Research and analysis

Hepatitis B in the West Midlands: 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 West Midlands 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:

• 869 new laboratory reports of hepatitis B in residents of West Midlands, representing a rate of 14.4 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 38.2% between 2021 and 2022, and increased by 9.2% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 495 (57%) and in females was 349 (40.2%) 
• in 2022, the number of new laboratory reports in males was highest in those aged 35 to 44 and for females aged 35 to 44 
• in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 12 in Shropshire to 284 in Birmingham; rates were highest in Coventry at 38.3 new laboratory reports per 100,000 population and lowest in Shropshire with 3.7 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.5 per 100,000 population. This was higher than the England average of 0.4 per 100,000 
• there have been 17,879 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in West Midlands UKHSA region in 2022, of which 1.03% tested positive - the proportion positive was higher for tests referred through GP surgeries and sexual health services and lower for tests through drug services

Monitoring HBV-related morbidity

Main trends are:

• there have been 795 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in West Midlands UKHSA region in 2022 which was higher than in 2021 
• the number of hospital admissions with a diagnosis code for hepatitis B-related end-stage liver disease (HBV-related ESLD) and hepatitis B-related hepatocellular carcinoma (HBV-related HCC) was 55 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 West Midlands UKHSA region was 93.7% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 0.3 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in West Midlands UKHSA region was 52.2% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 12.5 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 West Midlands UKHSA region, 2013 to 2022

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

Figure 1 shows all new laboratory diagnoses of hepatitis B (including both acute and chronic) in West Midlands residents between 2013 and 2022.

Over the 10-year period there has been a small increase (9.2%) in numbers of new diagnoses from 796 diagnoses in 2013 to 869 diagnoses in 2022, showing the West Midlands to have a consistently high number of diagnoses increasing slowly over time. Increases, particularly over longer periods may be driven by a number of factors such as increased awareness, targeted testing, and improved reporting and diagnostics. Various initiatives to improve testing uptake are likely to have influenced the increase in diagnoses. The introduction of Operational Delivery Networks (ODNs) and targeted work to increase bloodborne viruses (BBVs) testing (for hepatitis C, hepatitis B and HIV) for people most at risk of acquiring hepatitis C in 2015 to 2016 could have positively influenced the general uptake of BBVs testing over the proceeding years as these networks became more established and work towards elimination progressed.

During this time, there was only one significant drop in diagnoses seen between 2019 and 2020 (871 and 559 diagnoses respectively) which is likely to be due to the fall in testing activity, also seen nationally, as an effect of the COVID-19 pandemic on services and how people were able to access them. The following increase in diagnoses since 2020 to pre-pandemic levels shows a pattern of recovery with people once again presenting to services that test for HBV. The renewed focus following the pandemic on elimination and the widening of initiatives to improve identification of new cases of hepatitis, for example emergency department opt-out testing, may lead to further increases in diagnoses in future reports.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of West Midlands 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 compares the rate of new diagnoses per 100,000 population for West Midlands residents to that for England between 2013 and 2022. 

Between 2013 and 2019, the West Midlands had a consistent rate, where England showed more fluctuation but remained higher than the West Midlands other than in 2018 when the rates were similar. From 2019 onwards both England and West Midlands followed a similar pattern of the fall in diagnoses due to the effect of the pandemic followed by the increase showing a recovery in activity.

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

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

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

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

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

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

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

Table 1 shows the number of new laboratory reports of HBV for each region of residence and England between 2013 and 2022. Table 2 shows the rates per 100,000 population for each region of residence and England over the same period. 

London consistently has the highest number and rate of diagnoses and is significantly higher than other regions. In 2022, the West Midlands had the third highest number of cases and the rate is the second highest in the country but similar to most other regions apart from London.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of West Midlands 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 25 hepatitis B cases in West Midlands region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Figure 3 is a population pyramid showing the distribution of new diagnoses by age group and sex where age and sex are known. 

It shows most new diagnoses were amongst males which was 58.6% of all new diagnoses in 2022 where sex was known. Males in the 35 to 44 age group had the highest number of diagnoses, followed by males aged 25 to 34. The next highest number was seen in females aged 35 to 44 followed closely by females aged 25 to 34. The high numbers of new diagnoses seen in females aged between 25 and 44 could reflect the effect of antenatal screening amongst women within these age groups.

Figure 4. Ethnicity distribution of new laboratory reports of new diagnoses of HBV [note 4], residents of West Midlands 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 is a series of line graphs showing the proportion of new diagnoses of HBV in West Midlands residents by ethnicity from 2013 to 2022, where ethnicity was known. Ethnicity is not known for 33% of cases in 2013 and 50% in 2022.

