Research and analysis

Hepatitis B in the East Midlands: 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 (the latest report for 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 East Midlands 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:

• 559 new laboratory reports of hepatitis B in residents of East Midlands, representing a rate of 11.3 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 30.9% between 2021 and 2022, and increased by 47.1% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 338 (60.5%) and in females was 220 (39.4%) 
• in 2022, the number of new laboratory reports in males was highest in those aged 35 to 44 and for females aged 25 to 34 
• in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 27 in Derbyshire to 96 in West Northamptonshire; rates were highest in Nottingham at 23.5 new laboratory reports per 100,000 population and lowest in Derbyshire with 3.4 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.1 per 100,000 population. This was lower than the England average of 0.4 per 100,000 
• there have been 28,517 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in East Midlands UKHSA region in 2022, of which 0.67% tested positive - the proportion positive was higher for tests referred through GP surgeries and drug services and lower for tests through sexual health services

Monitoring HBV-related morbidity

Main trends are:

• there have been 490 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in East Midlands UKHSA region in 2022 which was lower 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 25 and less than 8 respectively in 2022

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in East Midlands UKHSA region was 93.4% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 1 percentage point between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in East Midlands UKHSA region was 60.3% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 3.3 percentage points between 2021 and 2022

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

New laboratory-confirmed diagnoses of HBV

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

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

Figure 1 shows all new laboratory diagnoses of hepatitis B (including both acute and chronic) in East Midlands residents between 2013 and 2022.

Over the 10-year period there has been an increase (47.1%) in numbers of new diagnoses from 380 in 2013 to 559 in 2022. Increases, particularly over longer periods may be driven by a number of factors such as increased awareness, targeted testing, and improved reporting and diagnostics. Various initiatives to improve testing uptake may have influenced the increase in diagnoses. The introduction of Operational Delivery Networks (ODNs) and targeted work to increase blood-borne virus (BBV) testing (for hepatitis C, hepatitis B and HIV) for people most at risk of acquiring hepatitis C in financial year (FY) 2015 to 2016 could have positively influenced the general uptake of BBV testing over the proceeding years as these networks became more established and work towards elimination progressed.

During this time, however, there were 2 years where number of diagnoses fell. The second, between 2019 and 2020 (536 and 343 diagnoses respectively) is likely to be due to the fall in testing activity, also seen nationally, as an effect of the COVID-19 pandemic on services and how people were able to access them. The following increase in diagnoses from 2020 to pre-pandemic levels shows a pattern of recovery with people once again presenting to services that test for HBV. The renewed focus following the pandemic on elimination and the widening of initiatives to improve identification of new cases of hepatitis, for example, emergency department opt-out testing, may lead to further increases in diagnoses in future reports.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of East Midlands 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 compares the rate of new diagnoses per 100,000 population for East Midlands residents to that for England from 2013 to 2022.

Prior to 2018, the East Midlands had a lower rate than England. In 2018, the East Midlands and England had similar rates following an increase in the rate in the East Midlands and a fall in the England rate. From 2019 onwards both England and East Midlands followed a similar pattern of the fall in diagnoses due to the effect of the pandemic followed by the increase showing a recovery in activity.

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 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 1 shows the number of new laboratory reports of HBV for each region of residence and England between 2013 and 2022. Table 2 shows the rates per 100,000 population for each region of residence and England over the same period.

London consistently has the highest number and rate of diagnoses and is significantly higher than other regions. In 2022 the East Midlands had the second lowest count of new diagnoses but had the fifth highest rate.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of East Midlands 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. 2 Hepatitis B cases in East Midlands region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Figure 3 is a population pyramid showing the distribution of new diagnoses by age group and sex where age and sex are known.

It shows most new diagnoses were amongst males which was 60.6% of all new diagnoses in 2022, where sex was known. Males in the 35 to 44 age group had the highest number of diagnoses, followed by males and females in the 25 to 34 age group.

