Acute hepatitis B: guide to national enhanced surveillance
Published 9 May 2016
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1. Introduction
Hepatitis B is a blood borne infection of the liver caused by the hepatitis B virus (HBV). The virus can provoke an acute illness characterised by nausea, malaise, abdominal pain, and jaundice but can also produce a chronic infection that is associated with an increased risk for chronic liver disease and hepatocellular carcinoma. Transmission is by parenteral exposure to infected blood and body fluids, most often through sexual contact, blood to-blood contact and perinatal transmission from mother to child. HBV infection can be prevented by vaccination and in the UK immunisation is offered to individuals at high risk of exposure to the virus e.g. people who inject drugs (PWID), healthcare workers. Immediate post-exposure vaccination is used to prevent infection, especially in babies born to infected mothers or following needle-stick injuries.
2. Epidemiological surveillance and reporting forms
Surveillance of acute hepatitis B is essential to target prevention and control activities such as the selective immunisation programme. Public Health England implemented national surveillance standards for hepatitis B which provide the framework for reporting of cases from local health protection teams.
There are number of forms designed for health protection teams to report acute hepatitis B cases as part of the ongoing surveillance.
- Form for reporting a newly diagnosed case acute hepatitis B
- Enhanced surveillance questionnaire for acute hepatitis B cases with undisclosed risk factors and/or associated with a cluster
Completed forms should be uploaded and attached to their relevant HP zone case by the local health protection team.
2.1 Genitourinary medicine (GUM) clinics
GUM clinicians should report acute cases of hepatitis to health protection teams using the relevant notification form.
3. Laboratory surveillance and reporting forms
Avidity testing and molecular characterisation investigations on samples linked to cases aim to confirm the acute hepatitis B diagnosis with additional genotyping and phylogenetic analysis informing on the diversity of the circulating viruses as well as investigating links to risk behaviour and possible transmission networks.
As of May 2016, PHE’s Blood Borne Virus Reference Department (BBVU) has reintroduced anti-HB core avidity testing alongside existing genotyping of samples of acute hepatitis B free of charge. Hospital microbiology/ virology departments are requested to send samples to Colindale for confirmation, avidity testing and genotyping as part of the national enhanced surveillance of acute hepatitits B.
4. Additional information and resources
Further information on PHE’s Blood Borne Virus Reference Department and guidance and data analysis on hepatitis B are available.