Research and analysis

Hepatitis B in the South 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 South 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:

• 702 new laboratory reports of hepatitis B in residents of the South West, representing a rate of 12.2 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 27.2% between 2021 and 2022, and increased by 127.9% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 376 (53.6%) and in females was 309 (44%) 
• in 2022, the highest number of new laboratory reports was in males aged 25 to 34 and females aged 35 to 44 
• in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 11 in Torbay to 149 in Bristol; rates were highest in Bournemouth, Christchurch and Poole at 32.5 new laboratory reports per 100,000 population and lowest in Cornwall and Isles of Scilly with 4.2 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 have been 36,021 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in the South West UKHSA region in 2022, of which 0.84% tested positive – the proportion positive was higher for tests referred through GP surgeries, lower for tests through sexual health services and higher for tests through drug services  

Monitoring HBV-related morbidity

Main trends are:

• there have been 405 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in the South West UKHSA region in 2022 which was the same as 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 20 and 10 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 West UKHSA region was 95.3% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 0.6 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in South West UKHSA region was 63.6% for 2022
• reported level of hepatitis B vaccine uptake among PWID has increased by 2.1 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 South West UKHSA region, 2013 to 2022

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

Testing laboratories have a statutory duty to report hepatitis B infections and the number of reports can provide an indication of regional trends.

As shown in Figure 1, there was an increase in laboratory reported cases of HBV (acute and chronic) between 2013 and 2017 (308 to 573), driven by factors such as improved diagnostics, targeted testing and improved (including mandatory) reporting. Cases then decreased between 2017 to 2020 (573 to 351), potentially reflecting the progress made with the introduction of the hexavalent HBV vaccine in routine childhood immunizations in 2017. Since 2020, laboratory reported cases of acute and chronic hepatitis B have increased. In 2022, there were 702 cases reported in the South West, the highest number of reports over the 10-year period, representing a 27.2% increase between 2021 to 2022. Over the 10-year reporting period, new laboratory cases increased by 127.9%. 

The COVID-19 pandemic had a significant impact on HBV detections during 2020 due to disruption in services. It has been reported elsewhere, an increase in detections could be attributed to the end of COVID-19 restrictions, recovery of health systems and changes in surveillance. Additionally, issues with delayed laboratory reporting may have led to reports being assigned to later years.

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

Trends in the rate of HBV (acute and chronic) reporting in the South West largely mirrored national trends; however, rates in the South West were lower (Figure 2). 

In the South West, rates increased from 5.7 reports per 100,000 population in 2013 to 10.3 per 100,000 population in 2017; rates then decreased. Since 2020, the rate of HBV (acute and chronic) reporting has increased and in 2022 was at the highest level over the 10-year period (12.2 per 100,000 population in 2022), although still lower than the national rate (16.4 reports per 100,000 population in 2022).

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 provides a summary of laboratory reported cases of hepatitis B (acute and chronic) by UKHSA region of residence. There are certain caveats to note when interpreting data in regional laboratory reports. If the patient postcode or GP information is unavailable, the patient will be assigned to the postcode of the testing laboratory and therefore reported for that UKHSA region. All UKHSA regions have seen an increase in laboratory reported cases of hepatitis between 2020 to 2022, with London reporting the highest number of reports in 2022 (3,882) (Table 1).

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.

Over the 10-year period, the rate of hepatitis B (acute and chronic) remained highest in London. All regions have seen an increase in rates since 2020 (Table 2). Between 2020 and 2022, the South West had the greatest increase in rates compared to other UKHSA regions (6.2 to 12.2 reports per 100,000 population; 96.7% increase).

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of South 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 18 hepatitis B cases in South West region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

The distribution of hepatitis B (acute and chronic) laboratory reported cases was slightly skewed towards males in 2022: 53.6% of cases were male (376) (Figure 3). 

In males, the highest number of cases was in those aged 25 to 34 years (95, 25.3%). In females, the highest number of cases was in those aged 35 to 44 years (91, 29.5%).

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

Between 2013 and 2022, the percentage of new HBV diagnoses varied by ethnic group in the South West (Figure 4). Data on ethnicity was available for 67.1% of laboratory reports of new diagnoses. 

Overall, higher proportions of individuals testing positive were classified as being of White British ethnic origin, with the proportion of new HBV diagnoses increasing between 2013 to 2022 (24.4% to 46.2%).