This shows that most newly identified cases amongst males are between 25 and 54, where most would be of peak working age, these could mostly be chronic cases identified late or amongst individuals who may have newly arrived in England. Most females testing positive for HBV were amongst the 25 to 34 age group followed closely by the 35 to 44 age group. The number of new diagnoses seen in females aged between 25 and 44 could reflect the effect of antenatal screening amongst women within these age groups.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of East Midlands 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 is a series of line graphs which represents the proportion of new diagnoses of HBV in East Midlands residents by ethnicity from 2013 to 2022, where ethnicity was known. Ethnicity is not known for 33% of cases in 2013 and 55% of cases in 2022.

The highest proportion of cases in 2013 were amongst the Asian or Asian British ethnicity (37.0%), which has shown a decrease in its proportion compared to other categories and is the second highest proportion of cases in 2022 (24.4%). The highest proportion in 2022 was amongst those who are from a White background which is not British, this category has shown a steady increase in proportion since 2013. Those from a Black or Black British ethnicity showed little change in the proportion of cases since 2013 and had the third highest proportion of cases in 2022, with White British cases having the fourth highest proportion and showing more of variation over time. The lowest proportion of cases was seen amongst both the ‘Any other ethnic group’ and ‘Any Mixed background’ categories, which have remained the lowest proportion of cases over the 10-year period.

Patterns seen in ethnicity and new HBV diagnoses may reflect changes in migration within the region. However, data on country of acquisition or country of birth are unknown and it is unclear if cases of hepatitis B have links to countries with higher rates of hepatitis B.

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Derby	10	9	45	19	46	82	59	26	39	47
Derbyshire	13	14	24	15	14	30	41	15	18	27
Leicester	86	69	5	97	113	119	85	73	64	87
Leicestershire and Rutland	22	27	10	36	40	40	42	21	33	58
Lincolnshire	43	59	56	74	59	50	49	32	46	62
North Northamptonshire	4	2	8	42	68	43	36	15	20	35
Nottingham	101	75	99	74	78	79	74	57	77	77
Nottinghamshire	55	39	27	39	65	45	35	23	40	70
West Northamptonshire	5	9	5	8	80	106	114	81	90	96

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 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], East Midlands UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Derby	3.9	3.5	17.5	7.3	17.6	31.3	22.4	9.9	14.9	17.8
Derbyshire	1.7	1.8	3.1	1.9	1.8	3.8	5.2	1.9	2.3	3.4
Leicester	25.4	20.1	1.4	27.2	31.2	32.4	23.0	19.8	17.4	23.4
Leicestershire and Rutland	3.2	3.8	1.4	5.0	5.5	5.4	5.7	2.8	4.4	7.6
Lincolnshire	5.9	8.0	7.6	9.9	7.8	6.6	6.4	4.2	6.0	8.0
North Northamptonshire	1.2	0.6	2.4	12.3	19.6	12.2	10.1	4.2	5.5	9.6
Nottingham	32.7	24.2	31.6	23.3	24.3	24.5	22.9	17.7	24.1	23.5
Nottinghamshire	6.9	4.9	3.4	4.8	8.0	5.5	4.3	2.8	4.8	8.4
West Northamptonshire	1.3	2.3	1.3	2.0	19.4	25.4	27.0	19.2	21.1	22.4

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.

Tables 3 and 4 show the number and rates respectively, of new reports of HBV for upper tier local authorities in the East Midlands.

While there is fluctuation over time, in recent years, West Northamptonshire, Leicester and Nottingham have consistently had the highest number of cases each year. In 2022, the highest rate of new laboratory reports was also seen in Nottingham, Leicester and West Northamptonshire with rates of 23.4, 23.3 and 22.4 per 100,000 respectively. These areas and Derby all have rates above the East Midlands rate of 11.5 per 100,000, and the England rate of 16.6 per 100,000.

Issues with reporting from some laboratories over this period resulted in unusually low figures for some local authorities, notably those seen in North and West Northamptonshire, but also Derby, Derbyshire, Leicester and Leicestershire. Work with these laboratories since then has meant reporting has now improved.

Acute or probable acute diagnoses of HBV

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 rates per 100,000 population of new acute or probable acute HBV diagnoses for all regions across England compared to the England rate.

The East Midlands region has the lowest rate amongst all regions.