The highest proportion of cases in 2013 were amongst the Asian or Asian British ethnicity (39%), which has shown a decrease in its proportion compared to other categories but is still the highest proportion of cases in 2022 (28%). The next highest proportion was amongst those who are from a Black or Black British ethnicity, which remained fairly consistent over this period (26% in both 2013 and 2022). The proportion of those from a White British and “Any other White background” have shown a steady increase between 2013 and 2022 both increasing by 4 percentage points over this period. Individuals from a Mixed background accounted for the lowest proportion of cases. 

Patterns in ethnicity and new HBV diagnoses may reflect changes in migration within the region. However, data on country of acquisition or country of birth are unknown and it is unclear if cases of hepatitis B have links to countries with higher rates of hepatitis B.

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Birmingham	381	274	282	283	383	390	337	184	196	284
Coventry	135	91	78	92	121	148	159	69	106	135
Dudley	26	15	17	10	5	30	22	20	16	19
Herefordshire	4	4	4	4	11	10	4	5	10	19
Sandwell	30	38	31	60	71	58	61	31	39	38
Shropshire	12	6	3	9	11	5	8	8	9	12
Solihull	11	10	9	12	11	11	10	4	9	20
Staffordshire	19	29	47	42	44	35	35	51	32	49
Stoke-on-Trent	30	31	29	27	38	38	60	37	60	66
Telford and Wrekin	17	14	11	11	11	16	17	18	15	19
Walsall	26	25	25	25	17	23	23	17	28	32
Warwickshire	34	27	49	45	38	31	41	23	29	57
Wolverhampton	45	27	39	36	47	45	59	66	51	67
Worcestershire	26	12	24	21	16	14	34	24	28	50

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

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

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Birmingham	34.8	24.8	25.3	25.0	33.6	34.0	29.3	16.0	17.1	24.6
Coventry	41.9	28.0	23.6	27.3	35.6	43.2	46.3	20.0	30.8	38.3
Dudley	8.3	4.8	5.4	3.1	1.6	9.3	6.8	6.2	4.9	5.8
Herefordshire	2.2	2.2	2.2	2.1	5.9	5.4	2.1	2.7	5.3	10.1
Sandwell	9.4	11.8	9.5	18.2	21.3	17.2	17.9	9.1	11.4	11.0
Shropshire	3.9	1.9	1.0	2.9	3.5	1.6	2.5	2.5	2.8	3.7
Solihull	5.3	4.7	4.3	5.6	5.1	5.1	4.6	1.8	4.2	9.2
Staffordshire	2.2	3.4	5.5	4.9	5.1	4.0	4.0	5.8	3.6	5.5
Stoke-on-Trent	11.9	12.2	11.4	10.5	14.7	14.7	23.1	14.3	23.2	25.4
Telford and Wrekin	10.1	8.2	6.4	6.3	6.2	8.9	9.3	9.8	8.1	10.1
Walsall	9.6	9.1	9.1	9.0	6.0	8.1	8.1	6.0	9.8	11.2
Warwickshire	6.1	4.8	8.7	7.9	6.6	5.4	7.0	3.9	4.8	9.4
Wolverhampton	17.8	10.6	15.2	13.9	18.0	17.1	22.4	25.1	19.3	25.0
Worcestershire	4.5	2.1	4.1	3.6	2.7	2.4	5.7	4.0	4.6	8.2

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.

Tables 3 and 4 show the number and rates, respectively, of new laboratory reports of HBV for upper tier local authorities in the West Midlands. Birmingham has consistently had the highest number of cases each year since 2013, while Coventry has the highest rate of new laboratory reports each year (apart from in 2015). Stoke-on-Trent and Wolverhampton also had rates above the regional average in 2022 and contrary to Birmingham and Coventry have seen an increase in the rate of diagnoses since 2013. Herefordshire, Sandwell, Solihull, Staffordshire, Walsall, Warwickshire and Worcestershire also saw an increase in the rate of diagnoses. Between 2021 and 2022 all upper tier local authorities, apart from Sandwell, had an increase in the rate of new diagnoses.

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.

Figure 5 shows the estimated incidence rates per 100, 000 population of new acute or probable acute HBV diagnoses for all regions across England compared to the England rate. 

The West Midlands has the second highest rate, with a rate similar to that of London and above the England rate.

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

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

The incidence of acute or probable acute cases per 100,000 population has shown a fluctuating pattern since 2013 in the West Midlands while the England rate gradually declined most years before an increase between 2021 and 2022. Since 2019 the incidence of cases in the West Midlands has been above the England rate and has followed the same pattern.

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 West Midlands UKHSA region, 2013 to 2022

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

Figures 7 to 10 use sentinel surveillance data. In the West Midlands only one laboratory (Birmingham Heartlands Hospital) submitted data to the sentinel surveillance scheme during this time period. 

Figure 7 shows the number of tests undertaken and the percentage positive between 2013 and 2022.

