Research and analysis

Hepatitis B in the North West: 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 West 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:

• 777 new laboratory reports of hepatitis B in residents of North West, representing a rate of 10.3 reports per 100,000 population in 2022 
• the number of new laboratory reports has decreased by 2.9% between 2021 and 2022, and decreased by 29.8% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 445 (57.3%) and in females was 328 (42.2%) 
• in 2022, the highest number of new laboratory reports was in males aged 35 to 44 and females aged 25 to 34 and 35 to 44 
• in 2022, the number of new positive laboratory reports by upper tier local authority (UTLA) of residence ranged from less than 5 in Knowsley to 235 in Manchester; rates were highest in Manchester at 41.5 new laboratory reports per 100,000 population and lowest in Knowsley with 0.6 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.3 per 100,000 population. This was lower than the England average of 0.4 per 100,000 
• there have been 55,444 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in North West UKHSA region in 2022, of which 0.74% tested positive - the proportion positive was higher (compared to overall positivity) 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 900 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in North West 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 55 and 20 respectively in 2022 

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in North West UKHSA region was 92.9% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 1.1% between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in North West UKHSA region was 59.1% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 5.9% 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 West UKHSA region, 2013 to 2022

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

There were 777 new laboratory reports of hepatitis B (both acute and chronic) in residents of the North West in 2022. This is similar to the number of new diagnoses in 2021 and 2020, but lower than the number of new diagnoses seen in 2019, when there was a notable increase in the number of reports. However, fluctuations seen since 2020 may be partly due to factors linked to the COVID-19 pandemic, including changes in healthcare seeking behaviors and access to healthcare. 

Overall, the number of new hepatitis B diagnoses in North West residents has decreased, with some fluctuations, since 2013.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of North West 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 laboratory reports of hepatitis B (both acute and chronic) in North West residents was 10.3 reports per 100,000 population. This is lower than the England overall rate of 16.4 reports per 100,000 population.

Since 2013, the North West rate has remained lower or the same as the England rate. The overall trend is the North West is a decrease compared to 2013 rates and remaining lower than the England rate, with the exception of the years 2018 to 2019 when we saw a notable increase in reports, roughly equivalent to the England rate. Decreases observed in 2020 and 2021 may be partly due to changes in health seeking behaviors and access during the COVID-19 pandemic. Increases in the overall England rate seen in 2021 and 2022 were not observed in the North West.

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.

In 2022, UKHSA received 777 laboratory reports of hepatitis B (acute and chronic) in the North West, which was 8.3% of all reports received in England. This is a decrease compared to 2021, when the 800 laboratory reports of hepatitis B (acute and chronic) in the North West accounted for 11.3% of all reports received in England. It is difficult to compare counts of laboratory reports between UKHSA regions as this does not take into account differences in the size of the resident population in each area.

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.

The rate of laboratory reports of hepatitis B (acute and chronic) in the North West was 10.3 reports per 100,00 population. This is similar to the rate of reports received in 2020 and 2021, but lower than the rate in 2019 (15.3 reports per 100,000 population), when we saw a notable increase in reports. This rate is lower than the 2022 England rate of 16.4 reports per 100,000 population. In 2022 the North West had the third lowest rate of laboratory reports of hepatitis B (acute and chronic) out of all UKHSA English regions.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of North West 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 9 hepatitis B cases in North West region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Among those with a reported age (768 of 777; 98.8%), males accounted for more (57.9%) laboratory reports of hepatitis B in the North West in 2022 compared to females (42.1%). The most affected group was males aged 35 to 44 years (134).

