Research and analysis

Hepatitis B in England 2025

Updated 19 November 2025

Applies to England

This report summarises England’s progress towards the WHO elimination targets for hepatitis B with data to the end of 2024.

Foreword

This year marks a milestone as the UK approaches 5 years remaining to achieve our commitment to eliminate viral hepatitis as a public health problem by 2030. The UK Health Security Agency (UKHSA) continues to prioritise work to evidence progress towards this goal and the ‘Hepatitis B in England 2025’ report provides a critical assessment of the progress made in England.

This report shows that while England meets and exceeds targets on incidence and mortality, we fall far short on targets for diagnosis and treatment, and lack data to produce robust estimates against these metrics. The introduction of opt-out testing in emergency departments (EDs) has contributed to an increase in new diagnoses over the past 2 years with over 12,000 people newly diagnosed in 2024. However, it remains insufficient to reach the World Health Organization (WHO) target of 90% of people living with hepatitis B being diagnosed; based on estimates in this report, new diagnoses would need to increase to 25,000 per year for the next 5 years to reach the target. Comprehensive data on treatment coverage is unavailable but estimates using procurement data and from the National Institute for Health and Care Research (NIHR) Health Informatics Collaborative (HIC) indicate this is also likely to be below the WHO 80% target. Efforts to meet this treatment target will need to be redoubled as treatment eligibility is expanded in line with national and international guidance.

There are sustained successes to celebrate. England has maintained very low rates of mother-to-child (also known as vertical or perinatal) transmission (less than 0.1%), achieved through consistently very high coverage of antenatal screening (99.8%) and targeted birth dose of vaccine (98% within 24 hours) and immunoglobulin (96.8% where indicated within 24 hours). Coverage of universal infant immunisation also remains high with 91.2% of all infants receiving 3 doses of vaccine by 12 months, although this has steadily declined over recent years. We hope that system-wide efforts to improve vaccine uptake in the routine childhood programme will prevent this dropping below the 90% target.

This year’s report shows continuing decline in self-reported vaccine coverage among people who inject drugs, and limited data on uptake among other at-risk groups including people accessing sexual health services (SHSs) and people in prison.

Stigma is known to be a barrier to people accessing vaccination, testing and treatment. UKHSA has led on a number of initiatives including collaboration with the World Hepatitis Alliance to produce and pilot a stigma index tool, convening a stigma workshop co-produced with community partners and people with lived experience, producing a language guide to ensure consistent and person centred language and undertaking a survey of healthcare workers knowledge and attitudes towards people living with viral hepatitis. Research in collaboration with the Health Protection Research Units at the University of Bristol and University College London is exploring the impact of stigma to identify interventions to address its harmful consequences.

The achievements highlighted in this report demonstrate our potential to achieve and maintain elimination of hepatitis B, and the expansion of the NHS England (NHSE) hepatitis C elimination programme to now include hepatitis B provides a welcome addition to health services leadership in viral hepatitis. However, based on current trajectories with existing levels of activity, we will not meet the targets for diagnosis and treatment by 2030.

Dr Mary Ramsay CBE
Director of Public Health Programmes, UKHSA
Professor of Vaccine Policy, London School of Hygiene and Tropical Medicine

Introduction

Hepatitis B virus (HBV) is a bloodborne virus (BBV) that infects the liver, potentially causing severe complications including inflammation, scarring, liver failure and cancer. It poses a significant public health threat globally, with millions affected and over 1.1 million lives claimed yearly. If untreated, chronic hepatitis B can lead to severe liver complications and death. In England, interventions have been implemented to reduce hepatitis B as a public health problem including antenatal and blood donor screening, selective and universal vaccination programmes, testing recommendations and, more recently, opt-out BBV testing in EDs. This report outlines current surveillance data on hepatitis B in England, highlighting both achievements and ongoing challenges in the continued efforts to eliminate viral hepatitis as a public health problem.

Despite the significant burden it places on communities across all global regions, hepatitis B has historically not received the same attention as other health and development priorities. In May 2016, the UK signed up to the WHO Global Health Sector Strategy on viral hepatitis committing to meet viral hepatitis elimination targets including:

• a mother-to-child transmission rate of less than 2%
• less than 0.1% hepatitis B surface antigen (HBsAg) prevalence in children aged 5 years and under
• a combined annual mortality of 6 deaths per 100,000 or fewer, attributable to hepatitis B or C

The programmatic targets are:

• at least 90% coverage of 3 doses of HepB containing vaccines by 12 months of age
• at least 90% coverage of at-risk infants with targeted timely hepatitis B birth dose (HepB-BD)
• at least 90% coverage of antenatal HBsAg screening
• at least 90% coverage with antivirals for eligible pregnant women
• 100% of healthcare facilities with safe injections or 90% of healthcare injection devices procured to be safety-engineered
• 100% of blood donations to be screened
• at least 90% of people living with chronic hepatitis B to be diagnosed
• at least 80% of people who are diagnosed with hepatitis B and eligible to be treated are treated

1. Reducing the incidence and prevalence of HBV infection

1.1 Prevalence of HBV infection

UKHSA published the estimated prevalence of hepatitis B in England in last year’s report using a methodology which has now been published. This estimates that there are 268,767 people living with hepatitis B, with a 95% confidence interval (CI) ranging from 227,896 to 314,004. This corresponds to a prevalence estimate of 0.58% (95% CI 0.50% to 0.68%) and continues to be the most current national estimate.

Additional analysis this year has allowed for regional estimates to be made (see Table 1) showing the variation in prevalence across the country. London is estimated to have the highest prevalence of 1.4% while the East Midlands has the lowest estimated prevalence of 0.2%. However, it is important to note that there is less confidence in the regional estimates compared to the national estimate and, as the estimates are based on data from the Sentinel Surveillance of Blood Borne Viruses (SSBBV), the accuracy of regional estimates may be influenced by the coverage of SSBBV in that region. For further details on methodology see Appendix 2. Technical notes, section 1.

Table 1. Estimated hepatitis B prevalence and number of people living with chronic hepatitis B, England, 2024

Region	Estimated number of individuals with chronic hepatitis B (95% CI)	Estimated hepatitis B prevalence (%), (95% CI)	Estimated SSBBV coverage (%)
England	268,767 (227,896 to 314,004)	0.58 (0.50 to 0.68)	45
East of England	19,584 (6,282 to 48,679)	0.38 (0.12 to 0.95)	40
East Midlands	7,584 (3,633 to 15,369)	0.19 (0.09 to 0.38)	64
London	99,067 (78,415 to 120,263)	1.39 (1.10 to 1.69)	75
North East	7,950 (2,700 to 20,289)	0.36 (0.12 to 0.93)	32
North West	25,406 (17,060 to 37,303)	0.42 (0.28 to 0.62)	43
South East	25,678 (12,326 to 53,207)	0.34 (0.16 to 0.70)	34
South West	15,978 (8,336 to 32,977)	0.34 (0.18 to 0.70)	30
West Midlands	24,756 (14,343 to 41,647)	0.52 (0.30 to 0.87)	35
Yorkshire and Humber	16,720 (9,012 to 29,921)	0.37 (0.20 to 0.67)	39

The above methodology uses ethnicity as a key characteristic to calculate prevalence estimates. However, as most chronic hepatitis B infections are amongst people born in higher prevalence countries, country of birth would be a better characteristic to use but is not available in routine health or surveillance data. Further work on estimating the prevalence of hepatitis B in England using mathematical modelling and incorporating migration data is underway at the University of Bristol (with partners at UKHSA and University of Cambridge). This new estimate should be published within the next year.

1.2 Monitoring WHO targets for hepatitis B incidence

The WHO targets for reducing incidence prioritise elimination of mother-to-child transmission, including universal antenatal screening, timely birth dose vaccination for at-risk infants and achieving high universal vaccination coverage. Additional targets address safe injection practices and blood transfusion safety. Table 2 presents these targets and England’s progress towards meeting them.

Table 2. WHO impact and programmatic targets for reducing incidence of HBV infection, England, 2024

Target type	Target	WHO 2030 target	Most recent data for England
Impact	HBsAg prevalence in children aged 5 years and under	0.1% or below	0.0% [note 1]
Impact	Mother-to-child transmission rate (where countries use a targeted birth dose programme)	2% or below	0.06% [note 2]
Programme	Hepatitis B 3 doses (HepB3) vaccine coverage	90% or above	91.2% [note 2]
Programme	Coverage of those infants at risk with targeted timely HepB-BD	90% or above	98.0% [note 2]
Programme	Coverage of maternal antenatal HBsAg testing	90% or above	99.8% [note 2]
Programme	Coverage with antivirals in pregnancy for those eligible	90% or above	81.7% [note 2]
Prevention	Safe injections	90%	83% [note 3]
Prevention	Blood safety	100%	100% [note 4]

Note 1: data  from 2017 to 2020, full details provided in Hepatitis B in England 2024.

Note 2: 2023 to 2024 data from Integrated Screening Outcomes Surveillance Service (ISOSS).

Note 3: 2023 data from NHS supply chain. Full details presented in Hepatitis C in England 2024.

Note 4: 2024 data from NHS Blood and Transport (NHSBT).

1.3 Elimination of mother-to-child transmission

The UK offers universal antenatal screening for hepatitis B, as well as syphilis and HIV. The selective hepatitis B immunisation pathway includes targeted neonatal birth dose vaccination (within 24 hours) and hepatitis B immunoglobulin (HBIG), where indicated, to babies born to women identified as living with hepatitis B through antenatal screening.

