prevention measures 

In 2015, World Health Organisation was introducing guidelines of prevention, treatment, and care of the person living with chronic hepatitis B infections. The guidelines was emphasising on use of simple non invasive diagnostic examination to recognise the stages of liver damage and implement the proper intervention process, prioritising the care practice for the individual with advance liver damage as it is increasing their risk of mortality, and recommending the desirable use of nucleoside for initial stage of treatment. It is also providing idea for the patients suffering from cirrhosis of liver and liver inflammation due to hepatitis B.  In 2016, WHO implemented “Global health sector strategy on viral hepatitis, 2016-2020” which is highlighting the universal health coverage and create target with sustainable development goals. It has a clear vision of eliminating the hepatitis B viral infection and reducing the death rate by 2030. The strategy was developing on based of the belief the it would eliminate the hepatitis B related death rate by 65% and hepatitis B infection rate by 90% in world(WHO, 2019).  

Control measures 

The control measure for reducing the incident of hepatitis B in refugee of Australia is described below:

Testing and vaccination

Vaccination is essential in prevention measures as it can offer excellent protection against the hepatitis virus. It is an effective and safe measure in prevention of the disease. It needs 3 doses over 6 months of time period and protects the individuals for 20 years to life.  As per the opinion of The American Academy of Paediatrics, every child should receive the vaccine immediately after birth. The individual travelling in countries with high hepatitis rate should take vaccine before commencing their journey. Testing and screening are another important aspect to identify the disease at initial stage and prevent the further deterioration of the situations(The Australian Immunisation Handbook, 2018). If individual find one or more risk factors of hepatitis B should perform the hepatitis B blood test to identify the susceptibility of illness or infection status. Based on the report the individuals are advised to take vaccine or proper medication for quick recovery. The name of hepatitis B testing is Hepatitis B Core IgM Antibody test which is an important procedure to identify the disease.     

 Identify the perinatal hepatitis

All pregnant women should perform the testing of hepatitis B before their delivery. If the mother is infected with the illness then she will pass the infection to their babies during the birth process and before the baby get immunisation after birth. In case of infected mother, the baby gets hepatitis B immune globulin immunisation right after the birth that will prevent the infections. The children should be vaccinated if family members are developing the acute hepatitis B. It would reduce the risk of chronic hepatitis B and control the spread of the disease (Locarnini et al., 2015).     

Healthy Habits

Healthy habits are the best way to prevent the hepatitis B. It can reduce the risk factors and help the individuals to fight against the virus. The best practice includes do not sharing the personal care items with other, try to avoid unsterilized syringe, avoid the unprotected sex with unknown person, go for testing before conception, and stay away from the piercing or tattooing in unhygienic places (Locarnini et al., 2015). The healthcare workers should maintain the precaution while handling the blood or body fluids, and safely handling of the patients.         

After Exposure to Hepatitis B

Hepatitis B can be prevented with hepatitis B immune globulin vaccine soon after contact with the viruses. Individual recently exposed with the hepatitis B virus need the vaccine within 24 hours of infections (Locarnini et al., 2015). However, the vaccine will not work after 2 weeks of exposure. The infected person required proper medical support and isolation for their quick recovery process.  

Implementation process

To support the prevention measures I will implement the following strategies for my peer groups:

Creating awareness

Awareness is essential for refugee community to reduce the rate of incidents. Educational awareness campaigning about the chronic hepatitis B can offer knowledge and information to the affected community. The community will realise the fact and risk factors behind the disease spreads and occurrence of infections. The disease is curable at initial stage if proper intervention received (Disease Prevention and Control, 2020). However, chronic patients can be cured if get proper treatment.  Therefore, the refuges can explain their family history of illness to the healthcare professionals or identify the close contact and seek for medical supports. It helps in screening and testing process. In addition, awareness program in healthcare professionals helps in proper prevention and identification of the disease. They can improve their patient handling practices.        

