Research and analysis

Hepatitis B in the North East: 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 2024 report and presents further information on HBV disease surveillance, trends in HBV diagnosis and testing and related diseases in North East 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:

• 210 new laboratory reports of hepatitis B in residents of North East, representing a rate of 7.8 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 45.8% between 2021 and 2022, and increased by 81% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 144 (68.6%) and in females was 62 (29.5%) 
• 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 4 in Darlington and Redcar and Cleveland to 75 in Newcastle upon Tyne; rates were highest in Newcastle upon Tyne at 24.5 new laboratory reports per 100,000 population and lowest in Northumberland with 2.8 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 24,885 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in North East UKHSA region in 2022, of which 0.66% tested positive – the proportion positive was higher for tests referred through GP surgeries, higher for tests through sexual health services and lower for tests through drug services

Monitoring HBV-related morbidity

Main trends are:

• there have been 200 (to the nearest 5) hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in North East 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 10 and between 1 and 8 respectively in 2022 

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in North East UKHSA region was 95.8% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 0.1 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in North East UKHSA region was 56.9% for 2022
• reported level of hepatitis B vaccine uptake among PWID has increased by 3.8 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 North East UKHSA region, 2013 to 2022

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

There were 210 new laboratory-confirmed reports of hepatitis B (acute and chronic) in North East residents (Figure 1). This is similar to the number reported prior to the COVID-19 pandemic in 2019 (207 reports) and 45.8% higher compared to 2021 (144 reports) when reports were substantially lower due to the impact of pandemic restrictions and disruption in services.

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

In 2022, the rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) in North East residents was 7.8 reports per 100,000 population and remained below that for England as a whole (16.4 per 100,000 population) (Figure 2). In 2022, the rate in the North East residents was comparable to the pre-pandemic rates in 2018 and 2019.

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.

In 2022, the North East region had the lowest number and rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) (210 reports and the rate of 7.9 reports per 100,000 population) (Table 1 and 2).

London reports (3,882 reports) accounted for 41% of all reports in England and was significantly higher than the rate for all other regions (43.8 per 100,000 compared to 7.8 to 14.4). This is potentially impacted by a higher proportion of London residents being born outside of the UK (where hepatitis B prevalence can be higher).

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of North East 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 4 hepatitis B cases in North East region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Age and sex information was known for 206 (98%) of the 210 new laboratory-confirmed reports of hepatitis B (acute and chronic) in North East residents in 2022. Of these, 144 (69.9%) were male and 62 (30.1%) were female (Figure 3). The highest number of new laboratory-confirmed reports in males was in those aged 35 to 44 (48 of 144, 33%) and in females was those aged 25 to 34 (20 of 62, 32.3%). Males accounted for a higher proportion of reports in all age groups in 2022.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of North East 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 laboratory-confirmed reports of new diagnoses of HBV in North East residents over the past 10 years by ethnicity. In 2022, individuals with ethnicity reported as Asian or Asian British accounted for the largest proportion of reports (28.8%), followed by White British (27.2%) and then Black or Black British (24.8%).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
County Durham	7	19	15	13	12	12	18	13	13	30
Darlington	4	3	5	6	8	7	6	5	3	4
Gateshead	11	20	11	23	20	10	11	11	12	14
Hartlepool	0	1	1	1	8	3	1	0	1	0
Middlesbrough	6	3	5	11	34	27	17	9	15	23
Newcastle upon Tyne	37	32	66	69	59	82	95	50	55	75
North Tyneside	6	10	11	10	15	9	13	2	13	8
Northumberland	9	13	4	12	7	6	5	6	8	9
Redcar and Cleveland	1	1	1	6	11	1	7	4	3	4
South Tyneside	7	8	4	9	11	8	8	4	3	8
Stockton-on-Tees	14	5	4	6	23	13	5	4	6	12
Sunderland	13	17	12	9	13	21	21	4	12	23

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

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

When looking across the North East region local authorities, the number of new laboratory-confirmed reports of hepatitis B (acute and chronic) ranged from 0 in Hartlepool and 4 in both Darlington as well as Redcar and Cleveland to 75 in Newcastle in 2022 (Table 3).