Indication for HBIG is based on whether a pregnant woman is considered to be at higher risk of passing on hepatitis B to their infant. This classification is based on the presence of hepatitis B e-antigen (HBeAg) or the absence of antibodies to hepatitis B e-antigen (anti-HBe), a high viral load of hepatitis B DNA (equal to or above 1 million international units (IU) per millilitre (ml)), or acute hepatitis B in pregnancy. HBIG is also indicated when the infant weighs 1,500g or less at birth.

Following the birth dose a further monovalent vaccine should be given at 4 weeks, in addition to the universal hepatitis B combination (hexavalent) vaccine given to all infants at 8, 12 and 16 weeks, and a final monovalent dose is also given at 12 months. The 12-month dose should be accompanied by a blood test to confirm mother-to-child transmission has not occurred and, in cases where it has, enable timely referral to specialist services.

In July 2025 an additional hepatitis B hexavalent vaccine dose at 18 months of age was introduced to the universal schedule for babies reaching 12 months old on or after 1 July 2025; the monovalent vaccine dose at 12-months of age has therefore been removed from the selective schedule for these infants. These infants should now be tested for HBsAg between 12 and 18 months old (to align with this change).

Full details are available in UKHSA’s Immunisation against infectious disease: Hepatitis B: the green book chapter 18 and NHSE and UKHSA guidance on the antenatal screening and selective neonatal immunisation pathway.

Please note that all data in this report pre-dates the July 2025 scheduling change and is based on the selective pathway as described above.

1.3.1 Maternal HBV screening

Hepatitis B screening coverage in pregnancy is a key performance indicator (KPI) to provide assurance that screening is offered and recommended to all eligible women in every pregnancy, and that each woman accepting screening has a confirmed screening result and is monitored and reported by the Infectious Diseases in Pregnancy Screening (IDPS) programme. This helps to ensure that pregnant women living with hepatitis B are diagnosed and interventions are implemented to prevent transmission of hepatitis B to their children. Antenatal screening uptake has consistently been above 99% between 2017 to 2024 (see Figure 1), exceeding the WHO target of 90%. Among women who were booked for antenatal care in the year 1 April 2023 to 31 March 2024, 582,384 (99.8%) women accepted screening. For further details on methodology see Appendix 2. Technical notes, section 2.

Figure 1. Maternal screening coverage for hepatitis B in England, 2017 to 2024 financial year (break shown with symbol in y-axis)

Source: IDPS programme standards reports and KPI indicator reports, NHSE.

Between 1 April 2023 and 31 March 2024, 2,105 women received a positive screening test result (HBsAg positive), corresponding to an antenatal prevalence of 0.4%. Prevalence has remained very low and stable at 0.3% to 0.4% each year. There is some regional variation, with London seeing the highest prevalence (around 0.5%) and the South of England the lowest (0.3%) in the 2023 to 2024 screening year. Analysis by ISOSS has shown that a higher proportion of pregnant women living with hepatitis B book for antenatal care later compared to the general population and a small proportion (0.7%) screened positive in labour having received no antenatal care in the UK in the 2021 to 2022 screening year. Further work is planned with the Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at University College London (UCL) to explore these disparities.

Of women who were HBsAg positive in 2023 to 2024, and where infectivity status was available, 8.6% were classified as being at higher risk of passing on hepatitis B to their baby. Country of birth and infectivity status were available for 2,084 samples (98.9% of those screened positive), of which the majority were from women born in Western Africa (33.3%), Eastern Europe (16.6%), and South Asia (15.1%) (see Figure 2). Eighty-two women (3.9%) had country of birth listed as the UK, of which 11 were classed as higher risk: these women are grouped within the Northern Europe region in Figure 2.

Figure 2. Region of birth and risk of passing on hepatitis B to their baby for pregnant women living with hepatitis B in England, 2021 to 2024 financial year

Source: Antenatal country of birth data is from ISOSS data shared with UKHSA, geographic region classifications are from the United Nations Statistics Division.

1.3.2 Coverage of antiviral treatment in pregnant women

Antiviral treatment is recommended for pregnant women living with hepatitis B and with a hepatitis B viral load (DNA level) greater than or equal to 200,000 IU per ml to reduce viral load (see British Viral Hepatitis Group (BVHG) guideline for the management of hepatitis B in pregnancy and the exposed infant).

In the financial year 2023 to 2024, 1,770 (95.3%) of the pregnant women who accepted and underwent hepatitis B screening also had a viral load reported. 93 (5.25%) of these women had a hepatitis B viral load of 200,000 IU per ml or more. Of these women, 76 (81.7%) were recorded as receiving antiviral treatment during pregnancy. This is a reduction from 89% in the 2021 to 2022 financial year and has remained below the WHO 90% target for the last 3 years. Additional data is now being captured by ISOSS on antiviral treatment in pregnancy including when treatment is stopped or declined. Further work will be required to explore and address reasons why pregnant women who are eligible for treatment are not receiving it.

1.3.3 Coverage of a timely HepB-birth dose and HBIG in the selective programme

Timely administration of the hepatitis B birth dose vaccine within 24 hours of birth for babies born to women living with hepatitis B is important to reduce the risk of these children acquiring hepatitis B infection (see Hepatitis B: the green book, chapter 18). Whilst coverage has remained high, and well over WHO targets, there has been a small decline in recent years from 99.2% (1,834 out of 1,849) in 2020 to 2021 to 98.0% (1,786 out of 1,822) in 2023 to 2024 (Figure 3). Of the 36 infants who did not receive a birth dose within 24 hours in 2023 to 2024, 24 had a vaccine dose recorded within the week following birth (19 within 72 hours) and 12 did not have any recorded birth dose. Reasons for not having a birth dose of vaccine included infant deaths and parental decline. The proportion of eligible infants who received HBIG within 24 hours is shown in Figure 4. When timely HBIG or vaccine is not given to an eligible infant, there are processes in place to flag and investigate these incidents to improve programme delivery.

Figure 3. Coverage for timely hepatitis B birth dose vaccination, England, 2017 to 2024 financial year (break shown with symbol in y-axis)

Source: ISOSS reports, NHSE.

Figure 4. Coverage for timely HBIG, England, 2017 to 2024 financial year (break shown with symbol in y-axis)

Source: ISOSS reports, NHSE.

1.3.4 Coverage of hepatitis B vaccination in selective neonatal programme

Figure 5 shows the proportion of eligible infants who received all 5 hepatitis B vaccines (birth dose, monovalent dose at 4 weeks, and 3 hexavalent doses as part of the routine childhood immunisation schedule) by 12 months of age and all 6 doses (including a further 12-month monovalent dose) by 24 months of age. This data is aggregated from the quarterly Cover of Vaccination Evaluated Rapidly (COVER) reports and shows increasing coverage over the past 6 years.

Figure 5. Coverage of hepatitis B vaccination in the selective neonatal programme, England, 2019 to 2024 financial year [note 5] (break shown with symbol in y-axis)

Source: Childhood vaccination coverage statistics, NHS Digital (co-authored with UKHSA).

Note 5: data prior to 2019 to 2020 is missing for some local authorities, particularly in London, and so is not presented.

1.3.5 Post-vaccination serologic testing (PVST) in infants born to women living with hepatitis B

PVST of infants born to women living with hepatitis B is mainly provided by UKHSA’s free national dried blood spot (DBS) testing service for 12 month old infants. PVST aims to confirm whether mother-to-child transmission has been prevented and ensure timely referral to specialist services for any children who have acquired chronic hepatitis B infection. Data from these tests is used to calculate the mother-to-child transmission rate. Between April 2014 and March 2025, 14,263 infants were tested via the UKHSA DBS service, with a year-on-year increase from 439 in 2014 to 2015 financial year to 1,781 in the 2024 to 2025 financial year. This increase is reflective of more centres using the service rather than an increase in the total number of children born to women living with hepatitis B nationally.

By comparing births reported to ISOSS with DBS samples received by UKHSA, in the 2023 to 2024 screening year, it is estimated that 84.5% (1,541 out of 1,824) of eligible children were tested through this service. This represents an increase in DBS uptake of around 6% compared to previous years (in both 2021 to 2022 and 2022 to 2023, uptake was around 78%).

Testing outside of the DBS service, through hospital phlebotomy and laboratory services, also occurs but is not consistently reported to UKHSA. The sharing of data between ISOSS and UKHSA means that PVST completion can be more accurately monitored and infants for whom a PVST result is missing can then be followed up. This should improve returns to the DBS service, allow greater understanding of serology testing outside the DBS service and increase the accuracy of the estimated mother-to-child transmission rate. This data will be used as part of a quality improvement project being conducted by UKHSA and a pathway review with multiple stakeholders, both of which are ongoing this year and will include strategies to improve coverage of PVST.

The estimated mother-to-child transmission rate by year is shown in Figure 6. This has consistently been below the 2% WHO target, having fallen from 0.95% between April 2014 and March 2015 to 0.06% between April 2024 to March 2025. As this is calculated by comparing the number of positive individuals identified by DBS in each year to the number of DBS tests conducted each year, positivity was higher in the earliest years due to the lower number of DBS tests received. Of the 14,263 samples tested up to end of March 2025, 839 (5.9%) infants were reported to be born to women considered at high risk of passing hepatitis B to their child. Since launching in 2014, the infant DBS service has diagnosed 18 children (0.13% of those tested) with hepatitis B, all of whom were born to women considered to be at higher risk of passing on hepatitis B.

Figure 6. Mother-to-child transmission rate for infants born to women living with hepatitis B, England, 2014 to 2025 financial year

Source: Modular Open Laboratory Information System (MOLIS) data (from DBS testing in blood borne virus unit (BBVU)), UKHSA.

1.4 Coverage of HepB3 in the universal programme

The UK introduced universal hepatitis B vaccination in autumn 2017 for babies born on or after 1 August 2017 as the hexavalent (6 in 1) vaccine, which includes hepatitis B, replaced the pentavalent (5 in 1) vaccine. UKHSA monitors vaccine coverage for all 3 doses of the universal hexavalent childhood vaccination programme in England (and all other childhood immunisation programmes) through COVER. Details on the COVER programme and methodology are described in COVER reports.