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

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

The incidence of acute or probable acute cases in the East Midlands has shown a gradual decrease since 2015, similar to that seen in England, however the decrease has continued from 2021 to 2022 where in England we can see a slight increase in incidence.

When looking at overall hepatitis B diagnoses, such as acute and chronic diagnoses seen in Figure 1, Tables 1 and 2, for the East Midlands we can see the rise in new diagnoses between 2020 and 2022 continuing, however, the pattern for acute cases seen in Figure 6 is the opposite between 2021 and 2022. This decline could indicate an increase in chronic cases being identified, some of whom could be individuals who were first diagnosed in another country and having their first test in the UK or, of more concern, difficulties in identification of acute cases during this period. Further investigation would be needed to understand the true cause for this pattern.

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 East Midlands UKHSA region, 2013 to 2022

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

Figures 7 to 10 use sentinel surveillance data. In the East Midlands only one laboratory (Nottingham University Hospitals Laboratory) submitted data to the sentinel surveillance scheme during this time period.

Figure 7 shows the number of tests undertaken and the percentage positive between 2013 and 2022.

The level of testing showed a steady increase since 2013, with a drop in testing during 2020 reflecting the reduced accessibility of services due to the COVID-19 pandemic. However, testing then increased again to a level similar to pre-pandemic levels. The percentage positive showed a decrease when testing increased between 2014 and 2016. Lower positivity implies less targeted testing, however, here reaching more people and overall the percentage positive has remained relatively stable.

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

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

The pattern seen with testing and positivity from GP surgeries seems similar to the overall picture seen in Figure 7, however positivity is generally higher.

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 East Midlands UKHSA region, 2013 to 2022

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

Relatively few individuals are tested at the sentinel laboratory through SHS, particularly since 2019 when there was a sharp decline. The percentage positive remained relatively stable until it dropped to zero in 2020 and showed a sharp increase in 2021 and dropping again in 2022 (when numbers being tested were low).

The fall in testing around 2019 may align with changes in how sexual health services had to adapt to the COVID-19 pandemic, where most testing and consultations took place online and over the phone, a pattern which is continuing or to how services were commissioned.

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 East Midlands UKHSA region, 2013 to 2022

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

The number of individuals tested at the sentinel laboratory through drug services has significantly increased between 2013 and 2022 although shows the same dip as other services in 2020 but increased post pandemic to a level higher than before the pandemic.

Positivity shows levels below 0.5% until 2019 where positivity peaked in 2020 which may reflect less but more targeted testing, falling in subsequent years when testing increased. Percentage positive has remained above 0.5%.

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 was high with 99.8% out of 116,109 eligible women being tested within the Midlands NHS region (note NHS region may not be the same as UKHSA regions).

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 East Midlands 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 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 East Midlands 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).

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 11 shows 2 line graphs. The first is the number of admissions for individuals with a hepatitis B diagnosis in East Midlands residents and the total for England. The second line graph is the rate of admissions for individuals with a hepatitis diagnosis per 100,000 population resident in the East Midlands compared to the rate for those in England.

The rate of admissions for the East Midlands is lower than for England between 2013 and 2022. There is a gradual increase in admission rates in the East Midlands during this period although the rate has been relatively stable since 2019.

Figure 12 shows that between 2015 and 2020, the numbers of admissions for those diagnosed with hepatitis B-related end-stage liver disease (HBV-related ESLD) have been low but increased from 15 to 30.

Admissions of individuals with a diagnosis of hepatitis B-related hepatocellular carcinoma (HBV-related HCC) were lower than those for HBV-related ESLD remaining at 10 or below each year. Data in 2013 and from 2020 onwards were suppressed due to small numbers.

Figure 13 shows a map of mortality rates with ESLD or HCC in those with acute or chronic HBV mentioned on their death certification for data from 2018 to 2022 by region across England. London had the highest rate and is significantly above the England rate of 0.16 per 100,000 population. The North East had the lowest rate and the East Midlands, South East and South West all had rates between 0.061 and 0.12 per 100,000 population.

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, East Midlands 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.