Prevent transmission 

The affected refuges are motivated and advised to avoid unprotected sexual activity and using of unsterilized medical equipment and tattooing process. The affected individuals are marked and isolated from their social life for certain period of time. Pregnant women are testing before their delivery and motivate the infected mothers to provide vaccination to their infant. The adults are advised to avoid the direct contact with blood and cover their body cuts (Chacowry Pala et al., 2018). They should not hide their illness as it increases the risk of spread of disease.           

Improve the screening  

Strong screening measure is essential for the government to prevent the high rate of hepatitis B in refugees. It would help to identify the presence of the illness in migrated people. in this respect, I would like to incorporate three screening test for hepatitis B identifications which includes hepatitis B surface antigen test, hepatitis B core antibody test and hepatitis B surface antibody test(Sharma et al., 2015). Hepatitis B surface antigen test will determine whether the individual have the infections or not. The positive test report means the individual is currently infected with the illness and can able to transmit the disease. Hepatitis B core antibody test determines whether the individual have been ever infected with the virus. The positive report of the test indicates that the individual was infected with hepatitis B. Furthermore, hepatitis B surface antibody test determines the status of the individual after the virus infection. The positive report suggests that the individual has achieving the life time immunity from the hepatitis B virus(NCBI, 2020)

Improve care facilities 

The healthcare facilities should be well equipped and trained to prevent and cure the illness. In addition, the proper hygienic atmosphere with appropriate intervention approach should be available for marinating the chronic hepatitis B patients.

6. Barrier in implementation 


As per my opinion, my control measure would be effective measures for controlling and preventing the illness. Controlling the illness requires prevention and cure of the illness. The refugee groups in Australia are moving from endemic countries which increasing the risk for the country. Therefore, improving screening process and healthcare facilities can change the scenario. In addition, creating awareness is also essential for controlling the illness. It would inform the people about the risk factors and risky behaviours of hepatitis B. It is highly contagious communicable diseases which need proper awareness program in prevention and control the disease. Thus, prevention of transmission of hepatitis B virus is important aspect in controlling the illness(Stauffer, 2011). It can spread through infected blood and body fluid or tissues and infection can cause severe liver damage. Thus, it is significant to stop the transmission of the disease and save the mankind.   


Poor awareness and knowledge 

The refugee community have low knowledge and wrong perception about the illness. The social stigma and discrimination prevent them to express their difficulties. They are neglecting their illness, as hepatitis B can be asymptomatic for long period of time and contaminated huge amount of people through direct contact (Li et al., 2019). Lack of knowledge and awareness prevent them to seek the medical help and hiding their disease.       

In adequate health education

Most of the refugees are coming from poor socio-economic countries where inadequate healthcare facilities and infrastructure are responsible for their poor health condition. The inadequate health education on hepatitis B can interfere in prevention and control of the disease(Li et al., 2019). However, implementation of heath education for refugees can educate them about the illness, motivate them, and eliminate the sense of stigma or social discrimination.      

Insufficient healthcare facilities 

Refugee communities require more healthcare supports and interventions to change their situations. It has been observed that insufficient screening processes with lack of prevention measures are responsible for increasing the hepatitis B in the refugees. Thus, the government should implement proper screening process with regular medical health check up facilities and vaccinate the infant immediately after the delivery (Mitruka et al., 2018).   

Elimination of the barriers

Strengthen health education

In this situation, it is urgent to enhance the health education among the refugees for prevention and control the hepatitis B. Health education can able to eliminate the social stigma about the hepatitis B and minimise the risk factors. It can create awareness among the refugees and healthcare professionals and prevent the transmission of the virus. Health education is improving the communication and mobilisation process of the community which helps in prevention and control of the disease(Mitruka et al., 2018).      

Improving the services 

High quality healthcare facilities can able to cure the hepatitis B and the individual can live a long and healthy life. Hepatitis B is curable if recognised at early stage and proper intervention is achieved (Hepatitis b virus, 2020). Thus, the government should offer better quality of diagnostic process for the existing refuges of the country to support and monitor their health and wellbeing. In addition, emigration process needs more strong screening practice to recognise the disease and eliminate the risk of transmission. 

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