England has consistently exceeded the WHO 90% coverage target for children receiving 3 doses of the hexavalent vaccine by their first birthday. There has been a decline in vaccination coverage, with the highest coverage in the last 10 years achieved in 2015 to 2016 at 93.6%. The COVER annual report for 2024 to 2025 reported a slight increase in universal hexavalent vaccine coverage, with 91.3% of children being vaccinated by their first birthday compared to 91.2% in 2023 to 2024 (see Figure 7).

Figure 7. Coverage for universal hexavalent vaccine at 12 months of age, England, 2018 to 2025 financial year (break shown with symbol in y-axis)

Source: COVER reports, UKHSA.

1.5 Prevention of infection by immunisation in other risk groups at risk of acquiring hepatitis B

In addition to the universal and selective infant immunisation programmes, targeted vaccination focussing on people at increased risk of acquiring hepatitis B or its complications is also recommended, as outlined in the green book.

1.5.1 Vaccine uptake in sexual health services (SHSs)

British Association for Sexual Health and HIV (BASHH) guidelines and the green book recommend that all services commissioned to manage sexually transmitted infections (STIs) should provide appropriate hepatitis B vaccination to non-immune gay, bisexual and other men who have sex with men (GBMSM), people who change sexual partners frequently and sex workers.

Vaccine provision in SHSs is reported to UKHSA using the GUMCAD STI Surveillance System. However, there is underreporting of hepatitis B immunity or prior hepatitis B vaccination by SHSs, leading to an overestimate of the denominator (people eligible for vaccination) and artefactually low estimates of vaccination coverage.

Therefore, Table 3 instead presents numbers of each hepatitis B vaccine dose administered to GBMSM within SHSs since 2015. These numbers give an indication of trends of vaccine delivery in SHS. The number of first doses administered peaked in 2019 but then more than halved in 2020 during the COVID-19 pandemic. Although there was a recovery in the following years, as of 2024 vaccination levels have not returned to 2019 levels. (For further details on methodology see Appendix 2. Technical notes, section 3).

Table 3. Hepatitis B vaccination in GBMSM, counts of first, second, third, fourth and booster doses, SHS, England, 2015 to 2024 calendar year

Hepatitis B vaccination dose [note 7]	2015	2016	2017	2018	2019	2020 [note 6]	2021 [note 6]	2022	2023	2024
1st dose	12,953	12,502	11,133	11,837	14,619	6,801	9,279	11,881	12,891	12,566
2nd dose	9,484	9,292	7,682	7,604	11,043	5,087	7,408	8,741	9,980	9,974
3rd dose	8,401	7,960	6,067	4,603	7,937	3,950	4,877	6,299	7,156	7,527
4th dose	440	868	856	807	893	458	493	773	853	830
Booster	1,367	2,518	2,742	3,321	4,289	2,193	2,862	3,609	3,773	3,642

Source: STI diagnoses and services by gender identity and sexual orientation, UKHSA.

Note 6: numbers reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Note 7: the recording of subsequent vaccine doses may be inconsistent or inaccurate, especially as individuals may receive their second or third doses at different clinics. As SHSs are covered by anonymous access provision in the Health and Social Care Action 2012 and the GUMCAD data they submit to UKHSA is pseudonymised, it is not possible to link records leading to the potential misclassification of subsequent doses as first doses in the new SHS records.

In 2024 data from Reducing inequalities in sexual health (RiiSH), an online community survey of GBMSM in the UK, 67% reported having had at least one dose of HBV vaccination. Among those who were unvaccinated, 65% reported not being offered a vaccine.

Seroprevalence data on the presence of hepatitis B antibodies (anti-HBs) amongst GBMSM conducted in 2017 to 2018 showed a seroprevalence of immunity of 77% and updated seroprevalence data from samples collected in 2022 to 2023 showed a similar level of 78%.

Other recent studies reporting HBV vaccination coverage for eligible populations in SHSs are summarised in the Hepatitis B in England 2024 report.

Data on vaccine uptake amongst other populations including sex workers remains sparse with the most recent estimates from research among female sex workers attending SHSs between 2015 to 2019 which found a low uptake (30%) and coverage (37%) of hepatitis B vaccination.

1.5.2 Vaccine uptake in people who inject drugs

People who inject drugs are at increased risk of acquiring hepatitis B and vaccination is therefore recommended for them and their close contacts. Vaccination recommendations for individuals engaged in, or potentially transitioning to, injecting drug use have been in place since the 1980s. Immunisation efforts for people who inject drugs have historically played a pivotal role in reducing acute hepatitis B infections (the green book, chapter 18).

Data from the Unlinked Anonymous Monitoring (UAM) Survey among people who inject drugs indicates that self-reported coverage of at least one dose of hepatitis B vaccine has decreased from 74.6% in 2015 to 62.5% in 2023 in England (see Figure 8).

Figure 8. Proportion of people who inject drugs self-reporting at least one hepatitis B vaccination, England, 2020 to 2023 calendar year [note 8][note 9]

Source: UAM survey of HIV and viral hepatitis among people who inject drugs: 2023 report, UKHSA.

Note 8: people who recently started injecting are defined as people who first injected drugs during the preceding 3 years.

Note 9: during 2020 and 2021, recruitment to the UAM survey was impacted by the COVID-19 pandemic. As a result, there were changes in the geographic and demographic profile of people taking part. This should be considered when interpreting data for these years. Due to small numbers, data for 2020 and 2021 are combined. For more information, please see the UAM annual data tables.

In 2023, hepatitis B vaccination coverage was particularly low among those aged 25 years and under as well as among those who first injected during the preceding 3 years, where vaccine coverage was 32.4% and 42.7%, respectively. However, the proportion of people participating in the UAM survey in England who were in the 25 years and under age group were small and continued to decline (from 3.7% in 2015 to 1.2% in 2023) and this was also the case for those who recently started injecting (from 8.7% in 2015 to 5.1% in 2023), making it challenging to interpret these trends.

Data from the National Drug Treatment Monitoring System (NDTMS) in England showed a similar trajectory in the proportion of those at risk who are offered and accept a hepatitis B vaccine, declining from 58% in 2011 to 48% in 2019, and, using a new methodology, from 42% in 2020 to 34% in 2023 (Figures 9a and 9b).

Figures 9a and 9b. Hepatitis B vaccine acceptance amongst people who inject drugs from the NDTMS, England, 2011 to 2020 financial year [note 10][note 11]

Figure 9a.

Figure 9b.

Source: NDTMS, Office for Health Improvement and Disparities (OHID).

Note 10: data is shown in separate charts because NDTMS data on the proportion offered and accepting a hepatitis B vaccine changed in 2020 to 2021 tax year and is not comparable to previous years. From 2020 to 2021 onwards, data represents people newly presenting for drug treatment, instead of all people who inject drugs presenting for drug treatment.

Note 11:  excludes those previously vaccinated, with acquired immunity, deferred due to clinical reasons or assessed as inappropriate to offer. Includes those with incomplete data.

1.5.3 Vaccine uptake in prisons and detained settings

People in prison and other detained settings are at a higher risk of BBVs than the general population in part because imprisonment is common among people who inject drugs. In the 2023 UAM Survey, 64% of participants reported they had been in prison at least once. Immunisation against HBV is recommended for everyone residing within a prescribed place of detention.

Data on HBV vaccination uptake within prisons and detained settings is not currently available but work is planned to update the vaccination templates used in prison health records which should improve reporting and our ability to monitor uptake in these settings.

1.6 Prevention of infection by ensuring safe blood supplies

Blood donors are a cohort with a lower risk of bloodborne virus infection because people with a history of associated risk factors are asked not to give blood. All donations in England have been screened for HBsAg indicating current hepatitis B since the 1970s, and hepatitis B nucleic acid testing (NAT) for the virus has been performed in pools of 24 since 2009. Screening for antibodies to hepatitis B core antigen (anti-HBc) indicating exposure to hepatitis B was rolled out in 2022 for all donors at least once to mitigate the potential risk of occult hepatitis B infection (OBI) to the blood supply. A person with OBI is defined as having undetectable levels of HBsAg in the blood but with low and variable levels of hepatitis B virus DNA which may not be detected by pooled screening but will have detectable levels of anti-HBc. This additional test for hepatitis B followed recommendations from the Advisory Committee on the Safety of Blood, Tissues and Organs OBI working group to screen all donors at least once.

If a donation is reactive for any of the markers screened for, it is re-tested and if still reactive the donation is removed from the supply and undergoes confirmatory testing. Donors with a confirmed positive donation test result indicating acute, chronic or occult hepatitis B are referred for follow-up and notified to the local health protection team. Donors with results indicating past exposure to hepatitis B are advised by letter.

There were approximately 815,717 blood and platelet donors in England in 2024 giving 1,492,302 donations, of which 133,627 (9%) donations were given by first-time donors.

The rate of hepatitis B (acute, chronic or occult) in first-time donors in 2024 was 46.4 per 100,000 donations. Rates peaked in 2021 and have been declining since but are still higher than the average rate for 1996 to 2020 at 34.3 per 100,000 donations (see Figure 10). The number and rate of hepatitis B in repeat donors is low (compared to first-time donors) ranging from 0.1 per 100,000 donations to 0.6 per 100,000 donations. In 2024, the rate in repeat donors was 0.4 per 100,000 donations. A further 1,715 of 397,179 (0.4%) donations tested in 2024 were positive for anti-HBc indicating past exposure to hepatitis B.