Figure 14 shows the coverage of the routine hepatitis B vaccine of 3 doses at 12 months for the East Midlands and England over the 4-year period of 2019/2020 to 2022/2023. The coverage in the East Midlands remains stable and slightly higher than for England each year. The East Midlands had a coverage of 93.3% in 2019 to 2020 and 92.2% in 2022 to 2023, compared to 92.6% and 91.8% in England.

Figure 15. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, East Midlands 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.

Figure 15 shows routine hepatitis B vaccine coverage of 3 doses at 24 months in the East Midlands between April 2019 to March 2023 compared to England. Over this 3-year period the East Midlands remained above the England average but both coverage figures have shown a small decrease over this time period. The East Midlands coverage was 94.6% in 2020 to 2021 and fell slightly to 93.4% in 2022 to 2023 while the England coverage fell slightly from 93.8% to 92.6%.

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, East Midlands UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Derby	5	5	100.00%
Derbyshire	5	5	100.00%
Leicester	21	19	90.48%
Leicestershire and Rutland	13	13	100.00%
Lincolnshire	7	6	85.71%
North Northamptonshire	17	17	100.00%
Nottingham	17	10	58.82%
Nottinghamshire	16	13	81.25%
West Northamptonshire	21	19	90.48%

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 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, East Midlands UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Derby	13	9	69.23%
Derbyshire	5	5	100.00%
Leicester	25	24	96.00%
Leicestershire and Rutland	9	9	100.00%
Lincolnshire	8	6	75.00%
North Northamptonshire	8	6	75.00%
Nottingham	21	15	71.43%
Nottinghamshire	9	9	100.00%
West Northamptonshire	28	27	96.43%

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.

Tables 5 and 6 show the number of children at high risk of maternal transmission who are eligible and vaccinated by their first and second birthdays respectively, by upper tier local authority.

Leicester and West Northamptonshire had the highest number of eligible children. The vast majority of eligible children were vaccinated by their first and second birthdays. For those receiving vaccinations by their first birthday, only 5 local authorities did not reach 100% coverage, with the lowest coverage being Nottingham (58.8%), followed by Nottinghamshire (81.3%), Lincolnshire (85.7%), and Leicester and West Northamptonshire (both 90.5%). Most areas saw a higher percentage covered by their second birthday, with the lowest coverage being 69.2% in Derby. In total in the East Midlands only 16 eligible individuals were not vaccinated by their second birthday.

Vaccine uptake in people who inject drugs

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

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

The reported level of uptake of at least one dose of the hepatitis B vaccine among people who inject drugs (PWID) in East Midlands has shown a gradual decrease of 16.2 percentage points since 2013 (from 76.5% to 60.3%) and is broadly similar to uptake for England during this period.

Further work to understand the reasons why individuals in this risk group choose not to accept the vaccination could help to improve uptake in the future.

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, East Midlands UKHSA region and England, 2013 to 2022

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

Figure 17 shows the level of sharing needles and/or syringes (direct sharing), while Figure 18 shows the level of direct sharing and sharing of injecting equipment (indirect sharing) amongst PWID in the East Midlands. This is self-reported. Sharing of injecting equipment is an important contributor to transmission of HBV.

The percentage of people who reported the direct sharing of equipment in the East Midlands has increased overall from 13.3% in 2013 17.1% in 2022. In 2018 the figure in the East Midlands was above the England figure at 30% compared to 18.3%. These increases in self-reported sharing of equipment could be due to a number of factors including availability of needle and equipment exchanges, although this is not explored in this report.

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

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

Figure 18 shows that the proportion that self-reported sharing of needles and/or syringe and injecting equipment was similar in 2013 and 2022 (34.8% and 32.2% respectively). The proportion was below the England level apart from in 2018 when as in Figure 17 there was a sharp increase with over half (51.1%) reporting sharing. Making the exchange of equipment and syringes available can reduce the incidence of sharing of equipment and therefore reducing the risk of hepatitis transmission.

We need to achieve a combination of reversing the downward trend in vaccination uptake in PWID in the East Midlands as well as further reducing the sharing of injecting equipment within this risk group to reduce transmission.

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 data set 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, re-used 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 data set 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 FSMidlands@ukhsa.gov.uk

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