Any other ethnic group also saw an increase in the percentage of new HBV diagnoses between 2013 to 2022 (4.7% to 7.2%) whereas all other ethnic groups showed a decrease, most markedly in Asian or Asian British heritage where new diagnoses decreased by over half over the 10-year period (28.2% to 13.6%).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Bath and North East Somerset	8	9	9	16	21	16	16	17	19	34
Bournemouth, Christchurch and Poole	34	31	27	20	39	35	16	19	104	131
Bristol	106	87	83	95	173	148	127	126	93	149
Cornwall and Isles of Scilly	12	17	19	9	47	18	13	10	14	24
Devon	31	26	21	13	18	11	10	36	138	46
Dorset	6	7	8	5	22	19	8	12	26	27
Gloucestershire	30	38	25	38	29	27	24	21	17	42
North Somerset	5	7	11	15	31	22	16	9	12	29
Plymouth	18	19	17	28	16	18	19	13	14	37
Somerset	15	12	23	30	37	47	20	10	27	37
South Gloucestershire	18	12	12	31	36	25	28	21	31	64
Swindon	11	13	17	10	25	18	19	18	20	29
Torbay	<5	5	10	7	4	9	6	8	<5	11
Wiltshire	13	17	17	25	32	33	48	31	32	41

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 breakdown of laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence between 2013 to 2022. There is considerable variation in the number of laboratory reports over the 10-year period. In 2022, the highest number of laboratory reports was seen in Bristol (149), followed by Bournemouth, Christchurch and Poole (131), whereas the lowest number of reports was in Torbay (11). There have been known issues with laboratory reporting in some areas of the South West, at times leading to reporting of historical records. Large changes in the number of cases between years need to be treated with caution.

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 West UKHSA region, 2013 to 2022

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Bath and North East Somerset	4.5	5.0	4.9	8.6	11.2	8.4	8.4	8.9	9.9	17.3
Bournemouth, Christchurch and Poole	8.8	8.0	6.9	5.0	9.8	8.7	4.0	4.8	26.0	32.5
Bristol	24.1	19.6	18.4	20.7	37.4	31.7	27.0	26.7	19.7	31.1
Cornwall and Isles of Scilly	2.2	3.1	3.5	1.6	8.4	3.2	2.3	1.8	2.4	4.2
Devon	4.1	3.4	2.7	1.7	2.3	1.4	1.3	4.5	16.9	5.6
Dorset	1.6	1.9	2.2	1.3	5.9	5.1	2.1	3.2	6.8	7.0
Gloucestershire	5.0	6.2	4.0	6.1	4.6	4.3	3.8	3.3	2.6	6.4
North Somerset	2.4	3.4	5.2	7.1	14.5	10.3	7.4	4.2	5.5	13.2
Plymouth	6.9	7.3	6.5	10.6	6.0	6.8	7.2	4.9	5.3	13.9
Somerset	2.8	2.2	4.2	5.4	6.6	8.4	3.5	1.8	4.7	6.4
South Gloucestershire	6.7	4.4	4.4	11.2	12.9	8.9	9.8	7.3	10.7	21.7
Swindon	5.1	5.9	7.7	4.5	11.0	7.8	8.2	7.7	8.6	12.3
Torbay	0.8	3.7	7.4	5.1	2.9	6.5	4.3	5.8	2.9	7.9
Wiltshire	2.7	3.5	3.5	5.1	6.4	6.6	9.5	6.1	6.2	7.9

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 provides a breakdown of rates per 100,000 population of laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence, South West UKHSA region between 2013 to 2022. There was considerable variation in the rate of hepatitis B reports by upper tier local authority over the 10-year time period.

In 2022, the highest reporting rates were observed in Bournemouth, Christchurch and Poole (32.5 reports per 100,000 population), Bristol (31.1 per 100,000 population) and South Gloucestershire (21.7 per 100,000 population). The lowest rates were seen in Cornwall and Isles of Scilly (4.2 per 100,000 population), Devon (5.6 per 100,000 population) and Somerset and Gloucestershire (both 6.4 per 100,000 population). 

However, as previously noted, laboratory reporting issues may to some extent explain recent notable changes in rates.

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 the South West, the estimated incidence of acute or probable acute hepatitis was 0.33 cases per 100,000 population, below the national baseline of 0.42 per 100,000 population. The South West had a lower incidence of acute or probable acute hepatitis compared to some other UKHSA regions, including London (0.52 per 100,000 population and the West Midlands (0.50 per 100,000 population), but a higher incidence than four regions including the East Midlands (0.14 per 100,000 population) and Yorkshire and Humber (0.31 per 100,000 population).

Figure 6. Estimated incidence of acute or probable acute hepatitis B per 100,000 population, South 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 of acute or probable acute hepatitis B decreased in the South West between 2013 to 2021 (0.67 to 0.33 cases per 100,000 population). 

Both England and the South West saw an uptick in incidence between 2021 to 2022 (0.31 to 0.42 cases per 100,000 population and 0.30 to 0.33 per 100,000 population in 2022, respectively). However, overall numbers are small in the South West and trends need to be treated with caution.

