Research and analysis

Hepatitis B in the South East: 2024 report

Published 22 May 2025

Applies to England

© Crown copyright 2025

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Introduction

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

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

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

This report complements the UKHSA Hepatitis B in England 2024 report and presents further information on HBV disease surveillance, trends in HBV diagnosis and testing and related diseases in the South 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                                    

Main trends are:

  • there have been 982 new laboratory reports of hepatitis B in residents of South East, representing a rate of 10.8 reports per 100,000 population in 2022 
  • the number of new laboratory reports has increased by 33.2% between 2021 and 2022, and increased by 41.3% over the past 10 years 
  • in 2022, the number of new laboratory reports in males was 592 (60.3%) and in females was 381 (38.8%); sex was unknown for 0.9% of cases
  • in 2022, the highest number of new laboratory reports was in males aged 35 to 44 and females aged 35 to 44 
  • in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 4 in Isle of Wight to 191 in Hampshire; rates were highest in Slough at 49.6 new laboratory reports per 100,000 population and lowest in Buckinghamshire with 1.2 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 were 27,631 individuals tested for hepatitis B surface antigen (HBsAg) in sentinel laboratories in the South East UKHSA region in 2022, of which 0.76% tested positive - the proportion positive was lower for tests referred through GP surgeries, higher for tests through sexual health services and lower for tests through drug services

Main trends are:

  • there were 865 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in the South East UKHSA region in 2022 which was 10% 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 35 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 the South East UKHSA region was 94.1% 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 the South East UKHSA region was 67.4% for 2022
  • reported level of hepatitis B vaccine uptake among PWID has increased by 12.2 percentage points between 2021 and 2022

New laboratory-confirmed diagnoses of HBV infection

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

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

Figure 1 shows the number of new laboratory reports of hepatitis B in the South East from 2013 to 2022. In 2022, 982 new laboratory reports of HBV were reported in the South East. This is an increase in reports from the previous year and the highest number in the time period. Reports have been rising since 2020 when the number of reports fell significantly, likely due to the impact of the COVID-19 pandemic.

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

Figure 2 shows the trend in rate of new laboratory reports of hepatitis B in the South East per 100,000 residents compared to England overall. The rate of new laboratory reports of HBV in the South East in 2022 was 10.8 per 100,000 population, lower than the national rate (16.4 per 100,000). The rate has been increasing since 2020, when it fell significantly, likely due to the impact of the COVID-19 pandemic.

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

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

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

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

Table 1 shows the numbers of new laboratory reports of hepatitis B for each region in England from 2013 to 2022. In 2022, London was the region with the highest number of laboratory reports, followed by the South East. Over the period 2013 to 2022, 8% of reports in England were in the South East.

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

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

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

Table 2 shows the rate of new laboratory reports of hepatitis B per 100,000 residents for each region in England from 2013 to 2022. In 2022, London was the region with the highest rate, followed by the West Midlands. The rate for the South East was significantly lower than the rate for England (11 per 100,000 versus 16).

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of South 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 246 hepatitis B cases in the South East region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Figure 3 shows the age-sex distribution of new laboratory reports of hepatitis B in the South East in 2022. The group with the most cases was males aged 35 to 44. In all age groups there were more cases in males than females, with males making up 60% of all reports where data on sex is available.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of South 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 new laboratory reports by ethnic group in the South East from 2013 to 2022. In 2022 the ethnic group with the highest percentage of hepatitis B reports was Asian or Asian British at 26%, followed by White British (24%) and Black or Black British (23%). Data on ethnicity was available for 54% of laboratory reports of new diagnoses in 2022 (61% for 2013 to 2022).

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

Upper tier local authority 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Bracknell Forest 12 16 7 5 9 9 14 8 13 11
Brighton and Hove 107 43 29 27 40 44 44 36 41 36
Buckinghamshire 42 29 34 34 45 35 35 6 13 7
East Sussex 26 19 28 18 33 28 30 16 18 25
Hampshire 32 37 38 41 30 33 94 24 185 191
Isle of Wight 2 6 4 2 10 4 9 0 2 4
Kent 77 87 84 68 78 94 103 79 79 128
Medway 26 24 24 22 39 18 10 15 15 22
Oxfordshire 78 57 50 53 63 74 64 66 57 56
Portsmouth 21 23 15 25 29 19 18 13 10 44
Reading 10 15 13 13 95 56 83 28 37 47
Slough 44 39 31 27 53 51 85 47 42 79
Southampton 24 13 26 32 25 20 21 29 21 17
Surrey 97 94 92 101 147 127 219 104 110 135
West Berkshire 0 6 1 5 15 14 9 10 14 20
West Sussex 71 46 42 38 31 69 83 46 55 102
Windsor and Maidenhead 16 18 10 5 19 17 25 6 4 11
Wokingham 2 8 4 10 34 20 26 6 13 31

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

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

Table 3 shows the number of new laboratory reports of hepatitis B in the South East by upper tier local authority from 2013 to 2022. In 2022 the upper tier local authority with the highest number of reports (191) was Hampshire. Kent, Surrey and West Sussex also experienced more than 100 reports.

