Research and analysis

Hepatitis B in the East of England: 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.

The 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 of England 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:

• 655 new laboratory reports of hepatitis B in residents of East of England, representing a rate of 9.8 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 27.7% between 2021 and 2022, and increased by 2.7% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 350 (53.4%) and in females was 286 (43.7%) 
• in 2022, the highest number of new laboratory reports was in males aged 35 to 44 and females aged 25 to 34 
• in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 7 in Southend-on-Sea to 144 in Hertfordshire; rates were highest in Luton at 38.3 new laboratory reports per 100,000 population and lowest in Suffolk with 3.5 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.4 per 100,000 population. This was the same as the England average of 0.4 per 100,000 
• there have been 32,141 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in East of England UKHSA region in 2022, of which 0.6% tested positive - the proportion positive was higher for tests referred through GP surgeries, lower for tests through sexual health services and higher for tests through drug services

Monitoring HBV-related morbidity

Main trends are:

• there have been 670 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in East of England 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 50 and 25 respectively in 2022

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in East of England UKHSA region was 92.9% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 0.4 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in East of England UKHSA region was 64.2% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 14.4 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 of England UKHSA region, 2013 to 2022

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

Figure 1 shows that the number of laboratory confirmed reports of hepatitis B has fluctuated broadly between 500 to 700 reports each year over the last decade. The decrease in reports in 2020 and 2021 to 497 cases was likely as a result of the COVID-19 pandemic, with reports in 2022 increasing to above pre-pandemic levels with 655 cases. 

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of East of England 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

The East of England has consistently had a crude laboratory reporting rate (per 100,000 population) below the England rate over the last decade, as shown in Figure 2 and Table 2. Reporting rates in the region have broadly followed national testing trends and reporting rather than trends in disease prevalence.

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.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of East of England 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 73 Hepatitis B cases in East of England region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

In the East of England, where gender was recorded (87% of reports) over half of reports were in males (53%) (Figure 3). Reports of HBV were overall most common in persons aged between 25 and 44 years of age with males aged 35 to 44 (n=95) and females aged 25 to 34 (n=91) as the most common groups.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of East of England 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.

Over the last 10 years, the majority of new laboratory reports have been amongst those from any other White and Black/Black British backgrounds. In 2022, amongst those with ethnicity data available (67%), the majority of cases were in Asian/Asian British populations (25%) followed by Black or Black British (25%) and any other White backgrounds (22%).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Bedford	25	22	9	32	20	19	12	26	19	48
Cambridgeshire	39	58	68	68	98	62	69	79	68	90
Central Bedfordshire	9	13	12	16	15	20	12	15	16	29
Essex	122	93	85	85	75	61	86	70	64	70
Hertfordshire	138	136	128	138	125	94	114	92	95	144
Luton	72	48	52	55	57	31	104	72	90	87
Milton Keynes	43	38	53	60	61	77	72	48	57	70
Norfolk	49	31	19	40	35	50	40	20	25	37
Peterborough	53	47	48	41	55	34	50	23	34	20
Southend-on-Sea	24	18	13	10	5	14	10	10	4	7
Suffolk	27	23	17	34	38	27	25	22	26	27
Thurrock	37	36	28	20	15	26	23	20	15	25

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 of England UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Bedford	15.3	13.2	5.3	18.4	11.4	10.7	6.6	14.3	10.2	25.6
Cambridgeshire	6.1	9.0	10.4	10.3	14.8	9.3	10.3	11.8	10.0	13.0
Central Bedfordshire	3.4	4.9	4.4	5.8	5.4	7.1	4.2	5.2	5.4	9.6
Essex	8.6	6.5	5.9	5.8	5.1	4.1	5.8	4.7	4.2	4.6
Hertfordshire	12.1	11.8	11.0	11.7	10.5	7.9	9.6	7.7	7.9	11.9
Luton	34.3	22.5	23.9	24.9	25.8	14.0	46.6	32.1	40.0	38.3
Milton Keynes	16.6	14.3	19.6	21.9	22.1	27.6	25.6	16.9	19.8	23.9
Norfolk	5.6	3.5	2.2	4.5	3.9	5.5	4.4	2.2	2.7	4.0
Peterborough	27.5	24.0	24.0	20.0	26.4	16.1	23.5	10.8	15.7	9.2
Southend-on-Sea	13.6	10.1	7.3	5.5	2.8	7.7	5.5	5.5	2.2	3.9
Suffolk	3.7	3.1	2.3	4.5	5.0	3.6	3.3	2.9	3.4	3.5
Thurrock	22.9	21.9	16.8	11.8	8.8	15.0	13.1	11.4	8.5	14.1

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.

