Research and analysis

Hepatitis B in London: 2024 report

Published 22 May 2025

Applies to England

Introduction

Hepatitis B virus (HBV) is a blood-borne virus that can cause an acute or chronic infection of the liver. Chronic infection can lead to liver cirrhosis, liver cancer, and even death.

Prevention and treatment efforts have been combined to combat HBV infection and progress towards elimination of HBV as a public health threat by 2030 (set out in the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis). The UK Health Security Agency (UKHSA) supported cross-agency expert advice group (National Strategic Group on Viral Hepatitis) has provided strategic direction and advice around viral hepatitis in England, supporting the achievement of the WHO HBV elimination goal.

UKHSA publishes a national report on the scale of HBV infection and related disease in England (Hepatitis B in England), presenting disease surveillance and programme data to support monitoring of England’s progress towards WHO HBV elimination targets.

This report complements the UKHSA Hepatitis B in England report and presents further information on HBV disease surveillance, trends in HBV diagnosis and testing and related diseases in London UKHSA region with data up to end of 2022. Although this report uses national data sources, regional figures may differ from the national figures for a given metric. For further details about data sources see Information on data sources.

Summary

Trends in HBV testing and diagnosis in the general population and risk groups

Main trends are:

• there have been 3,882 new laboratory reports of hepatitis B in residents of London, representing a rate of 43.8 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 42.4% between 2021 and 2022, and decreased by 2.1% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 2,385 (61.4%) and in females was 1,369 (35.3%); sex was unknown in 3.3% of cases
• the highest number of new laboratory reports was in males aged 35 to 44 and females aged 35 to 44 
• the number of new positive laboratory reports by upper tier local authority of residence ranged from 15 in Kensington and Chelsea and Richmond upon Thames to 484 in Camden; rates were highest in Camden at 222 new laboratory reports per 100,000 population and lowest in Hillingdon with 7 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.5 per 100,000 population. This was higher than the England average of 0.4 per 100,000 
• there were 169,970 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in London UKHSA region in 2022, of which 0.95% tested positive - the proportion positive was highest for tests referred through GP surgeries, through sexual health services and through drug services

Monitoring HBV-related morbidity

Main trends are:

• there were 3,970 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in London UKHSA region in 2022 which was higher than in 2021 
• the number of hospital admissions with a diagnosis code for hepatitis B-related end-stage liver disease (HBV-related ESLD) and hepatitis B-related hepatocellular carcinoma (HBV-related HCC) was 170 and 100 respectively in 2022

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in the London UKHSA region was 88.1% for 2022
• vaccine coverage of 3 doses at 24 months has increased by 0.9 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in the London UKHSA region was 73.4% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 0.2 percentage points between 2021 and 2022

Trends in hepatitis B testing and diagnosis in the general population and risk groups

New laboratory-confirmed diagnoses of HBV infection

Figure 1. Number of new laboratory reports of hepatitis B (acute and chronic), residents of London UKHSA region, 2013 to 2022

Data source: SGSS (Second Generation Surveillance System). For further information, see Information on data sources.

Figure 1 shows the number of new laboratory reports of hepatitis B in London from 2013 to 2022. In 2022, 3,882 new laboratory reports of HBV were reported in London. This is an increase in reports from the previous year, and the highest number since 2017. The number of reports in the period 2018 to 2022 is significantly lower than in the previous 5-year period.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of London UKHSA region and England, 2013 to 2022

Data sources: SGSS and Office for National Statistics (ONS) mid-year population Estimates (MYE). For further information, see Information on data sources.

Note 1: the error bands represent 95% confidence intervals

Figure 2 shows the trend in rate of new laboratory reports of hepatitis B in London per 100,000 residents compared to England overall. The rate of new laboratory reports of HBV in London in 2022 was 43.8 per 100,000 population, significantly higher than the national rate (16.4 per 100,000). The rate has been increasing since 2020, having previously been on a downward trend since 2016.

Table 1. Number of new laboratory reports of hepatitis B (acute and chronic) by UKHSA region of residence, 2013 to 2022

Area	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
East Midlands	380	392	281	407	577	594	536	343	427	559
East of England	638	660	638	675	619	515	617	497	513	655
London	3,964	5,913	5,597	6,691	4,900	2,867	3,326	2,543	2,726	3,882
North East	116	146	155	192	228	201	207	112	144	210
North West	1,107	1,011	781	764	718	833	1,125	752	800	777
South East	695	757	714	686	835	732	972	539	737	982
South West	308	353	385	434	573	446	371	351	552	702
West Midlands	796	792	859	890	892	854	871	559	629	869
Yorkshire and Humber	863	755	866	701	685	761	766	453	553	735
England [note 2]	8,883	10,786	10,279	11,443	10,028	7,803	8,791	6,150	7,081	9,371

Data source: SGSS. For further information, see Information on data sources.

Note 2: sum of all regional cases may not equal the number of England cases as some cases may not have been able to be assigned to a region.

Table 1 shows the numbers of new laboratory reports of hepatitis B for each region in England from 2013 to 2022. In 2022, London was the region with the highest number of laboratory reports, followed by the South East. Over the period 2013 to 2022, approximately half (47%) of reports in England were in London.