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

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

Upper tier local authority 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Bracknell Forest 10 14 6 4 8 7 12 7 10 9
Brighton and Hove 39 16 11 10 14 16 16 13 15 13
Buckinghamshire 8 6 6 6 8 7 6 1 2 1
East Sussex 5 4 5 3 6 5 6 3 3 5
Hampshire 2 3 3 3 2 2 7 2 13 14
Isle of Wight 1 4 3 1 7 3 6 0 1 3
Kent 5 6 6 4 5 6 7 5 5 8
Medway 10 9 9 8 14 7 4 5 5 8
Oxfordshire 12 8 7 8 9 11 9 9 8 8
Portsmouth 10 11 7 12 14 9 9 6 5 21
Reading 6 9 8 8 55 32 48 16 21 27
Slough 30 27 21 18 34 33 54 30 27 50
Southampton 10 5 11 13 10 8 8 12 9 7
Surrey 8 8 8 9 12 11 18 9 9 11
West Berkshire 0 4 1 3 9 9 6 6 9 12
West Sussex 9 6 5 5 4 8 10 5 6 11
Windsor and Maidenhead 11 12 7 3 12 11 16 4 3 7
Wokingham 1 5 3 6 21 12 15 3 7 17

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

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

Table 4 shows the rate per 100,000 residents of new laboratory reports for each upper tier local authority in the South East from 2013 to 2022. In 2022 the upper tier local authority with the highest rate was Slough with 50 reports per 100,000. The upper tier local authority with the lowest rate was Buckinghamshire (1 per 100,000).

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

Acute or probable acute diagnoses of hepatitis B

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

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

Figure 5 shows the estimated incidence (per 100,000) of acute or probable acute hepatitis B in each region in England in 2022. The incidence in the South East was 0.31 per 100,000, lower than the incidence for England overall (0.42 per 100,000).

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

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

Figure 6 shows the estimated incidence (per 100,000) of acute or probable acute hepatitis B in the South East and England from 2013 to 2022. In 2022, the incidence rate was 0.3 per 100,000, an increase from the previous year (0.1 per 100,000). The incidence rate in the South East has fluctuated but been on a general downward trend since 2013 and has remained below the national rate.

HBV testing in the wider population

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

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

Figure 7 shows the number of individuals tested for HBsAg in sentinel laboratories in the South East, and the percentage positive from 2013 to 2022. In 2022 the number of individuals tested was 27,631. The number of individuals tested has been on an upward trend since 2013, but fell in 2020 likely due to the impact of the COVID-19 pandemic. The percentage positive was 0.76% in 2022, similar to the previous year (0.74%). Positivity has been on a slight upward trend since 2013, although it fell in 2020.

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

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

Figure 8 shows the number of individuals tested for HBsAg and proportion positive in the South East through GP surgeries in sentinel laboratories from 2013 to 2022. In 2022 the number of individuals tested was 6,703, and the percentage positive was 0.75%. The percentage positive has been rising since 2020, before which it had been on a general downward trend. The number of people tested remains at lower levels than it was prior to 2020.

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 South East UKHSA region, 2013 to 2022

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

Figure 9 shows the number of individuals tested for HBsAg in the South East through sexual health services in sentinel laboratories and proportion positive from 2013 to 2022. In 2022, the number of individuals tested was 877 and the percentage positive was 2.85%. The percentage positive has been on an upward trend since 2013 (0.99%), while the number of people tested has been on a downward trend (3,140 in 2013).

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 South East UKHSA region, 2013 to 2022

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

Figure 10 shows the number of individuals tested for HBsAg and proportion positive in the South East through drug services in sentinel laboratories from 2013 to 2022. In 2022, the number of individuals tested was 4,590 and the percentage positive was 0.48%. The number of individuals tested has been on an upward trend since 2013 (18). The percentage positive has fluctuated and has also been on an upward trend since 2013 (0%).

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 94,116 eligible women, with 99.8% having been tested within the South East NHS region (note: NHS regions may not be the same as UKHSA regions).

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 South 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.

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

There were 865 hospital admissions for South East residents with a diagnosis code for acute or chronic hepatitis B in 2022, this was an increase of 10.2% from the previous year (2021: 785). The admission rate for the South East region in 2022 was 9.6 per 100,000 population, this was below the admission rate for England, which was 15.7 per 100,000.