In the East of England, the rate of laboratory-confirmed hepatitis B infections (acute and chronic combined) varies by upper tier local authority (Tables 3 and 4). In 2022, the rate per 100,000 population showed that Luton, Bedford, Milton Keynes, Thurrock, Cambridgeshire and Hertfordshire were all above the East of England average (9.8 per 100,000).

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.

Despite a number of upper tier local authorities showing incidence above the national average (Table 4), East of England, overall, remains below national incidence per 100,000 population, as the fourth highest region (Figure 5). Incidence of acute or probable acute hepatitis B has largely been decreasing in the region over the last decade. Since 2017, rates decreased from 0.65 to reach a nadir of 0.20 in 2021, followed by an increase in 2022 to 0.39 (Figure 6).

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

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

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 of England UKHSA region, 2013 to 2022

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

Data from sentinel surveillance systems operating in East of England show that that number of individuals tested has broadly increased over the last 10 years from 5,576 in 2013 to 32,141 in 2022. A noticeable dip in testing was observed between 2019 and 2021 as a result of the COVID-19 pandemic (Figure 7). The percentage of individuals testing positive has stayed broadly stable over the last 10 years with a range of 0.6% to 0.9% of people testing positive.

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

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

Data from GP surgeries participating in sentinel surveillance in East of England show that the number of individuals tested has remained broadly similar over the last 8 years of stable surveillance, ranging from 7,827 in 2015 to 7,204 in 2022. There was a notable dip in testing in 2019 to 2020, likely due to the COVID-19 pandemic.

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

Figure 9. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through drug services in sentinel laboratories in East of England 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 for HBsAg in people who inject drugs and/or attend drug services has increased significantly over the last decade and has now exceeded pre-pandemic levels. The percentage of individuals testing positive for HBsAg peaked in 2019 with 1.2% with a slight decrease in 2022 to 0.9%. 

Please note that data from testing and diagnoses in sexual health services using sentinel surveillance systems has not been included in this report due to limited data reporting and lack of generalisability to the region.

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 73,384 eligible women, with 99.7% having been tested within the East of England NHS region (note: NHS regions may not be the same as UKHSA regions).

Monitoring HBV-related morbidity

Hospital admissions from HBV

Figure 10. 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 of England 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. 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.

There were 670 hospital admissions for residents of East of England with a diagnosis code for acute or chronic hepatitis B in 2022, this was an increase of 6.7% from the previous year. The admission rate for the region in 2022 was 10.0 per 100,000 population, which is significantly below the national rate of 15.7.

Figure 11. 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 of England 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). 

In 2022, HES analysis identified 75 people with a first presentation to hospital with HBV-related ESLD and/or hepatocellular carcinoma: 50 people had a first presentation with HBV-related ESLD and 25 people had a first presentation with HBV-related HCC. This represents no change in levels seen in the previous year. However, over the last 4 years, the trend for ESLD appears upwards whereas the trend for HCC appears stable since 2013.

Monitoring HBV-related mortality

Figure 12. 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.

Between 2018 and 2022, the mortality rates in East of England was 0.1 per 100,000 population, half the national rate of 0.2 per 100,000 (Figure 12). East of England accounted for less than 5% of deaths with ESLD or HCC in people with acute or chronic hepatitis B

Prevention of infection by immunisation

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

Figure 13. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 12 months, East of England 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.

In FY 2022 to 2023, the 3-dose vaccination coverage at 12 months of age for children in East of England was 92.1%, which is above the national average (91.8%) and above the WHO target of 90%. This represents a decrease of 0.1% from the previous year (FY 2021 to 2022, 92.2%) (Figure 13).