Table 2. Rate per 100,000 population of new laboratory reports of hepatitis B (acute and chronic) by UKHSA region of residence, 2013 to 2022

Area	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
East Midlands	8.3	8.4	6.0	8.6	12.1	12.3	11.1	7.1	8.7	11.3
East of England	10.2	10.5	10.0	10.5	9.6	7.9	9.4	7.6	7.7	9.8
London	47.0	69.2	64.6	76.5	55.8	32.5	37.4	28.7	31.0	43.8
North East	4.5	5.6	5.9	7.3	8.7	7.6	7.9	4.2	5.4	7.8
North West	15.6	14.2	10.9	10.6	9.9	11.4	15.3	10.2	10.8	10.3
South East	8.1	8.8	8.2	7.8	9.5	8.3	10.9	6.0	8.2	10.8
South West	5.7	6.5	7.0	7.9	10.3	8.0	6.6	6.2	9.7	12.2
West Midlands	14.0	13.9	14.9	15.3	15.2	14.5	14.7	9.4	10.6	14.4
Yorkshire and Humber	16.2	14.1	16.1	13.0	12.6	14.0	14.0	8.3	10.1	13.3
England	16.5	19.8	18.8	20.7	18.0	14.0	15.6	10.9	12.5	16.4

Data sources: SGSS and ONS MYE. For further information, see Information on data sources.

Table 2 shows the rate of new laboratory reports of hepatitis B per 100,000 residents for each region in England from 2013 to 2022. In 2022, London was the region with the highest rate, followed by the West Midlands. The rate for London was significantly higher than the rate for all other regions (43.8 per 100,000 vs. 7.8 to 14.4). Note: a significantly higher proportion of Londoners were born outside of the UK (where hepatitis B prevalence is generally higher), compared to the rest of England.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of London UKHSA region, 2022

Data source: SGSS. For further information, see Information on data sources.

Note 3: cases reported in children under one year old have been removed. A total of 175 hepatitis B cases in London region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Figure 3 shows the age-sex distribution of new laboratory reports of hepatitis B in London in 2022. The group with the most cases was males aged 35 to 44. In all age groups there were more cases in males than females, with males making up 64% of all reports where data on sex is available.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of London UKHSA region, 2013 to 2022

Data source: SGSS. For further information, see Information on data sources.

Note 4: this figure excludes cases of unknown ethnicity.

Figure 4 shows the proportion of new laboratory reports by ethnic group in London from 2013 to 2022. In 2022 the ethnic group with the highest percentage of hepatitis B reports was Black or Black British at 34%, followed by Any other White background (26%) and Asian or Asian British (24%). Data on ethnicity was available for 52% of laboratory reports of new diagnoses in 2022 (70% for 2013 to 2022).

Table 3. Number of new laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence [note 5], London UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Barking and Dagenham	83	146	131	125	111	102	113	72	91	100
Barnet	115	166	188	133	131	103	121	59	90	207
Bexley	41	43	42	46	32	32	39	20	33	52
Brent	99	230	218	307	199	113	108	58	60	145
Bromley	22	22	18	21	11	13	24	25	27	26
Camden	248	113	143	113	146	128	132	474	346	484
Croydon	150	126	133	106	88	45	115	87	90	94
Ealing	164	196	180	340	263	158	137	108	105	182
Enfield	191	232	207	191	186	209	208	122	140	278
Greenwich	140	131	98	101	123	107	87	71	84	114
Hackney and City of London	186	173	158	166	154	146	136	82	99	111
Hammersmith and Fulham	4	149	150	255	704	33	17	26	23	18
Haringey	113	221	217	232	171	154	139	77	76	143
Harrow	57	102	91	96	117	65	57	43	49	103
Havering	96	54	46	42	115	133	110	52	57	128
Hillingdon	58	97	141	145	101	78	62	40	34	22
Hounslow	48	113	137	255	155	31	51	27	46	61
Islington	84	95	109	109	66	43	40	28	42	63
Kensington and Chelsea	8	99	107	212	125	10	10	9	15	15
Kingston upon Thames	40	39	45	47	41	11	38	20	23	35
Lambeth	356	235	175	190	179	199	197	96	115	118
Lewisham	217	211	149	133	98	99	99	64	68	94
Merton	81	124	78	68	48	26	47	36	47	41
Newham	161	288	294	261	141	39	157	186	183	211
Redbridge	88	131	109	95	105	61	85	87	74	74
Richmond upon Thames	12	33	36	46	36	12	19	10	11	15
Southwark	332	267	217	249	183	190	160	85	111	140
Sutton	57	36	38	28	30	39	45	30	36	53
Tower Hamlets	404	216	156	171	113	16	124	147	152	192
Waltham Forest	123	177	175	166	92	33	108	102	87	97
Wandsworth	155	156	133	151	113	42	129	92	101	80
Westminster	25	144	179	326	168	28	40	14	31	30

Data source: SGSS. For further information, see Information on data sources.

Note 5: this table excludes cases where upper tier local authority was unknown.

Table 3 shows the number of new laboratory reports of hepatitis B (acute or chronic) in London by local authority from 2013 to 2022. In 2022 the local authority with the highest number of reports (484) was Camden; Barnet, Enfield and Newham also experienced more than 200 reports. 