Figure 10. Rate of hepatitis B among donations from first-time and repeat blood donors, England, 1996 to 2024 calendar year

Source: NHSBT and UKHSA Epidemiology Unit.

In 2024, 64 blood donors in England were confirmed to be living with hepatitis B: 58 chronic, 6 OBI, and 4 people identified with acute hepatitis B. Acute hepatitis B infections were classified based on the presence of anti-HBc immunoglobulin M (IgM), results from previous donations and available clinical history.

All 58 chronic hepatitis B cases identified in 2024 were in first-time donors: the majority were male (86%), 25 to 44 years of age (81%), of Asian or Black heritage (76%), born abroad in Africa (28), Asia (15) or Europe (9) (90%) with no specific exposure reported. The rate of chronic hepatitis B infection in 2024 was highest among Black African first-time donors (870.4 per 100,000 donors), followed by Chinese first-time donors (262.6 per 100,000 donors). This contrasts with whole blood donors in 2024, the majority of whom were repeat donors (83%), comprised a slightly higher percentage of females (54%), just over half (52%) were 45 years and over and 90% were White British. The 6 donors with OBI were all over 45 years old and 5 were born abroad with no obvious exposure. The people with acute hepatitis B were all under 45 years old, 3 out of 4 were White British, 2 reported sex between men and 2 reported sex between men and women.

Overall, from 2009 when HBV NAT screening began to the end of 2024, 54 donors with an OBI were identified, including 15 identified by anti-HBc testing.

Screening donations does not completely prevent hepatitis B transfusion transmitted infection (TTI). With a low hepatitis B incidence in the general and donor populations, the estimated residual risk that a potentially HBV infectious donation made in the window period is not detected is around one in one million donations. This equates to up to 2 donations per year which may lead to a new acquisition of hepatitis B if an infectious dose is transfused to a susceptible recipient.

In the UK, between 1996 and 2024, there have been 16 reported hepatitis B TTI incidents (11 confirmed and 5 probable) involving 20 recipients, with 5 incidents due to OBI (1 confirmed and 4 probable), all prior to the introduction of anti-HBc testing.

Further data is available in the NHSBT and UKHSA Epidemiology Unit annual review.

1.7 Trends in incidence of acute hepatitis B

Acute infectious hepatitis is a notifiable condition. Data on incidence of reported acute hepatitis B infection is available from 1980 based on laboratory reports and reconciliation with clinician reporting of acute viral hepatitis. An acute hepatitis B infection is defined as test results positive for HBsAg and IgM from a person with abnormal liver function tests with a clinical pattern consistent with acute viral hepatitis. As part of enhanced molecular surveillance of acute hepatitis B, diagnostic laboratories are requested to submit blood samples from people diagnosed with acute hepatitis B to UKHSA BBVU for confirmation and sequencing.

Figure 11 shows the number of acute hepatitis B diagnoses in England since 1980. Between 2015 and 2024 an average of 332 acute hepatitis B diagnoses were reported annually to UKHSA (range from 175 to 457). Despite a continuous decline in the number of people with an acute hepatitis B infection in England since 2015, 277 individuals were reported in 2024 which indicates that reporting is returning to pre-pandemic levels. For the year 2024, where gender was reported, 74.9% (203 out of 271) of those diagnosed with acute hepatitis B were male. The median age of those presenting with acute hepatitis B was 40 years (interquartile range (IQR) 30 to 57 years; 41 years for those who reported their gender as male (IQR 31 to 58) and 40 years (IQR 28 to 54) for those who reported their gender as female.

Figure 11. Number of people diagnosed with acute hepatitis B, England, 1980 to 2024 calendar year [note 12][note 13]

Source: Second Generation Surveillance System (SGSS), MOLIS and HPZone. 

Note 12: data from 2004 to 2008 is not available due to change in the reporting and surveillance system. Laboratory and clinical reporting systems were reinstated in 2008.

Note 13: UKHSA transitioned to a new case management system for notifiable diseases in 2024 which has impacted the identification of people with acute hepatitis B and likely resulted in underreporting.

2. Reducing hepatitis B-related mortality by increasing diagnosis and treatment

2.1 Monitoring WHO impact targets for hepatitis B diagnosis and mortality

Targets related to reducing mortality include an absolute target of 6 or less hepatitis B and hepatitis C-related deaths per 100,000 population annually. Previous targets separated hepatitis B and hepatitis C mortality at 4 per 100,000 and 2 per 100,000 persons respectively but these have now been combined to reflect the overall goal of eliminating viral hepatitis.

As England is a low prevalence country for hepatitis B the absolute targets for mortality have been achieved for several years; the current estimated mortality rate is between 0.18 (lower bound) to 0.35 (upper bound) per 100,000 population (see section 2.2 for further details on the methodology). However, it is still important to monitor trends in hepatitis B-related mortality to ensure that progress continues to be made in addressing avoidable morbidity and mortality.

WHO programmatic targets relate to diagnosis of people living with hepatitis B and ensuring that those eligible for treatment are receiving it. Data on people diagnosed is derived from national surveillance systems and includes case-finding initiatives. Treatment monitoring data continues to be an area of development with significant collaborative work underway between UKHSA, NHSE, NHS trusts and academic partners (Table 4).

Table 4. WHO impact and programmatic targets for reducing hepatitis B-related mortality, England, 2024

Target type	Target	(WHO 2030 target)	Progress in England
Impact	Hepatitis B mortality	4 per 100,000 or less	0.18 to 0.35
Programme	Proportion of people living with hepatitis B diagnosed	90% or more	43.6% [note 14]
Programme	Proportion of people diagnosed with hepatitis B and eligible, receiving treatment	80% or more	Data not available

Note 14: this estimate is based on experimental data as described in section 2.4.

2.2 Deaths from hepatitis B-related end stage liver disease (ESLD) or hepatocellular carcinoma (HCC)

In 2025, the method for estimating deaths from hepatitis B-related ESLD and/or HCC has been updated. The previous method of reporting that solely used death registrations from the Office for National Statistics (ONS) was shown to underestimate mortality rates by up to 60% for hepatitis C-related liver disease. To address this, an updated method is used that presents the estimated mortality attributable to hepatitis B as a range. The lower bound of this range is similar to the previous methodology using only ONS death registration data while the upper bound uses ONS death registration data linked to data on hospital admissions for viral hepatitis and laboratory data on viral hepatitis diagnoses. The updated methodology has been applied to all previous years below and reports deaths by year of death rather than by year of registration as was previously used.

Deaths from hepatitis B-related ESLD and/or HCC have remained below 0.36 per 100,000 population since 2005 using the upper bound estimate. In 2024, the estimated annual hepatitis B-related ESLD and/or HCC mortality rate was between 0.18 (lower bound) and 0.35 (upper bound) per 100,000 population (see Figure 12), and this rate has remained stable with upper estimates between 0.15 and 0.36 since 2005. While hepatitis B-related mortality over this time has consistently been well below the WHO absolute target, the upper estimate for the number of hepatitis B-related deaths reported in 2024 was the highest since 2001 at 207 (Figure 13b). Hepatitis B-related HCC deaths have also been gradually increasing over time, with estimates of between 51 to 71 deaths in 2005 and 75 to 139 deaths in 2024 (Figure 13c). Further work to estimate the proportion of ESLD and HCC deaths attributable to hepatitis B is in progress which will improve our understanding of hepatitis B-related mortality and potential reasons for the observed increase.

Figure 12. Mortality rate per 100,000 population [note 15][note 16] for hepatitis B-related ESLD [note 17] and/or HCC, England, 2006 to 2024 calendar year

Source: ONS, SSBBV, SGSS,  Hospital Episode Statistics (HES).

Note 15: lower bound represents deaths where ESLD and/or HCC and hepatitis B were reported in ONS death registrations (as year of death is now used this is not comparable with previously published estimates which used year the death was registered). Upper bound represents deaths where ESLD and/or HCC were reported in ONS death registrations and hepatitis B diagnoses were identified by linking between ONS deaths, HES hospital admissions data and laboratory diagnosis data to yield a maximum number of deaths attributable to hepatitis B-related ESLD and/or HCC.

Note 16: excluding deaths of people aged under 16 and deaths registered in England where the deceased’s usual residence is outside England.

Note 17: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

Figures 13a, 13b and 13c. Number of deaths [note 15][note 16] from hepatitis B-related ESLD [note 17] and/or HCC, England, 2006 to 2024 calendar year

Figure 13a.

Figure 13b.

Figure 13c.

Source: ONS, SGSS, SSBBV, HES.

Note 15: lower bound represents deaths where ESLD and/or HCC and hepatitis B were reported in ONS death registrations (because year of death is now used, this is not comparable with previously published estimates which used the year the death was registered). Upper bound represents deaths where ESLD and/or HCC were reported in ONS death registrations and hepatitis B diagnoses were identified by linking between ONS deaths, HES hospital admissions data and laboratory diagnosis data to yield a maximum number of deaths attributable to hepatitis B-related ESLD and/or HCC.

Note 16: excluding deaths of people aged 16 years and under and deaths registered in England where the deceased’s usual residence is outside England.

Note 17: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

2.3 Monitoring hepatitis B-related hospital admissions and liver transplants

2.3.1 Hepatitis B-related hospital admissions

Hepatitis B-related morbidity can be estimated by monitoring the incidence of hepatitis B-related ESLD and/or HCC in England. The previous method of only using HES data may under report hepatitis B as it relies on a diagnosis of hepatitis B being recorded in HES. Therefore, an updated method is presented this year which links HES to laboratory diagnoses of hepatitis B from SGSS and SSBBV. This approach presents a lower and new upper bound for the number of incident cases of hepatitis B-related ESLD and/or HCC, mirroring the approach used to report hepatitis B-related deaths (see Appendix 2. Technical notes, section 4 for more details on methodology).