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], North East UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
County Durham	1.4	3.7	2.9	2.5	2.3	2.3	3.5	2.5	2.5	5.7
Darlington	3.8	2.8	4.7	5.6	7.5	6.6	5.6	4.7	2.8	3.7
Gateshead	5.5	10.0	5.5	11.4	10.0	5.0	5.5	5.6	6.1	7.1
Hartlepool	0.0	1.1	1.1	1.1	8.7	3.3	1.1	0.0	1.1	0.0
Middlesbrough	4.3	2.2	3.6	7.8	24.1	19.1	12.0	6.3	10.4	15.5
Newcastle upon Tyne	13.0	11.2	22.9	23.8	20.2	27.8	32.0	16.8	18.4	24.5
North Tyneside	3.0	4.9	5.4	4.9	7.3	4.4	6.3	1.0	6.2	3.8
Northumberland	2.9	4.1	1.3	3.8	2.2	1.9	1.6	1.9	2.5	2.8
Redcar and Cleveland	0.7	0.7	0.7	4.4	8.1	0.7	5.1	2.9	2.2	2.9
South Tyneside	4.7	5.4	2.7	6.1	7.4	5.4	5.4	2.7	2.0	5.4
Stockton-on-Tees	7.2	2.6	2.0	3.1	11.7	6.6	2.5	2.0	3.0	6.0
Sunderland	4.7	6.2	4.4	3.3	4.7	7.7	7.7	1.5	4.4	8.3

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.

The rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) ranged from 2.8 per 100,000 in Northumberland to 24.5 per 100,000 in Newcastle in 2022 (Table 4).

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.

In 2022, the North East region had the third highest estimated incidence of acute or probable acute hepatitis B (0.41 per 100,000 population) of all UKHSA regions and was similar to the England national rate of 0.42 per 100,000 (Figure 5).

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

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

In line with the England trend, the estimated incidence of acute or probable acute hepatitis B shows a general downward trajectory in the North East with the estimated incidence in 2022 (0.41 per 100,000 population) below that of 2019 and 2013 (0.61 and 0.69 per 100,000 population, respectively) (Figure 6). The substantially lower numbers reported in 2020 and 2021 were likely due to the impact of pandemic restrictions and disruption in services.

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 North East 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 sentinel laboratories has shown a general upward trajectory over the past 10 years in the North East UKHSA region (with a 90% increase from 13,096 individuals tested in 2013 to 24,885 in 2022). Of the 24,885 individuals tested for HBsAg in 2022, 0.66% tested positive (Figure 7).

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

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

Of the 24,885 individuals tested for HBsAg in the North East in 2022, 3,364 (14%) were referred through GP surgeries submitting samples to sentinel laboratories (Figure 8). Compared to all tests carried out as part of the sentinel surveillance system, the proportion positive was higher for tests referred through these GP surgeries. Specifically, 1.1% of tests referred through GP surgeries were positive for HBsAg in 2022. The increase in individuals tested in 2018 coincides with local initiatives to increase testing of bloodborne viruses as well as a Public Health England hepatitis C engagement exercise.

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 North East UKHSA region, 2013 to 2022

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

Of the 24,885 individuals tested for HBsAg in the North East in 2022, 887 (4%) were referred through sexual health services (SHS) (Figure 9). The proportion positive for tests coming from SHS was similar to the proportion positive for all sentinel laboratories tests in the North East in 2022 (0.68% and 0.66% respectively).

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 North East UKHSA region, 2013 to 2022

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

Of the 24,885 individuals tested for HBsAg in the North East in 2022, 2,234 (9%) were from people who inject drugs and/or attend drug services (Figure 10). The number of individuals tested through drug services in the North East has increased substantially over the last 10 years. The proportion positive was lower for tests referred through drug services (0.58%) compared to the proportion positive across all tests at sentinel laboratories in the North East (0.66%).

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 88,973 eligible women, with 99.8% having been tested within the North East and Yorkshire NHS region, surpassing the WHO 2030 target of greater than or equal to 90% (note: NHS regions 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 North East 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.