There may have been issues with laboratory reporting (for example, completeness of patient postcode) in some areas of London leading to significant changes in the number of cases reported between years. It is important to note that laboratory testing arrangements are determined by the NHS commissioning process and therefore, the figures provided do not reflect the burden by laboratory catchment or geography.

Table 4. Rate per 100,000 population of new laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence [note 6], London UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Barking and Dagenham	42	73	64	59	52	47	52	33	42	45
Barnet	31	44	50	35	34	27	31	15	23	53
Bexley	17	18	17	19	13	13	16	8	13	21
Brent	31	70	65	90	58	33	31	17	18	43
Bromley	7	7	6	6	3	4	7	8	8	8
Camden	112	51	65	51	67	59	61	221	164	223
Croydon	40	33	35	28	23	12	29	22	23	24
Ealing	47	55	50	94	73	43	37	29	29	49
Enfield	59	71	63	57	56	63	62	37	42	85
Greenwich	53	49	36	36	44	37	30	25	29	39
Hackney and City of London	71	65	59	61	57	53	50	30	37	41
Hammersmith and Fulham	2	80	80	136	375	18	9	14	13	10
Haringey	43	82	80	84	62	56	51	29	29	55
Harrow	23	41	36	37	45	25	22	16	19	39
Havering	40	22	18	17	45	51	42	20	22	48
Hillingdon	20	33	48	49	34	26	20	13	11	7
Hounslow	18	42	50	92	55	11	18	9	16	21
Islington	40	44	50	49	30	19	18	13	19	29
Kensington and Chelsea	5	63	69	139	84	7	7	6	10	10
Kingston upon Thames	24	24	27	28	24	7	22	12	14	21
Lambeth	113	74	54	58	55	61	60	30	36	37
Lewisham	76	73	50	45	33	33	32	21	23	31
Merton	39	59	37	32	22	12	22	17	22	19
Newham	51	89	89	78	42	11	45	53	52	59
Redbridge	30	44	36	31	34	20	27	28	24	24
Richmond upon Thames	6	17	19	23	18	6	10	5	6	8
Southwark	112	89	71	81	60	61	51	27	36	45
Sutton	29	18	19	14	15	19	22	14	17	25
Tower Hamlets	150	78	55	59	39	5	41	48	49	59
Waltham Forest	46	65	64	60	33	12	38	37	31	35
Wandsworth	49	49	42	46	34	13	39	28	31	24
Westminster	12	67	83	153	80	13	19	7	15	14

Data sources: SGSS and ONS MYE. For further information, see Information on data sources.

Note 6: this table excludes cases where upper tier local authority was unknown.

Table 4 shows the rate per 100,000 residents of new laboratory reports for each local authority in London from 2013 to 2022. In 2022 the local authority with the highest rate was Camden with 222.7 reports per 100,000. The local authority with the lowest rate was Hillingdon (7.1 per 100,000).

However, as previously noted, laboratory reporting issues and testing arrangements may to some extent explain significant differences in rates and therefore, the figures provided do not reflect the burden by laboratory catchment or geography.

Acute or probable acute diagnoses of hepatitis B

Figure 5. Estimated incidence of acute or probable acute hepatitis B per 100,000 population by UKHSA region, 2022

Data sources: SGSS and ONS MYE. For further information, see Information on data sources.

Figure 5 shows the estimated incidence (per 100,000) of acute or probable acute hepatitis B in each region in England in 2022. London had the highest incidence of all regions at 0.52 per 100,000, followed by the West Midlands (0.50 per 100,000). Both London and the West Midlands were higher than the national rate (0.42 per 100,000).

Figure 6. Estimated incidence of acute or probable acute hepatitis B per 100,000 population, London UKHSA region and England, 2013 to 2022

Data sources: SGSS and ONS MYE. For further information, see Information on data sources.

Figure 6 shows the estimated incidence (per 100,000) of acute or probable acute hepatitis B in London and England from 2013 to 2022. The incidence rate in London has been on a downward trend since 2017 but remains above the national rate.

HBV testing in the wider population

Figure 7. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive in sentinel laboratories in London UKHSA region, 2013 to 2022

Data source: Sentinel Surveillance of Bloodborne Virus Testing. For further information, see Information on data sources.

Figure 7 shows the number of individuals tested for HBsAg in London, and the percentage positive from 2013 to 2022. In 2022 the number of individuals tested was 169,970. The number of individuals tested has been rising since 2020 when numbers fell to their lowest since 2015 likely due to the impact of the COVID-19 pandemic. Testing has been on a general upward trend since 2013. The percentage positive was 0.95% in 2022. This has been on a downward trend since 2013.

Figure 8. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through GP surgeries in sentinel laboratories in London UKHSA region, 2013 to 2022

Data source: Sentinel Surveillance of Bloodborne Virus Testing. For further information, see Information on data sources.

Figure 8 shows the number of individuals tested for HBsAg and proportion positive in London through GP surgeries in sentinel laboratories from 2013 to 2022. In 2022, the number of individuals tested was 26,007, and the percentage positive was 1.26%. The percentage positive has been on a downward trend since 2013, when it was 1.68%. The number of people tested is slightly lower in 2022 than during the 4 years before the COVID-19 pandemic.

Testing and diagnoses in sexual health services (SHS)

Figure 9. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through sexual health services in sentinel laboratories in London UKHSA region, 2013 to 2022

Data source: Sentinel Surveillance of Bloodborne Virus Testing. For further information, see Information on data sources.