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 West UKHSA region, 2013 to 2022

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

Data from sentinel laboratories in the South West can provide information on trends in testing activity.

The number of individuals tested for HBsAg increased between 2013 and 2022 (19,933 to 36,021), with a slight decrease in 2020 coinciding with the COVID-19 pandemic (Figure 7). Testing recovered post-pandemic and levels in 2022 were the highest over the 10-year period.

Test positivity increased between 2013 to 2017 (0.54% to 1.06%). Between 2017 to 2021, there was a decreasing trend of those testing positive, which then increased between 2021 to 2022 (0.63% to 0.84%).

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

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

Figure 8 shows trends in testing and test positivity through GP surgeries in sentinel laboratories in the South West. 

The number of individuals tested was on an upwards trajectory since 2013, increasing from 7,691 to 12,070 individuals in 2022. There was a slight dip in this trend in 2020, coinciding with the COVID-19 pandemic. 

Test positivity was on a downwards trajectory between 2017 to 2021 (0.88% to 0.43%). Post pandemic, between 2021 to 2022, there was an increase in the proportion of individuals testing positive (0.43% to 0.99%).

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 West UKHSA region, 2013 to 2022

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

Between 2013 and 2018, the number of individuals tested in sexual health services (SHS) increased from 3,645 to 4,364 (Figure 9). The number tested subsequently decreased to 1,768 individuals in 2021. Testing increased post-pandemic, but in 2022 was at the lowest level over the 10-year reporting period excluding 2020 and 2021 (2,875 individuals tested). 

Between 2013 and 2022, test positivity through SHS appeared to be on a downwards trajectory (with an uptick in cases testing positive in 2017). In 2022, the number of individuals testing positive was the lowest in the 10-year period (0.10%).

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 West UKHSA region, 2013 to 2022

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

People who inject drugs (PWID) are a group at particular risk of acquiring hepatitis B infection. Figure 10 shows testing and test positivity through drug services in sentinel laboratories in the South West. 

Between 2013 and 2022, the number of individuals tested was on an upwards trajectory (62 to 2,321), with a slight decrease in those tested during 2020, coinciding with the COVID-19 pandemic. 

Test positivity in PWID has shown an upwards trend over the 10-year period and in 2022 was at 0.95%.

Coverage of maternal hepatitis B surface antigen (HBsAg) testing

Infectious Diseases in Pregnancy Screening (IDPS) is an antenatal screening programme which monitors pregnancies where the mother is screen positive or already known to have hepatitis B.

Due to the IDPS programme recently changing how they report on regions, data is only available for the financial year (FY) 2021 to 2022. During FY 2021 to 2022, 50,555 women were eligible for this screening in the South West region, and 99.7% of those eligible were tested.

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 South 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.

Figure 11 shows the number of admissions and admission rate per 100,000 population with a diagnosis code for acute or chronic hepatitis B between 2013 and 2022 in the South West and England. Data is not available for 2017 and 2018. 

The admission rate per 100,000 population in the South West was markedly lower compared to England.

Between 2013 and 2022, the number of admissions with a diagnosis of hepatitis B increased slightly from 320 to 405 admissions. The rate of admissions per 100,000 population with HBV in the South West increased from 5.95 admissions per 100,000 population in 2013 to 7.02 per 100,000 population in 2022.

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 South 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).

HBV-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 (HCC in England) using Hospital Episode Statistics data. 

Figure 12 shows the number of admissions with a diagnosis code for HBV-related ESLD or HBV-related HCC between 2013 and 2022 in the South West. Data is not available for 2017 and 2018. Numbers of admissions between 1 and 7 have been suppressed. 

Between 2013 and 2016, there was a decrease in the number of individuals admitted to hospitals in the South West with HBV-related ESLD. There was a peak in admissions in 2020 (35), with a subsequent decrease between 2020 and 2022 (20).

Due to omitted and suppressed data, trends in the number of admissions to hospitals in the South West with HBV-related HCC are less defined. There was a peak in admissions in 2020 (20), which subsequently decreased in 2022 (10). Caution should be taken when interpreting small numbers.

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.

Death registrations from HBV-related ESLD and/or HCC deaths ranged between 0.045 to 0.395 deaths per 100,000 population between 2018 to 2022 in UKHSA regions. Death rates in the South West were in the lower range when compared to other regions (0.063 deaths per 100,000 population) (Figure 13).

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 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.

Universal hepatitis B immunisation using a hexavalent vaccine has been included in the routine childhood programme in England since late 2017. Figure 14 shows the vaccine coverage of children at 12 months between FY 2019 to 2020 to FY 2022 to 2023. Coverage in the South West remained higher than the England figure over this time period. In FY 2022 to 2023, vaccination coverage was 94.6% compared to 91.8% in England.