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

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

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

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

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

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

In 2022, HES analysis identified 60 people with a first presentation to hospital with hepatitis B-related ESLD and/or hepatocellular carcinoma: 35 people had a first presentation with HBV-related ESLD and 25 people had a first presentation with HBV-related HCC. The overall number is the same as the number of people identified with first presentation in 2013 (60).

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

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

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

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

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

Between 2018 and 2022, the mortality rate in the South East region was 0.1 per 100,000 population, lower than the national rate of 0.2 per 100,000.

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, South 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.

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

In FY 2022 to 2023, the three-dose vaccination coverage at 12 months for children in the South East was 93.3%. This is above the WHO target and comparable to the coverage reported in the previous year, 2021 (93.4%).

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

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

In FY 2022 to 2023 the vaccine coverage in the South East for children aged 24 months was 94.1%, this was a decrease of 0.4 percentage points from the coverage in FY 2021 to 2022 (94.5%). The vaccine coverage in England in FY 2022 to 2023 at 24 months with 3 vaccine doses was 92.6% exceeding the WHO target of 90%.

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

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

Local authority Eligible population Number vaccinated Percentage covered (%)
Bracknell Forest 4 3 75%
Brighton and Hove [note 15] [note 15] [note 15]
Buckinghamshire 13 11 85%
East Sussex 3 3 100%
Hampshire 15 15 100%
Isle of Wight 0 0 Not applicable
Kent 29 20 69%
Medway 6 3 50%
Oxfordshire 25 25 100%
Portsmouth [note 15] [note 15] [note 15]
Reading 15 14 93%
Slough 9 8 89%
Southampton 6 6 100%
Surrey 20 20 100%
West Berkshire [note 15] [note 15] [note 15]
West Sussex 10 9 90%
Windsor and Maidenhead [note 15] [note 15] [note 15]
Wokingham 0 0 Not applicable

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

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

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

Table 5 shows proportion of eligible infants who received 5 hepatitis B vaccine-containing doses as part of the selective (and routine) immunisation programme by 12 months of age and South East local authority in FY 2022 to 2023. Only 5 of the 18 (28%) local authorities in the South East achieved 100% coverage of the eligible infant population, the percentage coverage by local authorities ranged from 50% to 100%.

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

Local authority Eligible population Number vaccinated Percentage covered (%)
Bracknell Forest [note 17] [note 17] [note 17]
Brighton and Hove 4 4 100%
Buckinghamshire 12 9 75%
East Sussex 3 3 100%
Hampshire 40 40 100%
Isle of Wight 3 3 100%
Kent 35 18 51%
Medway 8 3 38%
Oxfordshire 13 13 100%
Portsmouth 16 16 100%
Reading 9 9 100%
Slough 9 8 89%
Southampton 17 17 100%
Surrey 20 14 70%
West Berkshire 4 3 75%
West Sussex 8 4 50%
Windsor and Maidenhead 3 2 67%
Wokingham 3 3 100%

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

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

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

Table 6 shows coverage of eligible infants who received 6 hepatitis B vaccine-containing doses as part of the selective (and routine) immunisation programme by 24 months of age by South East local authority in FY 2022 to 2023. Half (50%) of the local authorities in the South East achieved 100% coverage of the eligible infant population, the percentage coverage by local authorities ranged from 38% to 100%.

Vaccine uptake in people who inject drugs

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

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

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

Figure 16 shows data from the UAM survey for reported levels of hepatitis B vaccine uptake among people who inject drugs (PWID) in the South East and England between 2013 and 2022.

In 2022, the reported level of hepatitis B vaccine uptake among PWID in the South East was 67.4% and is above the reported level in England (60.6%), this was an increase of 22% from the reported level in the previous year (2021: 55.2%) marking the first time the South East has exceeded the national reported level of uptake since 2013 and very nearly reaching levels of vaccine uptake seen pre-pandemic (2019 and earlier), whereas for England overall the uptake has fallen since 2017.

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, South East UKHSA region and England, 2013 to 2022

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

Figure 17 shows the reported level of direct sharing of needles and/or syringes among PWID in the preceding 4 weeks in the South East and England between 2013 and 2022.

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

The reported level of direct sharing of needles among PWID in the South East in 2022 was 16.5%, this is a decrease of 12.1 percentage points since the peak of 28.6% reported in 2020 and 2021 and is below the reported level in England in 2022 (19.5%).

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

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

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

The reported level of direct and indirect sharing of injecting equipment among PWID in the South East in 2022 was 40.8%, this is an increase of 8.2 percentage points since the lowest reported level seen in 2019 (32.5%) and remains slightly below the reported level in 2013 (41.3%) but above the reported level in England in 2022 (38.9%).

Between 2021 and 2022, the reported level of direct and indirect sharing of injecting equipment among PWID has decreased by 3.6 percentage points (2021, 44.4%) in the South East.

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.SEaL@ukhsa.gov.uk 

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

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