Figure 9 shows the number of individuals tested for HBsAg in London through sexual health services in sentinel laboratories and proportion positive from 2013 to 2022. In 2022, the number of individuals tested was 12,505 and the percentage positive was 1.25%. The percentage testing positive has been on a downward trend since 2013 (2.51%). The number of people tested is slightly lower in 2022 than during the 4 years before the COVID-19 pandemic.

Testing and diagnoses in people who inject drugs and/or attend drug services

Figure 10. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through drug services in sentinel laboratories in London UKHSA region, 2013 to 2022

Data source: Sentinel Surveillance of Bloodborne Virus Testing. For further information, see Information on data sources.

Figure 10 shows the number of individuals tested for HBsAg and proportion positive in London through drug services in sentinel laboratories from 2013 to 2022. In 2022, the number of individuals tested was 5,008 and the percentage positive was 1.08%. The number of individuals tested at drug services has risen significantly since 2013 (52) and has now exceeded pre-pandemic levels.

Coverage of maternal hepatitis B surface antigen (HBsAg) testing

Due to the Infectious Disease in Pregnancy Screening (IDPS) programme recently changing how they report on regions, data is only available for the financial year (FY) 2021 to 2022. The coverage of hepatitis B antenatal screening in FY 2021 to 2022 is 131,902 eligible women, with 99.9% having been tested within the London NHS region.

Monitoring HBV-related morbidity

Hospital admissions from HBV

Figure 11. Number of hospital admissions [note 7] and admission rate per 100,000 population [note 8] for individuals with a diagnosis code for acute or chronic hepatitis B [note 9], residents of London UKHSA region, 2013 to 2022

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2024, re-used with the permission of the NHS England. All rights reserved. For further information, see Information on data sources.

Note 7: data has been suppressed in accordance with NHS disclosure control guidance for sub-national breakdowns. Numbers between 1 and 7 (inclusive) are suppressed and represented in the figure by asterisks (*). All other numbers are rounded to the nearest 5. Zeroes are unchanged. Due to data quality issues around HES identifiers, data has been omitted for 2017 and 2018 (grey box).

Note 8: rates have been calculated using ONS mid-year population estimates.

Note 9: hepatitis B is defined by ‘International Statistical Classification of Diseases and Related Health Problems 10th Revision’ (ICD-10) codes B16.0, B16.1, B16.2, B16.9, B18.0 and B18.1.

Figure 11 shows the count of hospital admissions and admission rate per 100,000 population for residents of London with a diagnosis code for acute or chronic hepatitis B between 2013 and 2022. 

There were 3,970 hospital admissions for London residents with a diagnosis code for acute or chronic hepatitis B in 2022, this was an increase of 7.6% from the previous year (2021: 3,690). The admission rate for London UKHSA region in 2022 was 44.8 per 100,000 population, this was significantly above the admission rate for England, which was 15.7 per 100,000.

Figure 12. Number of hospital admissions [note 10] for individuals with a diagnosis code for hepatitis B-related end-stage liver disease (HBV-related ESLD) or hepatitis B-related hepatocellular carcinoma (HBV-related HCC) [note 11], residents of London UKHSA region, 2013 to 2022

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2024, re-used with the permission of the NHS England. All rights reserved. For further information, see Information on data sources.

Note 10: data has been suppressed in accordance with NHS disclosure control guidance for sub-national breakdowns. Numbers between 1 and 7 (inclusive) are suppressed and represented in the figure by asterisks (*). All other numbers are rounded to the nearest 5. Zeroes are unchanged. Due to data quality issues around HES identifiers, data has been omitted for 2017 and 2018 (grey box).

Note 11: end-stage liver disease (ESLD) is defined by ICD-10 codes for ascites (R18), bleeding oesophageal varices (I85.0 and I98.3), hepato-renal syndrome (K76.7), hepatic encephalopathy (K72.9) or hepatic failure (K72.0, K72.1 and K70.4).

Hepatocellular carcinoma (HCC) is defined by ICD-10 code for hepatocellular carcinoma (C22.0).

Hepatitis B-related morbidity can be estimated by monitoring the incidence of hepatitis B-related end-stage liver disease (HBV-related ESLD) and/or hepatitis B-related hepatocellular carcinoma (HBV-related HCC) using Hospital Episode Statistics (HES). 

Figure 12 shows the count of hospital admissions for individuals with a diagnosis code for HBV-related ESLD or HBV-related HCC in London residents between 2013 and 2022. Data for 2017 and 2018 are missing. 

In 2022, HES analysis identified 270 people with a first presentation to hospital with HBV-related ESLD and/or HBV-related HCC: 170 people had a first presentation with hepatitis B-related ESLD and 100 people had a first presentation with hepatitis B-related HCC. The overall number represents a 42% increase from 190 people with a first presentation in 2013. The trend for ESLD appears upwards since 2013 whereas the trend for HCC appears stable since 2015.

Monitoring HBV-related mortality

Figure 13. Rate of deaths with ESLD [note 12] or HCC in those with HBV mentioned on their death certificate [note 13] by UKHSA region, 2018 to 2022

Data sources: ONS Mortality and ONS MYE. For further information, see Information on data sources.