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

The ethnic group accounting for the highest proportion of laboratory reports of hepatitis B (acute and chronic) in the North West in 2022 with a known ethnicity were Asian or Asian British (37.4%). Black or Black British and White British also accounted for high proportions, 23.6% and 22.9% respectively. The proportion of cases in the Asian or Asian British group has increased from 25.4% in 2020, while the proportion of cases in the White British group has decreased in the same period (30.8% in 2020).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Blackburn with Darwen	6	6	7	6	<5	7	5	8	<5	<5
Blackpool	21	<5	9	<5	<5	<5	23	14	25	22
Bolton	34	37	30	34	43	36	38	30	29	28
Bury	11	25	22	28	17	17	31	12	12	19
Cheshire East	16	20	23	21	16	22	20	16	25	27
Cheshire West and Chester	36	12	12	16	11	12	23	13	16	24
Cumberland	<5	<5	<5	5	<5	6	5	<5	5	6
Halton	<5	5	<5	<5	<5	<5	9	<5	<5	6
Knowsley	9	6	<5	<5	6	<5	9	7	<5	<5
Lancashire	113	54	44	16	20	65	68	50	160	94
Liverpool	35	90	<5	12	<5	21	225	112	60	7
Manchester	560	284	251	241	286	324	269	203	216	235
Oldham	63	67	48	57	50	68	68	29	40	44
Rochdale	30	51	41	35	25	34	30	26	28	26
Salford	40	50	45	48	50	59	74	48	50	64
Sefton	6	14	<5	9	8	<5	25	20	7	<5
St. Helens	6	10	9	8	5	6	14	20	6	8
Stockport	29	17	19	21	21	24	26	19	10	29
Tameside	19	13	22	19	21	24	18	19	16	22
Trafford	32	23	21	35	25	22	21	22	28	45
Warrington	5	11	8	6	21	12	21	10	14	23
Westmorland and Furness	14	9	<5	<5	<5	8	7	<5	<5	<5
Wigan	14	13	23	23	22	36	62	38	23	22
Wirral	<5	10	10	5	15	16	32	22	15	14

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

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

Manchester had the highest number of laboratory reports of hepatitis B (acute and chronic) each year from 2013 to 2022 in the North West, with 235 reports in 2022. Knowsley had the lowest number of reports in 2022, with less than 5 reports. In Liverpool, the fluctuating trend seen is due to changes in laboratory reporting. It is difficult to compare counts of laboratory reports between local authorities as this does not take into account differences in the size of the resident population in each area.

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 West UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Blackburn with Darwen	4.0	4.0	4.7	4.0	0.7	4.6	3.2	5.2	2.6	2.6
Blackpool	14.7	2.8	6.3	0.0	2.1	2.8	16.2	9.9	17.7	15.5
Bolton	12.1	13.1	10.5	11.8	14.8	12.3	12.9	10.1	9.8	9.4
Bury	5.9	13.3	11.6	14.7	8.9	8.8	16.0	6.2	6.2	9.8
Cheshire East	4.3	5.3	6.1	5.5	4.2	5.7	5.1	4.1	6.2	6.6
Cheshire West and Chester	10.8	3.6	3.5	4.7	3.2	3.4	6.5	3.7	4.5	6.6
Cumberland	0.7	0.0	0.7	1.8	1.5	2.2	1.8	0.7	1.8	2.2
Halton	0.8	4.0	1.6	3.2	3.1	2.3	7.0	3.1	0.8	4.7
Knowsley	6.1	4.1	2.0	2.0	4.0	2.0	5.9	4.6	1.9	0.6
Lancashire	9.6	4.6	3.7	1.3	1.7	5.4	5.6	4.1	12.9	7.5
Liverpool	7.5	19.3	0.6	2.5	0.8	4.3	46.4	23.2	12.4	1.4
Manchester	109.6	55.1	48.0	45.2	53.3	59.9	49.3	37.1	39.2	41.5
Oldham	27.6	29.1	20.6	24.3	21.1	28.3	28.1	12.0	16.5	18.0
Rochdale	14.1	23.9	19.1	16.2	11.4	15.5	13.5	11.7	12.5	11.5
Salford	16.7	20.6	18.2	19.1	19.6	22.8	28.1	18.0	18.5	23.0
Sefton	2.2	5.1	1.5	3.3	2.9	1.4	9.0	7.2	2.5	1.1
St. Helens	3.4	5.6	5.0	4.5	2.8	3.3	7.7	11.0	3.3	4.3
Stockport	10.2	5.9	6.6	7.2	7.2	8.2	8.9	6.5	3.4	9.8
Tameside	8.6	5.8	9.8	8.4	9.3	10.5	7.8	8.2	6.9	9.4
Trafford	13.9	9.9	9.0	15.0	10.6	9.3	8.9	9.3	11.9	19.0
Warrington	2.4	5.3	3.8	2.8	9.9	5.7	9.9	4.7	6.6	10.9
Westmorland and Furness	6.2	4.0	1.8	0.0	0.0	3.5	3.1	1.3	1.8	1.3
Wigan	4.4	4.1	7.2	7.2	6.8	11.1	19.0	11.6	7.0	6.6
Wirral	0.9	3.1	3.1	1.6	4.7	5.0	10.0	6.9	4.7	4.3

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 upper tier local authority with the highest rate of laboratory reports of hepatitis B (acute and chronic) in the North West in 2022 was Manchester, with 41.5 reports per 100,000 population. However, rates in Manchester remain lower than the notable peak seen of 109.6 reports per 100,000 population seen in 2013. Other upper tier local authorities in the upper quartile of rates in 2022 were Salford, Trafford, Oldham, and Blackpool. 