The previously used method (lower bound) represents incident cases of ESLD and/or HCC that linked to an episode of hepatitis B in HES from any year. The upper bound represents incident cases of ESLD and/or HCC that linked to an episode of hepatitis B in HES or a laboratory diagnosis of hepatitis B from any year (see Figure 14). These methods were applied to data from 2010 to 2024 to give a full time series using the new approach. In 2024, the upper bound was 826 first presentations to hospital with hepatitis B-related ESLD and/or HCC which is lower than in 2023 (841) (see Figure 14). A similar pattern is seen for the lower bound estimate, with 681 cases in 2024 compared to 720 in 2023.

As most adults clear acute hepatitis B infection it is likely that most hepatitis B diagnoses recorded after an episode of ESLD and/or HCC represent longstanding chronic hepatitis B infections acquired at birth or in early childhood and as such contributed to the ESLD or HCC. To account for the possibility that a hepatitis B diagnosis made after an episode of ESLD or HCC was from an infection acquired after the episode of ESLD or HCC a sensitivity analysis was conducted. The sensitivity analysis restricted later hepatitis B diagnoses to those up to 1 year, 3 years, and 5 years after an episode of ESLD and/or HCC. These scenarios slightly reduced the numbers but showed a similar pattern to the upper and lower bound estimates (see Figure 14).

Figure 14. Incidence of hepatitis B-related ESLD and/or HCC in England, 2010 to 2024 calendar year [note 18][note 19][note 20]

Source: HES, NHSE Produced by UKHSA (copyright © 2025, re-used with the permission of the NHSE, all rights reserved), SGSS, SSBBV.

Note 18: estimates of incidence of hepatitis B-related ESLD and/or HCC are not available for 2017 and 2018. This is due to an interruption in the supply of identifiers by NHS Trusts in tax year April 2017 to March 2018.

Note 19: 2024 data is provisional. Data based on HES as of September 2025.

Note 20: defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy, or hepatic failure.

2.3.2 Hepatitis B-related liver transplants

Between 2009 and 2023 first registrations for a liver transplant where post-hepatitis B cirrhosis or acute hepatitis B were given as either primary, secondary or tertiary indications for transplant fluctuated between 18 and 40 per year. Over this period, 426 patients had post-hepatitis B cirrhosis or acute hepatitis B reported as either the primary, secondary, or tertiary indication for a transplant. Over the same period, first liver transplants fluctuated between 13 and 33 per year with a total of 307 patients receiving a first liver transplant where post-hepatitis B cirrhosis and/or acute hepatitis B or hepatitis B-related HCC were reported as primary, secondary or tertiary indication at registration or transplant. The percentage of all first liver transplants that were due to hepatitis B has been between 2.0% and 4.8% since 2009 (Figure 15).  (See Appendix 2. Technical notes, section 5 for more details on methodology).

Figure 15. Number of hepatitis B-related liver transplant registrations and transplants, England, 2009 to 2023 calendar year [note 21][note 22][note 23][note 24]

Figure 15a.

Figure 15b.

Source: NHSBT UK Transplant Registry. These figures are based on registry data as of January 2024 and include both elective and urgent registrations.

Note 21: hepatitis B status was ascertained by interpreting results for the following HBV markers: HBV DNA, HBsAg and HBeAg.

Note 22: number of first registrations for a liver transplant where post-hepatitis B cirrhosis or acute hepatitis B were given as either primary, secondary or tertiary indications for transplant.

Note 23: first liver transplants undertaken where post-hepatitis B cirrhosis and/or acute hepatitis B or hepatitis B-related HCC were given as primary, secondary, or tertiary indication for transplant at registration and transplant.

Note 24: first liver transplants undertaken where post-hepatitis B cirrhosis or acute hepatitis B or hepatitis B-related HCC were given as primary, secondary, or tertiary indication for transplant at registration and transplant as a percentage of all liver transplants.

2.4 Proportion of people with chronic hepatitis B diagnosed and aware of their infection

Using methodology recommended by WHO on estimating the proportion of people diagnosed, the prevalence in 2021 has been selected as the baseline year as it is the last year a census was conducted giving the most accurate population estimate used for prevalence calculation.

The number of people diagnosed with hepatitis B between 1998 (the earliest year available in surveillance data) and 2020 who are still alive and likely to still be resident in England was estimated using an experimental methodology linking laboratory-confirmed reports of hepatitis B diagnoses (HBsAg) reported to UKHSA to NHS healthcare activity data sets and ONS death registrations. All laboratory-confirmed reports of hepatitis B diagnoses from NHS or private laboratories in England, excluding reported acute infections, were linked to the ONS death registrations to remove people who are known in England to have died prior to 2021. Remaining records were linked to the NHS Personal Demographic Service (PDS) to map an individual’s current region of residence and linked to HES to identify those who have engaged with secondary care for any reason after 31 December 2017 as a proxy indicator for still residing in England in the baseline year. Diagnoses made from 2021 onwards were then added to those prior to 2021 to estimate the total proportion of people from the baseline year who have been diagnosed. (See Appendix 2. Technical notes, section 6 for more details of methodology.)

Between 1998 and 2024, 178,577 individuals had a diagnosis of hepatitis B (HBsAg) reported to UKHSA. After excluding people who have died, have a recorded address outside England or have no evidence of still residing in England from 2018 onwards, 117,079 individuals were estimated to be living with diagnosed hepatitis B in England between 2019 and 2024. This represents 43.6% of the 268,767 people estimated (using the methodology described above) to be living with chronic hepatitis B; 37.0% for London and 41.9% outside London. Figure 16 shows the cumulative proportion diagnosed since 2021, with an increase from 31.1% (83,676) in 2021 to 43.6% (117,079) in 2024, a 34.3% increase for London and 33.3% for outside London.

Based on this trajectory it will take more than 10 years to achieve the WHO goal of 90% diagnosed. If England is to achieve the goal by the 2030 commitment new diagnoses will need to increase to approximately 25,000 per year for the next 5 years.

Figure 16. Estimated proportion of people living with chronic hepatitis B who have been diagnosed, England, 2021 to 2024 calendar year

Source: ONS census and deaths data, SGSS, SSBBV, HES, NHS Personal Demographics Service.

2.5 New laboratory confirmed diagnoses of hepatitis B in England

England’s laboratory-confirmed reports of HBV infection received through SGSS have steadily climbed over 20 years, driven by improvements in awareness, diagnostics, reporting (including mandatory) and targeted testing (see Appendix 2. Technical notes, section 7 for more details). New diagnoses have increased during 2023 and 2024 with 11,910 new diagnoses in 2023 and 12,566 in 2024, exceeding the previous peak of 11,406 new diagnoses in 2016 (see Figure 17).

Figure 17. Number of new laboratory diagnoses of hepatitis B, England, 1999 to 2024 calendar year

Source: SGSS.

2.5.1 Location of testing of hepatitis B diagnoses

This increase in new diagnoses is due in part to the introduction of the BBV ED opt-out testing programme in selected sites (in areas of high HIV diagnosed prevalence) since 2022, however testing in primary care and other hospital settings continues to be where the majority of hepatitis B diagnoses are made (see Figure 18). Since the start of the ED opt-out programme in 2022, approximately 11% of new hepatitis B diagnoses where testing location is known have been made in EDs. Data presented in this report for new hepatitis B diagnoses includes all ED sites and differs to those published in the 33-month public health evaluation of BBV opt-out testing in EDs in England (see the report for more information on those tested and diagnosed through the programme).

Figure 18. Proportion of new hepatitis B diagnoses by test location [note 25], England, 2016 to 2024 calendar year

Source: SGSS.

Note 25: ‘other’ includes mental health services, community healthcare, occupational health services, care or residential homes, university, and fertility clinics.

2.5.2 Age and sex distribution of hepatitis B diagnoses

Between 1999 and 2024, males consistently comprised on average 55.5% (range 49.6% to 60.8%) of people diagnosed.

There has been an increase in average age at diagnosis. In 1999, 59.3% of diagnoses occurred in individuals 35 years and under and this has steadily decreased to 30.4% in 2024 (see Figure 19).

Historically, among females there was much higher proportion of diagnoses amongst those aged 35 years and under compared with other age groups, likely in part due to hepatitis B screening in pregnancy, although that proportion has decreased over time. Among females, the proportion of new diagnoses that were among people 34 years and under decreased from 71.0% in 1999 to 33.4% in 2024, with the proportion of males newly diagnosed aged 34 years and under dropped from 52.6% to 28.4% over the same period.

Figures 19a and 19b. Number of new hepatitis B diagnoses by age group, sex and year, England, 1999 to 2024 calendar year

Figure 19a.

Figure 19b.

Source: SGSS.

2.5.3 Ethnicity distribution of hepatitis B diagnoses

An estimated 95% of new chronic hepatitis B diagnoses in the UK are in migrants, who acquired HBV infection overseas in endemic countries, most often early in life. Data on ethnicity was available for 70.8% of laboratory reports of new diagnoses. Figure 20 shows that, between 1999 and 2024, of all laboratory reports where ethnicity was available, 27.8% of diagnoses were in people of Asian or Asian British ethnicity, followed by 27.2% of diagnoses among people of Black, Black British, Caribbean or African ethnicity.

Figure 20. Proportion of new hepatitis B diagnoses by ethnic group, England, 1999 to 2024 calendar year (shown in multiple charts)

Source: SGSS, HES.

2.5.4 Socioeconomic distribution of hepatitis B diagnoses  

Figure 21 presents the Index of Multiple Deprivation (IMD) distribution of people newly diagnosed with hepatitis B in England between 2018 and 2024.