Note 12: ESLD is defined by codes or text entries for ascites, bleeding oesophageal varices, hepato-renal syndrome, hepatic encephalopathy or hepatic failure. Patients were identified via ICD-10 codes and text searching.

Note 13: there were 10 missing postcodes between 2018 and 2022 and a further 7 deaths removed as patients’ residence was outside of England.

Figure 13 displays the rate of deaths with ESLD or HCC in people with acute or chronic hepatitis B mentioned on their death certification by region between 2018 and 2022 per 100,000 population.

Between 2018 and 2022, the mortality rate in London was 0.4 per 100,000 population, double the national rate of 0.2 per 100,000. London accounted for about half (50%) of deaths with ESLD or HCC in people with acute or chronic hepatitis B and therefore had the highest rate of deaths reported compared to other regions.

Prevention of infection by immunisation

Coverage of hepatitis B vaccine 3 doses (HepB3) in universal programme

Figure 14. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 12 months, London UKHSA region and England, FY 2019 to 2020 to FY 2022 to 2023

Data source: NHS Childhood Vaccination Coverage Statistics (COVER). For further information, see Information on data sources.

Universal hepatitis B immunisation using a hexavalent vaccine has been included in the routine childhood programme in England since late 2017. The WHO targets for reducing incidence include achieving vaccination coverage of at least 90% for all 3 vaccine doses in the universal infant programme.

In FY 2022 to 2023, the 3-dose vaccination coverage at 12 months of age for children in London was 88.3%. This is below the WHO target; however this was an increase of 1.5 percentage points from the previous year, FY 2021 to 2022 (86.8%). 

The percentage vaccine coverage in England in FY 2022 to 2023 at 12 months with 3 vaccine doses was 91.8% exceeding the WHO target of 90%.

Figure 15. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, London UKHSA region and England, FY 2020 to 2021 to FY 2022 to 2023

Data source: NHS COVER. For further information, see Information on data sources.

In FY 2022 to 2023 the vaccine coverage in London for children aged 24 months was 88.1%, this was an increase of 0.9 percentage points from the coverage in FY 2021 to 2022 (87.2%). The vaccine coverage in England in 2022-23 at 24 months with 3 vaccine doses was 92.6% exceeding the WHO target of 90%.

Coverage of hepatitis B vaccine 3 doses (HepB3) in selective programme

Table 5. Children at high risk of maternal transmission vaccinated against hepatitis B by their first birthday by upper tier local authority: vaccine coverage (5 doses routine and selective combined [note 14]) and eligible population, London UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Barking and Dagenham	38	34	89.47%
Barnet	29	29	100.00%
Bexley	12	12	100.00%
Brent	16	15	93.75%
Bromley	10	10	100.00%
Camden	10	9	90.00%
Croydon	34	33	97.06%
Ealing	25	24	96.00%
Enfield	26	21	80.77%
Greenwich	34	31	91.18%
Hackney and City of London	15	14	93.33%
Hammersmith and Fulham	13	13	100.00%
Haringey	23	20	86.96%
Harrow	28	24	85.71%
Havering	17	15	88.24%
Hillingdon	20	19	95.00%
Hounslow	20	19	95.00%
Islington	4	3	75.00%
Kensington and Chelsea	4	4	100.00%
Kingston upon Thames	5	5	100.00%
Lambeth	27	24	88.89%
Lewisham	29	26	89.66%
Merton	11	11	100.00%
Newham	46	44	95.65%
Redbridge	29	22	75.86%
Richmond upon Thames	7	7	100.00%
Southwark	34	29	85.29%
Sutton	8	8	100.00%
Tower Hamlets	10	9	90.00%
Waltham Forest	21	15	71.43%
Wandsworth	10	8	80.00%
Westminster	[note 15]	[note 15]	[note 15]

Data source: NHS COVER. For further information, see Information on data sources.

Note 14: babies received 2 monovalent vaccines (at birth and at 4 weeks), and 3 doses of hexavalent vaccines (at 8, 12 and 16 weeks).

Note 15: denotes that data is suppressed due to potential disclosure issues associated with small numbers.

Table 5 shows proportion of eligible infants who received 5 hepatitis B vaccine-containing doses as part of the selective (and routine) immunisation programme by 12 months of age and London local authority in FY 2022 to 2023. Only 8 of the 32 (25%) local authorities in London achieved 100% coverage of the eligible infant population, the percentage coverage by local authorities ranged from 71% to 100%.

Table 6. Children at high risk of maternal transmission vaccinated against hepatitis B by their second birthday by upper tier local authority: vaccine coverage (6 doses routine and selective combined [note 16]) and eligible population, London UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Barking and Dagenham	36	23	63.89%
Barnet	27	18	66.67%
Bexley	20	19	95.00%
Brent	31	28	90.32%
Bromley	15	11	73.33%
Camden	10	8	80.00%
Croydon	36	36	100.00%
Ealing	29	26	89.66%
Enfield	57	31	54.39%
Greenwich	28	22	78.57%
Hackney and City of London	15	15	100.00%
Hammersmith and Fulham	9	8	88.89%
Haringey	22	9	40.91%
Harrow	13	10	76.92%
Havering	29	26	89.66%
Hillingdon	32	28	87.50%
Hounslow	24	21	87.50%
Islington	12	9	75.00%
Kensington and Chelsea	8	6	75.00%
Kingston upon Thames	6	6	100.00%
Lambeth	19	13	68.42%
Lewisham	30	25	83.33%
Merton	9	9	100.00%
Newham	53	33	62.26%
Redbridge	21	12	57.14%
Richmond upon Thames	7	6	85.71%
Southwark	38	29	76.32%
Sutton	7	7	100.00%
Tower Hamlets	16	13	81.25%
Waltham Forest	16	14	87.50%
Wandsworth	10	9	90.00%
Westminster	6	5	83.33%

Data source: NHS COVER. For further information, see Information on data sources.