The upper tier local authority with the lowest rate of laboratory reports of hepatitis B (acute and chronic) in the North West in 2022 was Knowsley, with 0.6 reports per 100,000 population. Other upper tier local authorities in the lowest quartile of rates were Sefton, Westmorland and Furness, Cumberland, and Liverpool. 

The fluctuating trend observed in Liverpool was due to changes in laboratory reporting

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.

The estimated incidence rate of acute or probable acute hepatitis B infection in North West residents in 2022 was 0.32 new acute or probable acute infections per 100,000 population, this is lower than the England average incidence rate of 0.42 new acute or probable acute infections per 100,000 population. The North West rate was the fourth lowest of all rates for UKHSA English regions.

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

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

The estimated incidence rate of acute or probable acute hepatitis B infection has been declining in England and the North West since 2013 (0.86 infections per 100,000 population). The large decrease seen in 2020 and sustained in 2021 and 2022 may be partly due to changes in access to healthcare during the COVID-19 pandemic.

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 West UKHSA region, 2013 to 2022

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

There have been 55,444 individuals tested for HBsAg (hepatitis B surface antigen) in sentinel laboratories in the North West in 2022, of which 0.74% tested positive. The proportion of positive test results declined between 2013 (1%) and 2015 (0.78%) and has remained largely stable from 2015 to 2022. The number of individuals tested increased from 2013 to 2019 but decreased in 2020 and remains below pre-pandemic levels, likely due to changes in access to healthcare during the COVID-19 pandemic.

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

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

In 2022, 7,591 individuals were tested for tested for HBsAg through GP surgeries in sentinel laboratories in North West, of which 1% tested positive. The proportion of positive test results has declined from 1.43% in 2013. Fluctuations from 2020 and 2021 are likely due to changes in access to healthcare during the COVID-19 pandemic, when fewer tests were being performed.

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 West UKHSA region, 2013 to 2022

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

In 2022, 7,187 individuals were tested for tested for HBsAg through sexual health services in sentinel laboratories in North West, of which around 0.71% tested positive. Positivity had remained stable (0.78 to 0.9%) from 2013 to 2018 but decreased in 2019 to 0.67%, which has been sustained up to 2022. The number of individuals tested in sexual health services also increased from 2013 to 2019 but decreased in 2020, likely linked to the COVID-19 pandemic, and decreased further in 2022.

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 West UKHSA region, 2013 to 2022

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

In 2022, 6,609 individuals were tested for tested for HBsAg through drug services in sentinel laboratories in North West, of which 1.17% tested positive. The proportion of positive tests among those performed through drug services has decreased since 2013 (2.62% positivity). The number of individuals tested has increased substantially over this period.

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 79,658 eligible women, with 99.7% having been tested within the North West NHS region (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 West 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.

The admission rate per 100,000 people for those with a diagnosis code of acute or chronic hepatitis B was 11.97 admissions per 100,000 population. This is lower than 2021 and around the same rate as 2013. This rate is also lower than the England rate of 15.71 admissions per 100,000 population, which increased compared to 2021.

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 West 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). 

The number of hospital admissions for individuals with HBV-related ESLD in the North West decreased in 2022 compared to the previous 3-year period (2019 to 2021). The number of hospital admissions for individuals with HBV-related HCC also decreased in 2022 in the North West compared to the previous 3-year period (2019 to 2021). However, changes in access to healthcare and healthcare seeking behaviour in 2020 and 2021 may have impacted these figures.

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.

The rate of deaths with end-stage liver disease and hepatocellular carcinoma in the North West from 2018 to 2022 was 0.138 per 100,000 population. This is similar to the West Midlands (0.145 per 100,000 population), lower than London (0.395 per 100,000 population) and England overall (0.156 per 100,00 population), and higher than all other UKHSA English regions.

Prevention of infection by immunisation

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

Figure 14. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 12 months, North West 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.

From FY 2019 to 2020 to FY 2022 to 2023 the coverage rate of 3 doses of the hexavalent vaccine at 12 months in the North West declined from 92.6% to 91.8%. This is identical to the decrease seen in England overall.