Approximately 62.3% of new hepatitis B diagnoses over the 5-year period are in people residing in IMD quintile 1 and 2, the 2 most deprived IMD quintiles. This underscores the association between hepatitis B infection and socioeconomic deprivation, highlighting the disproportionate burden of the disease on socioeconomically disadvantaged communities.

Figure 21. IMD distribution of new hepatitis B diagnoses, England, 2018 to 2024 calendar year

Source: SGSS.

2.6 HBV testing and positivity

Analysis of data from 35 sentinel laboratories, available since January 2015, provides information on trends in testing activity (see Appendix 2. Technical notes, section 8 for further details). Overall, the number of individuals tested for HBsAg demonstrated a steady increase of 67% between 2015 and 2019, followed by a 30% decrease in 2020, associated with the COVID-19 pandemic. Since the COVID-19 pandemic, overall testing rates have recovered, peaking in 2024 with 980,285 tests. The overall increase in testing in 2022 to 2024 is partly due to the scale-up of opt-out testing in EDs. In 2024, 49.3% of HBV tests were done in EDs compared to 8.3% in 2019. Whilst this recovery is seen across many settings, testing in prisons has declined and remains 62% lower in 2024 than 2019.  Between 2023 and 2024 there was underreporting of hepatitis B testing data from a sentinel laboratory which undertakes a large proportion of testing for drug treatment services making it difficult to monitor trends in drug treatment services over this period.

Test positivity remained stable throughout this period, ranging from 1.02% in 2015 to 0.73% in 2024. This suggests a consistent testing focus on people at increased risk of exposure to hepatitis B, despite overall fluctuations in volumes of testing.

Throughout this period, the largest proportion of tests were conducted among people aged 35 to 64 years, representing 45.5% to 50.1% of those tested each year. Higher positivity rates were identified in individuals aged 35 to 64 years, ranging between 1.0% and 1.3%, compared to positivity in individuals aged 35 years and under ranging between 0.6% and 1.0% and individuals 65 years and over ranging between 0.3% and 0.5%.

Individuals tested in SHS were younger with the majority (58.7% to 65.0%) of tests conducted among those aged 15 to 34 years, with a similar age distribution of tests conducted in prison. Whilst a higher proportion of men tested in SHS, drugs services, renal services and prisons compared to women, a higher proportion of women tested through general practitioners (GPs). Positivity was generally higher in males.

Regardless of testing service, the highest proportion of HBsAg tests were conducted among people of White ethnicity. However, overall, positivity rates were highest for those of Black, Black British, Caribbean or African ethnicity; this was especially highlighted in GP settings where positivity in this group reached over 3%. Those of White ethnicity had the lowest positivity across the majority of settings.

2.7 Hepatitis D testing and diagnosis

Hepatitis D is caused by the hepatitis D virus (HDV), and only occurs in people who are also living with hepatitis B. Coinfection of both HDV and HBV can cause the most severe form of chronic viral hepatitis due to more rapid progression towards cirrhosis, HCC and liver-related death. The most common routes of transmission are exposure to the blood of a person living with hepatitis D, either directly or via blood products. National Institute of Health and Care Excellence (NICE) guidelines state that a test for HDV antibodies should be arranged following a HBsAg positive diagnosis. The most recent data in HDV testing and diagnosis is available in the Hepatitis B in England 2024 report.

2.8 Monitoring access to hepatitis B treatment

Entecavir and tenofovir disoproxil fumarate (TDF) are the primary recommended options for people in whom antiviral treatment is indicated and although a national comprehensive treatment monitoring system has not yet been established, IQVIA  (data science and clinical research company) collects data on antiviral prescriptions dispensed in secondary care pharmacies in England from which numbers receiving treatment for hepatitis B can be estimated.

Volume data (number of packs) was extracted from IQVIA for entecavir (0.5mg or 1mg once daily) and for TDF (245mg once daily) between 2020 and 2024. The number of doses was estimated by number of packs provided by IQVIA. We identified any single use of TDF as indicating hepatitis B treatment. It is important to note that these estimates are based on aggregated data and do not account for people receiving combination therapies, such as people living with both HIV and hepatitis B or people receiving treatment for hepatitis B alongside receiving HIV PrEP (see Appendix 2. Technical notes, section 9 for further details).

The average number of prescriptions (which equates to packs) per year between 2020 and 2024 was 74,599 units for entecavir and 121,156 units for tenofovir disoproxil. Numbers of prescriptions increased between 2020 and 2024 from 54,624 to 94,706 units for entecavir and from 116,022 to 130,192 units for TDF. Between 2020 and 2024, an estimated annual average of 6,131 individuals were treated with entecavir (see Figure 22) and 9,958 individuals treated with TDF (see Figure 23). Between 2020 and 2024 the estimated number of individuals treated with entecavir increased from 4,489 to 7,784 and from 9,536 to 10,700 for TDF. For London, an estimated annual average of 3,000 individuals were treated with entecavir and 4,430 with TDF; outside London the estimated numbers were 3,130 and 5,527 individuals, respectively.

Figure 22. Estimated number of people treated for hepatitis B with entecavir, England, 2019 to 2024 calendar year

Source: Secondary care usage within NHS hospitals, IQVIA Hospital Pharmacy Audit (HPA) May 2024.

Figure 23. Estimated number of people treated for hepatitis B with tenofovir disoproxil fumarate, England, 2019 to 2024 calendar year

 Source: Secondary care usage within NHS hospitals, IQVIA HPA May 2024.

As this prescription data is not linked to individual patients it cannot be used to estimate treatment coverage based on eligibility in current guidelines. Data from the HIC viral hepatitis and liver disease theme have been used to estimate treatment coverage against a range of treatment guidelines. Longitudinal cohort data from 6 secondary care centres providing hepatitis B care to 7,558 adults in England were reviewed, with 27% having a record of antiviral treatment prior to April 2023.

With changes in hepatitis B treatment guidelines which relax eligibility criteria, an increasing proportion of the population is estimated to become treatment eligible. Based on the updates to WHO guidelines, (closely mirrored by European Association for the Study of the Liver (EASL) recommendations), to offer hepatitis B treatment to everyone with a viral load greater than 2,000 IU per ml and alanine aminotransferase (ALT) above the upper limit of normal, 42% of the population living with diagnosed hepatitis B were predicted to be treatment eligible in the study cohort. This is likely to be an underestimate of the proportion who should be offered treatment, as this data framework does not capture all eligibility criteria (including factors such as comorbidities, coinfection, family history, and patient preference). Notably, treatment was less likely in people living in the most deprived areas, thus further exacerbating the health inequality due to a disproportionate burden of infection among socioeconomically deprived communities.

2.9 Hepatitis Infection Paediatric Surveillance Network (HIPSNet) (enhanced surveillance of childhood hepatitis B)

UKHSA has conducted enhanced surveillance of hepatitis B amongst children since 2017; in 2022 the HIPSNet network was established to improve enhanced surveillance for hepatitis B in individuals aged 18 years and under in collaboration with clinicians. The enhanced surveillance programme aims to collect detailed epidemiological and clinical information on childhood hepatitis B to evaluate the effectiveness of the childhood immunisation programme and to monitor trends, clinical management and outcomes in children diagnosed with hepatitis B.

Data is collected through the completion of enhanced surveillance questionnaires and clinical baseline forms completed by the child’s GP and paediatric specialist, respectively. Between November 2017 to March 2025, UKHSA has been notified of 651 cases of childhood hepatitis B in England, including 171 now aged over 18, and has received 364 enhanced surveillance questionnaires and 123 clinical baseline forms. 72.2% (470 out of 651) of the children reported have been confirmed to be under the care of a paediatric specialist.

The median age of children at the time of notification was 16 years, with 70.2% being male. The highest numbers of reports came from London and the West Midlands, accounting for 24.1% and 14.9% of cases, respectively. Of the children with completed enhanced surveillance forms, 69.8% (254) are known to have been born outside of the UK, with Sudan and Afghanistan being the most common countries of birth.

The most common reason for testing reported by GPs was due to the child being a new arrival to England (31.0%), followed by mother-to-child transmission of hepatitis B (30.5%). Similarly, the most reported routes of transmission were the child known to be at risk of mother-to-child transmission of hepatitis B (32.4%), followed by household contact with a person (other than the mother) living with hepatitis B (14.8%).

Of the children with clinical baseline forms completed, 53.7% were HBeAg positive, 39.0% were HBeAg positive but anti-HBe antibody negative, whilst only 6.5% (8 out of 123) were positive for both HBeAg and anti-HBe.

10.6% (13 out of 123 baseline forms) had responded that the child was on treatment, 90 responded that the child was not on treatment and 20 were unknown. Of those children on treatment, the most common were entecavir (7 out of 13) followed by peginterferon alfa (3 out of 13).

Members of HIPSNet meet quarterly to discuss current trends and guidance related to paediatric hepatitis B management in England. Members can review epidemiological and clinical data for their hospital on the HIPSNet dashboard and compare this to national data. Data is used to ensure linkage to care, monitor demand on services and drive improvements in testing and treatment.

3. Current and planned work

The Hepatitis B in England 2024 report set out the current and planned work which could support progress towards achieving and evidencing elimination of hepatitis B as a public health problem. Progress updates against each of these areas is summarised below along with further areas for development.

3.1 Maintaining elimination of mother-to-child transmission

3.1.1 Planned work from 2024

Improving uptake of post-vaccination serological testing; evidencing seroprevalence of hepatitis B amongst children aged 5 years and under.