Note 16: babies received 3 monovalent vaccines (at birth, 4 weeks and 12 months), and 3 doses of hexavalent vaccines (at 8, 12 and 16 weeks).

Note 17: denotes that data is suppressed due to potential disclosure issues associated with small numbers.

Table 6 shows coverage of eligible infants who received 6 hepatitis B vaccine-containing doses as part of the selective (and routine) immunisation programme by 24 months of age by London local authority in FY 2022 to 2023. Only 5 of the 32 (16%) local authorities in London achieved 100 % coverage of the eligible infant population, the percentage coverage by local authorities ranged from 41% to 100%.

Vaccine uptake in people who inject drugs

Figure 16. Reported level of hepatitis B vaccine uptake among people who inject drugs (PWID), London UKHSA region, 2013 to 2022

Data source: Unlinked Anonymous Monitoring (UAM) survey. For further information, see Information on data sources.

PWID are at increased risk of acquiring HBV and vaccination is therefore recommended for this population and their close contacts.

Figure 16 shows data from the Unlinked Anonymous Monitoring (UAM) Survey for reported levels of hepatitis B vaccine uptake among people who inject drugs (PWID) in London and England between 2013 and 2022.

In 2022, the reported level of hepatitis B vaccine uptake among PWID in London was 73.4% and remains above the reported level in England (60.6%), however uptake in London has remained fairly stable since 2013 whilst it appears to have fallen in England overall since 2017. 

Between 2021 and 2022, the reported level of hepatitis B vaccine uptake among PWID decreased by 0.2 percentage points (2021: 73.6%) in London.

Prevention of infection by harm reduction

Figure 17. Reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks, London UKHSA region and England, 2013 to 2022

Data source: UAM survey. For further information, see Information on data sources.

Figure 17 shows the reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks in London and England between 2013 and 2022.

Direct sharing refers to self-reported sharing of needles and syringes among people who had injected in the 4 weeks preceding survey participation and indirect sharing refers to self-reported sharing of injecting equipment other than needles and syringes. 

The reported level of direct sharing of needles among PWID in London in 2022 was 10.0%, this is a decrease of 10 percentage points since the peak of 20.0% reported in 2019 and is significantly below the reported level in England in 2022 (19.5%). 

Between 2021 and 2022, the reported level of direct sharing of needles and/or syringes among PWID in London decreased by 3.1 percentage points (2021: 13.1%).

Figure 18. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID) in the preceding 4 weeks, London UKHSA region and England, 2013 to 2022

Data source: UAM survey. For further information, see Information on data sources.

Figure 18 shows the reported level of direct and indirect sharing of injecting equipment among PWID in the preceding 4 weeks in London and England between 2013 and 2022.

The reported level of direct and indirect sharing of injecting equipment among PWID in London in 2022 was 29.6%, this is an increase of 5.8 percentage points since the lowest reported level seen in 2017 (23.8%) but remains below the reported level in 2013 (36.1%) and in England in 2022 (38.9%). 

Between 2021 and 2022, the reported level of direct and indirect sharing of injecting equipment among PWID has increased by 0.3 percentage points (2021, 29.3%) in London.

Information on data sources

Second Generation Surveillance System (SGSS)

Brief description

SGSS captures routine laboratory surveillance data on infectious diseases and antimicrobial resistance from laboratories within England. Along with a number of other organisms hepatitis B is notifiable under the Health Protection (Notifications) Regulations (2010).

Technical notes

Laboratory reports of new diagnoses of HBV include positive test results for HBV surface antigen (HBsAg) and are submitted to UKHSA or predecessor organisations via SGSS/CoSurv.

Data includes laboratory reports for both acute and chronic hepatitis B infections and therefore cannot be used to estimate incidence.

Data is assigned to local authority and UKHSA region by patient postcode where present, if patient postcode is unknown, data is assigned to local authority and UKHSA region of registered general practice; where both patient postcode and registered general practice are unknown data is assigned to local authority and UKHSA region of laboratory.

Dates are assigned based on earliest positive specimen date.

Patient identifiable data submitted by NHS laboratories is variable, particularly from sexual health and drug and alcohol services, which limits the ability to deduplicate.

Laboratory reports for children under one year of age are excluded from the analyses to rule out detecting maternal antibody.

Rates per 100,000 have been calculated using mid-year population estimates supplied by the Office for National Statistics (ONS).

Caveat: SGSS data in this report may differ from data shown in the Hepatitis B in England report and from data reported in other surveillance outputs at a different point in time. This is due to the SGSS dataset being a live system and a number of cleaning, deduplication, remapping and other operational processes being routinely applied to the data to improve data quality.