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

Figure 15 shows the routine vaccine coverage of children at 24 months between FY 2020 to 2021 to FY 2022 to 2023. Coverage in the South West was higher than the England figure over this time period. The vaccine coverage of 3 doses at 24 months decreased by 0.6 percentage points between FY 2021 to 2022 and FY 2022 to 2023. In FY 2022 to 2023, coverage in the South West UKHSA region was 95.3% compared to 92.6% in England.

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 West UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bath and North East Somerset	4	4	100.00%
Bournemouth, Christchurch and Poole	13	12	92.31%
Bristol, City of	18	15	83.33%
Cornwall and Isles of Scilly	[note 15]	[note 15]	[note 15]
Devon	9	9	100.00%
Dorset	0	0	Not applicable
Gloucestershire	10	10	100.00%
North Somerset	3	3	100.00%
Plymouth	[note 15]	[note 15]	[note 15]
Somerset	8	8	100.00%
South Gloucestershire	5	5	100.00%
Swindon	16	14	87.50%
Torbay	[note 15]	[note 15]	[note 15]
Wiltshire	9	9	100.00%

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 vaccination coverage of children at risk of maternal transmission vaccinated against hepatitis B by their first birthday by upper tier local authority. Overall numbers of eligible children in this selective programme are very low at upper tier local authority level; therefore, numbers should be treated with caution, however percentage coverage was above 83.3%.

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 West UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bath and North East Somerset	5	5	100.00%
Bournemouth, Christchurch and Poole	6	5	83.33%
Bristol, City of	24	22	91.67%
Cornwall and Isles of Scilly	3	2	66.67%
Devon	7	7	100.00%
Dorset	[note 17]	[note 17]	[note 17]
Gloucestershire	5	5	100.00%
North Somerset	4	4	100.00%
Plymouth	4	4	100.00%
Somerset	[note 17]	[note 17]	[note 17]
South Gloucestershire	3	2	66.67%
Swindon	9	9	100.00%
Torbay	[note 17]	[note 17]	[note 17]
Wiltshire	9	9	100.00%

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 vaccination coverage of children at risk of maternal transmission vaccinated against hepatitis B by their second birthday by upper tier local authority. Once again, overall numbers of eligible children in this selective programme are very low at upper tier local authority level; therefore, numbers should be treated with caution

Vaccine uptake in people who inject drugs

Figure 16. Reported level of hepatitis B vaccine uptake among people who inject drugs (PWID), South West 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 the self-reported uptake of at least one dose of the hepatitis B vaccine in the South West region between 2013 and 2022 compared to England overall. Between 2013 and 2022, self-reported vaccine uptake averaged at 69.1%, with a peak of 78.1% in 2017. There was a decrease in self-reported uptake between 2017 to 2021 to 61.5%. Uptake in the South West appears to be increasing - uptake in 2022 was reported as 63.6% (2.1% increase since 2021), slightly higher than 60.6% reported for England. As noted in the data sources section, small samples sizes should be considered when interpreting trends in UAM Survey data.

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 West UKHSA region and England, 2013 to 2022

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

Figure 17 shows the percentage of direct needle and/or syringe sharing in PWID in the 4 week prior to reporting between 2013 to 2022 for the South West and England. There was an increase in the percentage of individuals directly sharing needles between 2013 to 2019 (19.6% to 32.2%) which subsequently decreased to 26.8% in 2022. Levels of direct sharing of needles and syringes remains higher in the South West compared to England overall.

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

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

Figure 18 shows the percentage of direct and indirect sharing of injecting equipment among PWID in the four week prior to reporting between 2013 to 2022 for the South West and England. Indirect sharing the involves common use of other drug preparation or injection equipment, such as mixing containers or filters rather than directly sharing needles. 

Overall, trends were on a downwards trajectory from 2013 to 2018 (53.6% to 42.4%). Trends then fluctuated, with an increase seen between 2021 to 2022 (43.3 to 47.9%) Levels of direct or indirect sharing of injecting equipment remains higher in the South West compared to England overall.

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 first dose of PCV at 12 weeks of age
• prior to this, PCV primary at 12 months was 2 doses administered at 8 and 16 weeks - FY 2021 to 2022 is the first year that coverage reported is based on the single dose primary course

Data from the Selective Programme:

• the ‘eligible population’ is the total number of children reaching their first birthday during the specified evaluation period with maternal Hep B positive status
• the ‘number of children vaccinated’ by their first birthday is total number of children from the eligible population receiving 2 monovalent HepB vaccines (at birth and one month) and 3 doses of hexavalent vaccine (at 8, 12 and 16 weeks) before their 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.southwest@ukhsa.gov.uk

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