3.1.2 Progress update

In the past year, PVST coverage has increased by 5% (from 78% to 83%) partly due to the introduction of a domiciliary service in London. UKHSA is undertaking an analysis to further understand inequalities associated with DBS completion, which could be used to support focused interventions amongst population groups with lower completion rates. UKHSA has discussed alternative approaches to monitor seroprevalence in children aged 5 years and younger in the absence of a population seroprevalence study with WHO. These approaches include the use of modelled estimates based on current elimination of mother-to-child transmission surveillance data, as well as undertaking focused seroprevalence studies in populations at higher risk of mother-to-child transmission, such as people seeking asylum and population groups with lower DBS completion rates as identified through UKHSA analyses.

3.1.3 Further activity

Once completed, the findings from the analysis exploring inequalities associated with DBS completion will be used to inform a quality improvement project and an IDPS task and finish group, co-chaired by the NHSE Antenatal and Newborn Screening Programme and UKHSA. This group will explore opportunities to improve PVST completion and vaccination reporting and consider potential changes to the screening pathway following recent changes to hepatitis B treatment guidelines.

3.2 Preventing new infections

3.2.1 Planned work from 2024

Improving hepatitis B vaccine uptake amongst key populations; increasing awareness of hepatitis B among healthcare workers.

3.2.2 Progress update

UKHSA continue to work with NHSE on integrating prison healthcare data into routine surveillance. Data on vaccine uptake in SHSs remains challenging as GUMCAD STI Surveillance System data is de-personalised, and records cannot be linked across services. Recently published survey and seroprevalence data from GBMSM show high levels of self-reported vaccine uptake and seroprevalence of immunity to HBV. As part of the ED opt-out BBV testing programme, a range of materials were developed to increase BBV knowledge amongst healthcare professionals including printed information sheets and videos. The Royal College of General Practitioners (RCGP) e-learning course on hepatitis B and C, which is supported by UKHSA, continues to be a valuable, free-to-access training resource for healthcare professionals and has been accessed 860 times since being updated in August 2023.

3.2.3 Further activity

Seroprevalence data on hepatitis B immunity amongst GBMSM is not geographically representative with samples predominantely from London. Efforts will be made this year to recruit additional laboratories to provide a more geographically representative sample. Work is ongoing to improve vaccine reporting from prisons and enable data linkage from prisons healthcare data to UKHSA surveillance data.

3.3 Prevalence, testing and diagnosis

3.3.1 Planned work from 2024

Improving estimates of hepatitis B prevalence and the proportion of people living with hepatitis B that are undiagnosed; evaluating interventions to increase diagnosis and linkage to care.

3.3.2 Progress update

Modelling work is underway through the NIHR HPRU in Evaluation and Behavioural Science (a partnership between the University of Bristol, UKHSA and the University of Cambridge) to produce new estimates of the prevalence of hepatitis B in England. UKHSA has developed new estimates of the proportion of people living with hepatitis B who have been diagnosed. A systematic review on strategies to increase hepatitis B diagnosis and improve linkage to care has been completed and will be published.

3.3.3 Further activity

Modelling studies to evaluate the effectiveness of different intervention strategies for increasing diagnosis of hepatitis B are being taken forward by academic partners through the NIHR Health Protection Research Unit in Evaluation and Behavioural Science. UKHSA is developing a pilot study utilising home sampling testing kits for household contacts of people newly diagnosed with hepatitis B. The pilot will be evaluated to understand whether home sampling is effective at improving testing rates, as well as onward referrals for vaccination or care where appropriate.

3.4 Linkage and retention in care

3.4.1 Planned work from 2024

Developing new models of care including tools for monitoring the cascade of care; piloting a hepatitis B dashboard.

3.4.2 Progress update

In response to the large number of new hepatitis B diagnoses from the ED opt-out testing programme, NHSE London established a hepatitis B pathways task and finish group in January 2024. The group included representation from people with lived experience, voluntary sector organisations, commissioners, clinicians, allied health professionals and UKHSA. UKHSA is exploring opportunities to collaborate with the HIC Viral Hepatitis and Liver Disease theme to utilise anonymised clinical data from people living with hepatitis B to estimate treatment coverage and retention in care. UKHSA has developed the first version of a national hepatitis B dashboard which includes data on new diagnoses and test positivity by integrated care board (ICB) and local authority areas. The dashboard is currently being piloted with a range of stakeholders. Hepatitis B metrics have also been added to the UKHSA dashboard providing an overview of progress towards achieving elimination.

3.4.3 Further activity

The NHSE hepatitis C elimination programme has now been expanded to include hepatitis B and a viral hepatitis elimination programme oversight board has been established. NHSE has also launched a series of time-limited hepatitis B working groups to review with stakeholders, including UKHSA, current care pathways and opportunities for improvements across peer support, close contact vaccination, primary care, pharmacy and secondary care. Over the coming 5 years, the HPRU in Evaluation and Behavioural Science at the University of Bristol will be exploring funding opportunities for modelling the relative contribution and cost effectiveness of different case finding, linkage to care, and treatment delivery models required to achieve elimination.

3.5 Reducing mortality

3.5.1 Planned work from 2024

Defining a new national target to reduce hepatitis B-related deaths.

3.5.2 Progress update

UKHSA held a hepatitis B deep dive round table in September 2024, bringing together a range of stakeholders across the UK including public health professionals, clinicians and civil society, as well as hepatitis leads from WHO. The recommendation to define a more ambitious national hepatitis B mortality target was discussed at this meeting and consensus was reached not to set this additional target until further progress has been made towards the programmatic targets for diagnosis and treatment as improvements in these areas will impact mortality. UKHSA has conducted an analysis to evaluate the impact of underreporting of hepatitis B mortality using ONS death registration data. The findings from this evaluation have led to a change in the methodology for estimating mortality which has been used for this report.

3.5.3 Further activity

While an additional national target for hepatitis B-related mortality has not been set, UKHSA will continue to analyse hepatitis B-related outcomes and deaths including work to estimate the proportion of ESLD and HCC deaths attributable to hepatitis B. UKHSA is also exploring late diagnosis of hepatitis B, which can lead to poorer health outcomes. This work will help to identify opportunities for earlier diagnosis and treatment, and to identify potential inequalities associated with late diagnosis.

3.6 Increasing equity

3.6.1 Planned work from 2024

Improving understanding of disparities associated with hepatitis B access to care and health outcomes; reduce hepatitis B-related stigma.

3.6.2 Progress update

In February 2025, UKHSA hosted a workshop on viral hepatitis stigma co-produced with people with lived experience. Discussions from this workshop have informed new studies, such as a survey of knowledge and attitudes of viral hepatitis amongst healthcare workers. UKHSA successfully applied for a PhD studentship with the University of Bristol to explore lived experience and stigma amongst people living with hepatitis B which started in January 2025. The new hepatitis B dashboard provides a breakdown of hepatitis B testing and diagnoses by demographics including ethnicity, age, gender and IMD at a ICB and local authority level.

3.6.3 Further activity

Research project proposals have been developed to investigate experiences of stigma, explore options for monitoring stigma, and to develop interventions to reduce stigma. The project proposals have been developed by UKHSA in collaboration with HPRU in Blood Borne and HPRU in Blood Borne and Sexually Transmitted Infections at UCL and the HPRU in Evaluation and Behavioural Science at the University of Bristol. These projects will run over the five-year duration of the HPRUs. Further work on monitoring treatment using NHIC data and potentially utilising new NHSE secure data environments will be explored to improve data on the care cascade and identify potential inequalities in access and retention in care.

Appendix 1. HBV markers

Table 5. HBV markers and descriptions

HBV marker	Abbreviation	Description
Hepatitis B surface antigen	HBsAg	Marker of HBV infection. Can be detected in both the acute and chronic HBV infections.
Hepatitis B e antigen	HBeAg	Marker detected in the early phases of an acute infection and some chronic infections. Its presence is usually associated with high levels of virus replication.
Antibody to hepatitis B e antigen	Anti-HBe	Marker appears following HBeAg seroconversion and is detected in late acute and in chronic HBV infections. Its presence usually indicates lower levels of virus replication.
IgM antibody to hepatitis B core antigen	Anti-HBc IgM	Marker indicates recent HBV infection and can be used to differentiate between an acute and chronic infection. It may also be present during flares in chronic HBV infection.
Total antibody to hepatitis B core antigen	Total anti-HBc	Marker indicates current or past HBV infections.
Antibody to hepatitis B surface antigen	Anti-HBs	Marker indicates recovery and immunity to HBV infection. It is also detectable in those who have been immunised.
Hepatitis B virus DNA	HBV DNA	Marker measures viral load and indicates level of virus replication. Used to guide treatment decisions and to monitor response to antivirals.

Appendix 2. Technical notes

1. Prevalence of HBV infection

Prevalence estimates are generated utilising a method that employs laboratory surveillance data and population estimates from the 2021 census. HBV laboratory test data from pregnant women tested as part of antenatal screening is broken down by age and ethnicity, providing baseline estimates of prevalence. This data is assumed to be representative of women of childbearing age given the high uptake of antenatal screening. HBV laboratory test data from non-antenatal settings by sex, ethnic group and age group provides information on differences in prevalence, represented by the ratio of HBV positivity, applied to antenatal screening estimates. Population estimates by age, sex and ethnicity for England are used to extrapolate the number of people living with chronic hepatitis B. It is important to note that these estimates need to be corroborated as they assume that routine laboratory testing in non-antenatal settings can generate unbiased ratios.

2. Monitoring elimination of mother-to-child transmission

2.1 Monitoring screening coverage in the antenatal population

For IDPS HBsAg coverage, eligible women are the total number of pregnant females booked for antenatal care during the reporting period, or presenting in labour without previously having booked for antenatal care, excluding women who:

• miscarry between booking and testing
• opt for termination between booking and testing
• transfer out between booking and testing (where they do not have a result)
• transfer in who have a result from a screening test performed elsewhere in the NHS in this pregnancy

3. Monitoring vaccination in GBMSM in SHSs

3.1 Historical GBMSM vaccination coverage monitoring

In 2001, the Department of Health’s Strategy for Sexual Health and HIV introduced specific vaccination standards for men who have sex with men (MSM) to improve vaccination coverage in this group. A standalone enhanced surveillance system called HBV3 was introduced across all genitourinary medicine (GUM) clinics in England in 2003 which collected data on first dose and complete (3 dose) courses of vaccine among new MSM attendees. The survey ran from January 2003 to June 2008. Since then, vaccine data has been collected in GUMCAD.