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

From FY 2020 to 2021 to FY 2022 to 2023 the coverage rate of 3 doses of the hexavalent vaccine at 24 months in the North West declined from 93.9% to 92.9%. This is less than the decline seen in England overall from 93.9% to 92.6%. In both the North West and England, coverage at 24 months was higher than at 12 months. 

Data presented in Tables 5 and 6 show vaccination coverage for children where the mother is hepatitis B screen positive or is already known to have hepatitis B.

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 West UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Blackburn with Darwen	3	3	100.00%
Blackpool	[note 15]	[note 15]	[note 15]
Bolton	15	15	100.00%
Bury	7	6	85.71%
Cheshire East	7	5	71.43%
Cheshire West and Chester	6	6	100.00%
Cumbria	0	0	Not applicable
Halton	[note 15]	[note 15]	[note 15]
Knowsley	[note 15]	[note 15]	[note 15]
Lancashire	14	12	85.71%
Liverpool	22	18	81.82%
Manchester	42	40	95.24%
Oldham	7	7	100.00%
Rochdale	10	10	100.00%
Salford	8	8	100.00%
Sefton	3	3	100.00%
St. Helens	[note 15]	[note 15]	[note 15]
Stockport	[note 15]	[note 15]	[note 15]
Tameside	[note 15]	[note 15]	[note 15]
Trafford	3	3	100.00%
Warrington	[note 15]	[note 15]	[note 15]
Wigan	4	3	75.00%
Wirral	[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.

In FY 2022 to 2023, the proportion of eligible children vaccinated against hepatitis B by their first birthday in UTLAs in the North West ranged from 71.43% in Cheshire East to 100% in Blackburn with Darwen, Bolton, Cheshire West and Chester, Oldham, Rochdale, Salford, Sefton, and Trafford. It is challenging to draw further conclusions due to issues interpreting statistics based on 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, North West UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Blackburn with Darwen	6	6	100.00%
Blackpool	[note 17]	[note 17]	[note 17]
Bolton	20	18	90.00%
Bury	[note 17]	[note 17]	[note 17]
Cheshire East	10	9	90.00%
Cheshire West and Chester	[note 17]	[note 17]	[note 17]
Cumbria	0	0	Not applicable
Halton	[note 17]	[note 17]	[note 17]
Knowsley	[note 17]	[note 17]	[note 17]
Lancashire	13	11	84.62%
Liverpool	8	8	100.00%
Manchester	23	19	82.61%
Oldham	9	7	77.78%
Rochdale	14	14	100.00%
Salford	13	11	84.62%
Sefton	[note 17]	[note 17]	[note 17]
St. Helens	4	3	75.00%
Stockport	7	7	100.00%
Tameside	4	4	100.00%
Trafford	[note 17]	[note 17]	[note 17]
Warrington	[note 17]	[note 17]	[note 17]
Wigan	0	0	Not applicable
Wirral	[note 17]	[note 17]	[note 17]

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.

In FY 2022 to 2023, the proportion of eligible children vaccinated against hepatitis B by their second birthday in UTLAs in the North West ranged from 75% in St. Helens to 100% in Blackburn with Darwen, Liverpool, Rochdale, Stockport, and Tameside. It is challenging to draw further conclusions due to issues interpreting statistics based on small numbers.

Vaccine uptake in people who inject drugs

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

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

The proportion of PWID who have reported vaccination in the North West in 2022 was 59.1%, this is slightly lower than the proportion for England in 2022 and a declining trend compared to previous years. Since 2018, the North West has seen a decline similar to the decline seen in England overall.

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 West UKHSA region and England, 2013 to 2022

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

The reported level of direct needle and/or syringe sharing amongst PWID in the North West in 2022 was 23.6%, this was higher than the reported level for England of 19.5%. The number of PWID reporting direct needle and/or syringe sharing has decreased in both the North West and England since 2020, but is not as low levels seen in 2018 and earlier.

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

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

The reported level of direct and indirect needle and/or syringe sharing amongst PWID in the North West in 2022 was 47.6%, this was higher than the reported level for England of 38.9%. The number of PWID reporting indirect needle and/or syringe sharing has increased in the North West since 2020, whereas in England overall it has decreased. The reported level in the North West in 2022 is above pre-pandemic (2019 and earlier) levels, whereas for England overall the rate is in line with pre-pandemic levels.

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 are 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.NorthWest@ukhsa.gov.uk.

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