There were 200 (rounded to nearest 5) hospital admissions for individuals for acute or chronic hepatitis B in the North East UKHSA region in 2022 which was higher than in 2021 (125). Admission rates per 100,000 people increased from 4.72 in 2021 to 7.46 in 2022 (Figure 11). Rates are lower than England as a whole.

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 North East 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). 

As shown in Figure 12, HES identified 10 presentations of HBV-related ESLD in the North East in 2022. This is an increase since 2020 and 2021 and the same number as 2019. In 2022, HES identified less than 8 presentations of HBV-related HCC, which (except for 2021) was similar to previous years.

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.

Rate of deaths with end-stage liver disease or hepatocellular carcinoma with hepatitis B mentioned on their death certificate between 2018 and 2022 was 0.045 per 100,000 people (Figure 13). This is the lowest rate of any region; the rate in England was 0.156 per 100,000 people.

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, North East 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.

The North East has consistently maintained over 90% coverage of children receiving 3 doses of HepB vaccine by their first birthday between FY 2019 to 2020 (95.8%) and FY 2022 to 2023 (94.9%) (Figure 14). However, similar to other infant immunisation programmes in UK, a general decline in coverage has been occurring in the North East as well as England as a whole.

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

Coverage of children receiving 3 doses of HepB vaccine improved by 24 months of age compared to coverage at 12 months, and ranged from 96.6% in FY 2020 to 2021, 95.9% in FY 2021 to 2022 and 95.8% in FY 2022 to 2023 (Figure 15). However, it was again showing a general downward trend over time.

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, North East UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
County Durham	4	4	100.00%
Darlington	3	3	100.00%
Gateshead	0	0	Not applicable
Hartlepool	0	0	Not applicable
Middlesbrough	4	4	100.00%
Newcastle upon Tyne	17	13	76.47%
North Tyneside	0	0	Not applicable
Northumberland	0	0	Not applicable
Redcar and Cleveland	[note 15]	[note 15]	[note 15]
South Tyneside	0	0	Not applicable
Stockton-on-Tees	[note 15]	[note 15]	[note 15]
Sunderland	[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.

For most local authorities in the North East, FY 2022 to 2023 data on coverage of children in the high risk selective programme by their first birthday were suppressed due to small numbers or not applicable as there were no eligible individuals. Overall numbers of eligible children in this selective programme are very low at local authority level; therefore, numbers should be treated with caution.

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, North East UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
County Durham	3	3	100.00%
Darlington	[note 17]	[note 17]	[note 17]
Gateshead	[note 17]	[note 17]	[note 17]
Hartlepool	[note 17]	[note 17]	[note 17]
Middlesbrough	[note 17]	[note 17]	[note 17]
Newcastle upon Tyne	13	12	92.31%
North Tyneside	0	0	Not applicable
Northumberland	0	0	Not applicable
Redcar and Cleveland	[note 17]	[note 17]	[note 17]
South Tyneside	0	0	Not applicable
Stockton-on-Tees	4	4	100.00%
Sunderland	0	0	Not applicable

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.

For most local authorities in the North East, data on coverage of children in the high risk selective programme by their second birthday were suppressed due to small numbers or not applicable as there were no eligible individuals.

Vaccine uptake in people who inject drugs

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

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

Hepatitis B vaccine uptake in people who inject drugs has decreased from 79% in 2017 to 57% in 2022 in the North East (Figure 16). However, uptake did increase by 3.8 percentage points from 53.1% in 2021 to 56.9% in 2022. For the last 3 years, uptake has been lower than England as a whole (60.6% in 2022).

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, North East UKHSA region and England, 2013 to 2022

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

After a sharp increase between 2019 and 2020 in the percentage of PWID who reported direct sharing of needles and/or syringes in the preceding 4 weeks (from 11% to 39.4%, respectively), this proportion has decreased in 2022 (19.5%) and is similar to England as a whole (19.5%) (Figure 17).

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

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

Similar to Figure 17 showing direct sharing of injecting equipment, the percentage of PWID who reported direct and indirect sharing of injecting equipment in the preceding 4 weeks doubled between 2019 (29.6%) and 2020 (61.8%) (Figure 18). This percentage has decreased to 37.9% in 2022 and is similar to England as a whole (38.9%).

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, 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 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 second 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.NorthEast@ukhsa.gov.uk

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