3.2 Current GBMSM HBV vaccination monitoring

Current data on HBV vaccination coverage in GBMSM is collected through the GUMCAD STI Surveillance System (GUMCAD) which collects pseudo-anonymised patient level data on all STI diagnoses and services provided by all SHSs in England.

4. Monitoring hepatitis B-related morbidity associated with ESLD and HCC

4.1 Hospital admissions from hepatitis B-related ESLD and/or HCC

New cases of hepatitis B-related ESLD and/or HCC are monitored using HES for incidence of ESLD and HCC, and HES, SSBBV and SGSS for hepatitis B diagnoses.

This is a new method in 2025 which presents data as a sensitivity analysis with upper and lower bounds, mirroring the updated methodology for deaths from hepatitis B-related ESLD and/or HCC.

New cases are identified by first linking all episodes of ESLD and/or HCC in HES for an individual using their unique patient identifier. These are classified as ‘new’ if no previous episodes of ESLD and/or HCC for that individual are found in at least the previous 5 years (less than 1% of HCC and/or ESLD episodes are estimated to have had a previous episode more than 5 years earlier).

Linkage to hepatitis B diagnoses uses the following 3 methods:

1. Original (linked to episode of hepatitis B in HES for all years): first diagnosis of ESLD and or HCC linked to hepatitis B diagnosis in HES for any year. First diagnosis of ESLD and/or HCC used data from 2003 to 2024 to give minimum 5-year window for first episode starting at 2010. Hepatitis B diagnosis started from 1 April 2000 onwards. Hepatitis B includes both acute and chronic cases.
2. Linkage to diagnoses of hepatitis B in HES or surveillance data: all years (linked to earliest episode of HBV in HES, SGSS, SSBBV for all years, upper bound): first diagnosis of ESLD and or HCC linked to earliest diagnosis of hepatitis B in any of HES, SSBBV or SGSS. Acute cases of hepatitis B removed if they occurred during or after the year of ESLD and/or HCC incidence.
3. Linkage to diagnoses of hepatitis B in HES or surveillance data limited by year (linked to earliest episode of hepatitis B in HES, SGSS, SSBBV for up 1 year, 3 years or 5 years from first ESLD and/or HCC episode date): first diagnosis of ESLD and or HCC linked to earliest diagnosis of hepatitis B in any of HES, SSBBV or SGSS for limited years (1 year, 3 years and 5 years after the year of first ESLD and/or HCC diagnosis). Acute cases of hepatitis B removed if they occurred during or after the year of ESLD and/or HCC incidence.

Due to the loss of identifiers in HES data for 2017, data for 2017 and 2018 is omitted. Further information is available in the Technical notes for Hepatitis B in England 2024.

5. Registrations and liver transplant for hepatitis B-related disease given as the indication for transplant

A total of 426 first registrations in England between 2009 and 2023 had either post-hepatitis B cirrhosis or acute hepatitis B given as the primary, secondary or tertiary indication for a liver transplant. These cases may have also had other indications for a liver transplant including:

• primary biliary cirrhosis
• alcoholic cirrhosis
• post hepatitis C cirrhosis
• HCC non-cirrhotic
• HCC carcinoma cirrhotic
• autoimmune cirrhosis
• non-alcoholic fatty liver disease
• haemochromatosis
• primary liver sarcoma
• chronic Wilson’s disease
• other

Hepatitis B virus test markers were not available for registrations.

There was a total of 140 first liver transplants in England between 2009 and 2023 that had a code for post-hepatitis B cirrhosis and acute hepatitis B given as the primary, secondary, or tertiary indication at registration and/or transplant. These had no other indicators for a transplant. A number of these people also had a positive result for hepatitis B.

In addition, there were a total of 167 first liver transplants that had codes for HCC non-cirrhotic or HCC cirrhotic. These also had a positive result for hepatitis B and/or post-hepatitis B cirrhosis or acute hepatitis B as a transplant indicator. A small number of these people had additional indicators for transplant, which included:

• autoimmune cirrhosis
• secondary biliary cirrhosis
• alcoholic cirrhosis
• post hepatitis C cirrhosis
• non-alcoholic fatty liver disease
• other indicator not described

A positive hepatitis B result was described as a positive result for HBsAg and/or hepatitis B DNA and/or hepatitis B virus E-antigen.

Of the people who had post-hepatitis C cirrhosis, all had a negative or unknown result for hepatitis C ribonucleic acid (RNA). NHSBT transplant indicator codes are listed in previous hepatitis B reports.

6. Monitoring proportion of people with chronic hepatitis B diagnosed and aware of their infection

It is important to note that this data is experimental and should be treated with caution and is subject to change. Some individuals will have been diagnosed in England prior to comprehensive laboratory surveillance so are not included in diagnosed figures. Furthermore, those who fall into the undiagnosed fraction include a proportion of individuals who may have been diagnosed before residing in England and therefore may be aware of their status but have not engaged in care for their chronic hepatitis B resulting in a HBsAg test not being conducted and reported to UKHSA.

7. Testing and diagnosis: SGSS

Laboratory reports of new diagnoses of hepatitis B include positive test results for HBsAg and are submitted to UKHSA or predecessor organisations via SGSS. Mandatory reporting by laboratories of notifiable organisms started in 2010. 2024 data is provisional and figures for previous years are subject to change as a result of late reporting and the associated de-duplication procedure. Patient identifiable data submitted by NHS laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to deduplicate. Results for children under one year of age are excluded to rule out detecting maternal antibody.

8. Testing and diagnosis: SSBBV testing

Sentinel surveillance data is from 35 laboratories and is based on complete and consistent reporting for a 5-year period. This means that the numbers of laboratories included for trend data may change each year depending on their reporting history. Sentinel surveillance covers approximately 45% of all testing in the GP registered population. As sentinel surveillance includes the 2 laboratories processing DBS tests for the major drug services in England, it is likely that sentinel surveillance covers most tests coming from drug services, where DBS is the main method of testing.

Sentinel surveillance excludes samples collected outside routine testing such as look back studies, reference testing, and children aged one year and under. Patient identifiable data submitted by laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to de-duplicate. Data is de-duplicated subject to availability of date of birth, Soundex, NHS number and first initial. The proportion positive is calculated using number of individuals tested.

For antenatal testing only women aged 12 to 49 years old are included. Test request location and free text clinical field accompanying the test request are used to identify antenatal testing, not all women will have been correctly classified. Ethnicity is identified through linking to HES and is dependent on an individual having their NHS number reported as part of the test request.

Trend data does not reflect cumulative data as only locations that have consistently reported during the 5 years presented are included in trend data to remove any artificial changes in testing. The positive result is the first reported by participating laboratories and may not reflect an individual’s first diagnosis.

9. Monitoring hepatitis B treatment

Treatment data is subject to limitations which may over or underestimate true numbers of people on treatment. The data is anonymised and aggregated so we cannot deduplicate records and cannot account for individuals who commence, cease or switch treatments midway through a year. As there is no data on reason for prescription It is important to note that these estimates are based on aggregated data and do not account for people receiving combination therapies, such as people living with both HIV and hepatitis B or people receiving treatment for hepatitis B alongside receiving HIV PrEP. Furthermore, IQVIA data does not capture treatment eligibility so we can only estimate the numbers receiving treatment and not the proportion of those eligible, which is required for monitoring progress towards WHO elimination targets.

Acknowledgements

Authors: Maulik Ankolia, Eleanor Clarke, David Leeman, Sameera Lyons, Sema Mandal, Holly Mitchell, Claire Reynolds, Thomas Rimmer, Rachel Roche, Claire Sharp, Ruth Simmons.

Contributors: Simon Burton, Saira Butt, Annastella Costella, Jamie Crummy, Katy Davison, Monica Desai, Becky Haywood, Matthew Hibbert, Samreen Ijaz, Stephanie Migchelsen, Yasmin Mohammadi, Hamish Mohammed, Debbie Mou, Sarah Murdoch, Annabel Powell, Rajani Raghu, Panida Silalang, Justin Shute, Rhiannon Taylor.

We would also like to thank the clinicians, microbiologists, scientists, data analysts, public health practitioners, academics, commissioners, third sector organisations and other colleagues who have contributed insights and/or data to the surveillance and monitoring systems presented in this report, in particular:

• National Strategic Group for Viral Hepatitis
• NIHR HPRU in Blood Borne and STIs at UCL
• NIHR HPRU in Behavioural Science and Evaluation at University of Bristol
• NHS community, primary and secondary care services
• NHS Screening and Immunisation Teams
• community drug service staff and service users who support and participate in the UAM survey of people who inject drugs
• NHSBT
• HES, NHSE, produced by UKHSA (copyright © 2025, re-used with the permission of the NHSE, all rights reserved)
• ONS carried out the original collection and collation of the data but bears no responsibility for their future analysis or interpretation
• OHID
• National Drugs Treatment Monitoring System team
• staff who work in the laboratories and contribute to the laboratory surveillance of new diagnoses of hepatitis B (SGSS) and SSBBV
• NHS IDPS programme team (part of NHS Antenatal and Newborn Screening Programmes)
• ISOSS
• NHSE H&JRU
• NHSE Public Health Commissioning
• Royal College of General Practitioners
• WHO Global HIV, Hepatitis and STI Programmes