HPZone

Brief description

HPZone is a case and outbreak management system used by the health protection teams (HPTs) in UKHSA. Cases of hepatitis A, B, C and E are stored on this system as well as a number of infections reported to the HPTs. 

This is a secure system used to capture where hepatitis B cases are acute and further risk factor data about these cases to inform public health action.

Hepatitis B case definitions using SGSS and HPZone data

The definition for acute hepatitis B is ‘HBsAg positive and anti-HBc IgM positive and abnormal liver function tests with a pattern consistent with acute viral hepatitis’. As information on liver function is not usually available to UKHSA, for the purpose of this analysis the following case definitions were used:

• cases classified as acute viral hepatitis B by the local UKHSA region or the laboratory and/or with a documented positive anti-HBc IgM were classified as acute cases 
• cases classified as acute viral hepatitis B by the local UKHSA region but without an anti-HBc IgM test result or not classified but a positive anti-HBc IgM reported were assumed to be probable acute hepatitis B cases 
• cases initially classified as acute by the local UKHSA region but with contradictory laboratory evidence were reclassified as chronic infections 
• cases classified as chronic infections or those not classified where anti-HBc IgM was negative or equivocal or missing were assumed to be chronic infections

The case definitions were derived using the following methodology: cases reported to UKHSA regions via HPZone were extracted from 1 January 2013 to 31 December 2022 and matched using identifiers to SGSS data. The SGSS data was used to determine final classification of any cases reported from the UKHSA region via HPZone. A final reconciled data set including cases classified as acute or probable acute was used for this report.

Sentinel Surveillance of bloodborne viruses (BBVs)

Brief description

The sentinel surveillance study of hepatitis, HIV and HTLV began in 2002 and provides information on testing, individual risk exposures and clinical symptoms. The study collects information on blood borne virus testing carried out in participating sentinel laboratories regardless of result. In 2022 there were 24 participating laboratories and at the time this report was produced there were 28 participating laboratories, some of the new laboratories would have provided legacy data if they were able to.

Technical notes

Excludes dried blood spot, oral fluid, reference testing and testing from hospitals referring all samples. Data is de-duplicated subject to availability of date of birth, Soundex and first initial.

Individuals under one year old are excluded from the analysis.

Regional and England data is aggregated data for all organisations who provided complete data for all 4 quarters. Data is assigned to UKHSA region by the location of the requesting testing site.

Infectious Diseases in Pregnancy Screening (IDPS)

Brief description

NHSE’s IDPS Programme has commissioned the Integrated Screening Outcomes Surveillance Service (ISOSS). ISOSS monitors pregnancies where the mother is screen positive or is already known to have hepatitis B. Monitoring is also conducted for HIV, syphilis as well as continuing monitoring cases of congenital rubella syndrome.

Technical notes

Published data can be found at Antenatal screening standards: data report 2020 to 2021.

Hospital Episode Statistics (HES)

Brief description

HES is a database containing details of all admissions, A&E attendances and outpatient appointments at NHS hospitals in England. This data is used to calculate the number of individuals per year that have a hospital admission related to hepatitis B associated end-stage liver disease (ESLD) or hepatocellular carcinoma (HCC). It is also used to calculate incidence of HBV-related ESLD and HCC.

Technical notes

Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2024, reused with the permission of the NHS England. All rights reserved. 

Data is based on Hospital Episode Statistics as at August 2024. 

Patients who have had more than one hospital episode with a diagnosis of HBV in any one year and who have moved residence within that year have been grouped into the UKHSA region of their latest hospital episode in that year. 

Hepatocellular carcinoma (HCC) is defined by ICD-10 code for hepatocellular carcinoma (C22.0). End-stage liver disease (ESLD) is defined by ICD-10 codes for ascites (R18), bleeding oesophageal varices (I85.0 and I98.3), hepato-renal syndrome (K76.7), hepatic encephalopathy (K72.9) or hepatic failure (K72.0, K72.1 and K70.4). 

Data for 2017 and 2018 has been omitted. This is due an interrupt in the supply of identifiers in the HES year April 2017 to March 2018 making it impossible to distinguish repeat hospital episodes for the same person within the same year, and thus determine the number of prevalent cases of HBV and HBV-related HCC/ESLD in 2017 and 2018.

Office for National Statistics (ONS) Mortality data

Brief description

Data from the Mortality and Birth Information System is used to calculate the number of deaths from end-stage liver disease (ESLD) or hepatocellular carcinoma (HCC) with hepatitis B mentioned on the death certificate. 

Technical notes

Published data about deaths can be found on the ONS website. 

Data on the number of deaths from ESLD and HCC in this report was identified by searching the ONS Mortality dataset using a combination of 2 methodologies described below, deaths that met either of these criteria were included in this report:

• searching for all causes of mortality using the following ICD-10 codes - ‘C220’, ‘R18’, ‘K767’, ‘K729’, ‘K720’, ‘K721’, ‘K704’, ‘I850’, ‘I983’
• searching all free-text variables for the following terms - “hepatocellular c%”, “primary liver c%”, “hcc”, “ascites”, “encephal%”, “liver failure”, “hepatorenal syndrome”, “hepatic failure”, “hepatic coma”, “bleeding o%”, “ruptured oesoph%”, “haemorrhage from oesoph%”, where ICD-10 codes ‘B160’, ‘B161’, ‘B162’, ‘B169’, ‘B181’, ‘B180’ were also reported on the death certificate

There has been no additional clinical review stage, as may be conducted on other UKHSA reporting for ESLD/HCC mortality, and therefore numbers may vary slightly from other reports.