Figure 14. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, East of England 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, vaccine coverage of 3 doses of the hexavalent vaccine at 24 months in the East of England was 92.9%, which is higher than the national coverage (92.6%) and higher than the WHO target of 90%. This represents a regional decrease in coverage of 0.4% from FY 2021 to 2022 (93.3%) (Figure 14).

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 of England UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bedford	3	2	66.7%
Cambridgeshire	13	13	100%
Central Bedfordshire	8	7	87.5%
Essex	25	24	96%
Hertfordshire	36	35	97.2%
Luton	26	24	92.3%
Milton Keynes	26	25	96.2%
Norfolk	6	6	100%
Peterborough	16	16	100%
Southend-on-Sea	4	4	100%
Suffolk	9	8	88.9%
Thurrock	11	10	90.9%

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.

There was significant regional variation in vaccine coverage at one year old of the selective hepatitis B vaccine programme for children at high risk of maternal transmission. Coverage ranged from 66.7% in Bedford to 100% coverage in Norfolk, Peterborough and Southend-on-Sea.

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 of England UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bedford	11	10	90.9%
Cambridgeshire	7	7	100%
Central Bedfordshire	6	6	100%
Essex	30	26	86.7%
Hertfordshire	32	32	100%
Luton	22	21	95.5%
Milton Keynes	19	19	100%
Norfolk	17	17	100%
Peterborough	18	16	88.9%
Southend-on-Sea	5	5	100%
Suffolk	10	8	80%
Thurrock	10	9	90%

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.

There is variation in vaccine coverage at 2 years old of the selective hepatitis B vaccination programme for children at high risk of maternal transmission. Coverage ranged from 80% in Suffolk to 100% in 6 local authorities (Cambridgeshire, Central Bedfordshire, Hertfordshire, Milton Keynes, Norfolk and Southend-on-Sea).

Vaccine uptake in people who inject drugs

Figure 15. Reported level of hepatitis B vaccine uptake among people who inject drugs (PWID), East of England UKHSA region, 2013 to 2022

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

Data from the Unlinked Anonymous Monitoring (UAM) Survey for vaccine uptake amongst PWID in East of England was 64.2% in 2022. This represents a decrease of 14.4 percentage points from the previous year (2021, 78.6%). Coverage has remained above the national uptake since 2019. It is also notable that the number of UAM survey participants increased from 71 in 2021 to 143 in 2022 and the number of participating centres increased from 7 to 8 over the same period.

Prevention of infection by harm reduction

Figure 16. Reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks, East of England UKHSA region and England, 2013 to 2022

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

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. 

Reported levels of direct sharing of needles among PWID in East of England in 2022 was 22.2%, representing a 4.9 percentage point increase from the previous year (2021, 17.3%). This is the first time the region has increased above national rates since 2019.

Figure 17. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID) in the preceding 4 weeks, East of England UKHSA region and England, 2013 to 2022

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

In terms of direct and indirect sharing of injecting equipment, East of England reported 25.9%, which represents a 5.5 percentage point decrease from the previous year (2021, 31.4%). The region has remained below the national percentage since 2018.

Conclusions 

National and regional reporting highlights that tackling hepatitis B requires a comprehensive and systems-wide approach to tackle transmission and its impact in England. Key recommendations for system partners include expanding early diagnosis through improving the coverage of antenatal screening and targeting testing to ensure timely linkage to care and treatment. 

Recent data has also highlighted the need to maintain and boost vaccination efforts, both through the universal childhood immunisation programme and targeted adult vaccination for at-risk groups. For example, despite HBV vaccination being recommended as high priority for all people who currently inject drugs, nearly 40% of PWID in the East of England report that they have never been vaccinated. Data from the UAM survey of people who inject drugs for England indicates that vaccination should be promoted more widely amongst PWID of younger age and recent initiates to injecting, who have reported lower uptake. Further work is required to understand the facilitators and barriers to uptake of HBV vaccination to better inform policy and practice.

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.

Data is 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, 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 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 first 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 first 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 phe.eoefs@nhs.net 

If you have any comments or feedback regarding this report or the Field Services, please contact phe.eoefs@nhs.net