Cover of Vaccination Evaluated Rapidly (COVER)

Brief description

The COVER programme is a quarterly data collection that started in 1987 with the aim of providing timely data. COVER data is extracted from Child Health Information Systems at the local authority level for children aged one, 2 and 5 years of age. Babies born to mothers with hepatitis B have been offered the hepatitis B vaccine from birth since the late 1980s. During autumn 2017 hepatitis B became part of the routine childhood immunisation schedule for all babies in a 6-in-1 vaccine.

Technical notes

Data from the Universal Programme:

• in FY 2019 to 2020, all children in the 12 month cohort were eligible for the DtaP/IPV/Hib/HepB (6-in-1) vaccination, which replaced the 5-in-1 vaccination
• this is the first year coverage is fully reported against the 6-in-1 vaccine for the 12 month cohort
• the DTaP/IPV/Hib (5-in-1) vaccine was replaced by the DTaP/IPV/Hib/HepB (6-in-1) vaccine in August 2017; therefore the 24 month age cohort in FY 2019 to 2020 (born in FY 2017 to 2018), will have received either the 5-in-1 or the 6-in-1 vaccination, depending on when in the year they were vaccinated
• from FY 2020 to 2021 onwards, all children in the 12 month cohort and 24 month cohort were eligible for the DtaP/IPV/Hib/HepB (6-in-1) vaccination, which replaced the 5-in-1 vaccination in 2017
• the DTaP/IPV/Hib (5-in-1) vaccine was replaced by the DTaP/IPV/Hib/HepB (6-in-1) vaccine in August 2017; therefore the 5 year age cohort in FY 2022 to 2023 (born in FY 2017 to 2018), will have received either the 5-in-1 or the 6-in-1 vaccination, depending on when in the year they were vaccinated
• all babies born on or after 1 January 2020 received their 1st dose of PCV at 12 weeks of age
• prior to this, PCV primary at 12 months was 2 doses administered at 8 and 16 weeks - FY 2021 to 2022 is the first year that coverage reported is based on the single dose primary course

Data from the Selective Programme:

• the ‘eligible population’ is the total number of children reaching their first birthday during the specified evaluation period with maternal Hep B positive status
• the ‘number of children vaccinated’ by their first birthday is total number of children from the eligible population receiving 2 monovalent HepB vaccines (at birth and one month) and 3 doses of hexavalent vaccine (at 8, 12 and 16 weeks) before their 1st birthday
• the ‘number of children vaccinated’ by their second birthday is total number of children from the eligible population receiving 3 monovalent HepB vaccines at birth, 4 weeks and 12 months, and 3 doses of hexavalent vaccine (at 8, 12 and 16 weeks) before their 2nd birthday
• small number suppression is carried out on data in this table, adhering to the following methodology; suppress all data (that is, eligible population, number vaccinated and coverage) where the eligible population is 1 or 2, and where the eligible population is greater than 2 and the number of children vaccinated is 0 or 1, suppress the number of children vaccinated and the coverage

Due to small number suppression, some local authorities had to be combined, therefore:

• Leicestershire also contains data for Rutland
• Hackney also contains data for City of London
• Cornwall also contains data for Isles of Scilly

More information can be found at Childhood Vaccination Coverage Statistics, England, 2022 to 2023.

Unlinked Anonymous Monitoring (UAM) Survey

Brief description

The voluntary UAM survey recruits people who have ever injected psychoactive drugs through specialist services (such as needle and syringe programmes and addiction treatment centres) across England, Wales and Northern Ireland. Those who agree to take part complete a questionnaire and provide a biological specimen that is tested anonymously for HIV, hepatitis B and hepatitis C.

Technical notes

Regional level data from the UAM survey should be interpreted cautiously as the survey recruits participants through a nationally reflective sample of the services provided to people who inject drugs.

Published regional-level data and more information can be found at People who inject drugs: HIV and viral hepatitis monitoring.

Acknowledgements

We would like to thank the following: 

• local laboratories for supplying the hepatitis data 
• the UKHSA Blood Safety, Hepatitis, STI and HIV Division for collection, analysis and distribution of data 
• the UKHSA Regions Data Science team for producing the figures and tables contained in this report
• the Office for National Statistics (ONS carried out the original collection and collation of the data but bears no responsibility for their future analysis or interpretation) 
• the Hospital Episode Statistics (HES), NHS England, produced by UKHSA

About Field Services

Field Services is a Division within UKHSA that provides a national service comprising geographically dispersed multi-disciplinary teams integrating expertise in Field Epidemiology, Public Health Microbiology, Rapid Investigation, Real-time Syndromic Surveillance, Field Epidemiology Training, and Data Science to strengthen the surveillance, epidemiological intelligence and response functions of UKHSA.

You can contact your local Field Services team at FES.SEaL@ukhsa.gov.uk

If you have any comments or feedback regarding this report or the Field Services, please contact FES.SEaL@ukhsa.gov.uk