The level of testing showed a steady increase since 2013, with a drop in testing during 2020 reflecting the reduced accessibility of services due to the COVID-19 pandemic. However, testing then increased again to a number slightly below that of 2019. After a sharp increase between 2013 and 2014, the percentage positive slowly declined but remained above 1% even where testing patterns fluctuated.

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

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

The testing pattern seen in individuals referred by GP surgeries remained stable apart from a dip in 2020 due to the pandemic. Positivity showed a large increase between 2013 and 2015, which then appeared to become more level remaining above 1% and further increasing between 2021 and 2022 to 2%.

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 West Midlands UKHSA region, 2013 to 2022

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

Relatively few individuals are tested at the sentinel laboratory through SHS apart from in 2014 but then the percentage positive was low. In 2016 and 2018 the percentage positive is high but is based on a low number of tests.

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 West Midlands UKHSA region, 2013 to 2022

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

The number of individuals tested at the sentinel laboratory through drug services has significantly increased between 2013 and 2022 although shows the same dip as other services in 2020. 

Positivity levels fell from above 3% to 0.2% from 2013 to 2016. However, after 2016 the positivity rose to approximately 1% where it remained relatively stable.

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 was high with 99.8% out of 116,109 eligible women being tested within the Midlands NHS region (note: NHS region 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 West Midlands 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 2 line graphs. The first is the number of admissions for individuals with a hepatitis B diagnosis in West Midlands residents and the total for England. The second line graph is the rate of admissions for individuals with a hepatitis B diagnosis per 100,000 population resident in the West Midlands compared to the rate for those in England. 

The rate of admissions for the West Midlands is slightly lower than that for England and follows a similar pattern between 2013 and 2022. There is a steady increase in admission rates between 2013, 8.37 per 100,000 population, and 2016, 12.47 per 100,000 population. Following the portion of missing data the rates start at a slightly higher point of 14.61 per 100,000 population declining slightly to 13.21 per 100,000 population.

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 West Midlands 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).

Figure 12 shows that between 2013 and 2016, the number of admissions for those diagnosed with hepatitis B-related end-stage liver disease (HBV-related ESLD) was relatively stable (between 25 and 35 admissions a year) but the number increased after 2019, ranging from 45 to 55 admissions a year.

Admissions of individuals with a diagnosis of hepatitis B-related hepatocellular carcinoma (HBV-related HCC) were relatively stable between 2013 and 2022 with 20 in 2013 and 25 in 2022.

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.

Figure 13 shows a map of mortality rates with ESLD or HCC in those with acute or chronic HBV mentioned on their death certification for data from 2018 to 2022 by region across England. London had the highest rate and is significantly above the England rate of 0.156 per 100,000 population. The West Midlands, North West, East of England and Yorkshire and Humber all had rates between 0.121 and 0.18 per 100,000 and were all below the England rate.

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, West Midlands 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.

Figure 14 shows the coverage of the routine hepatitis B vaccine of 3 doses at 12 months for the West Midlands and England over the 4-year period of FY 2019 to 2020 to FY 2022 to 2023. The coverage in the West Midlands remains stable and slightly higher than for England each year. The West Midlands had a coverage of 93.1% in FY 2019 to 2020 and 92.4% in FY 2022 to 2023, compared to 92.6% and 91.8% in England.

Figure 15. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, West Midlands 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 routine hepatitis B vaccine coverage of 3 doses at 24 months in the West Midlands between April 2020 to March 2023 compared to England. Over this 3-year period the West Midlands remained above the England average but both coverage figures have shown a small decrease over this time period. The West Midlands coverage was 94.9% in FY 2020 to 2021 and fell slightly to 93.7% in FY 2022 to 2023 while the England coverage fell slightly from 93.8% to 92.6%.

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, West Midlands UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Birmingham	97	94	96.91%
Coventry	27	26	96.30%
Dudley	4	4	100.00%
Herefordshire	[note 15]	[note 15]	[note 15]
Sandwell	11	11	100.00%
Shropshire	4	4	100.00%
Solihull	4	4	100.00%
Staffordshire	10	10	100.00%
Stoke-on-Trent	15	15	100.00%
Telford and Wrekin	9	8	88.89%
Walsall	14	12	85.71%
Warwickshire	8	8	100.00%
Wolverhampton	13	13	100.00%
Worcestershire	5	4	80.00%

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 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, West Midlands UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Birmingham	106	100	94.34%
Coventry	26	26	100.00%
Dudley	13	13	100.00%
Herefordshire	3	3	100.00%
Sandwell	15	15	100.00%
Shropshire	[note 17]	[note 17]	[note 17]
Solihull	6	6	100.00%
Staffordshire	12	12	100.00%
Stoke-on-Trent	12	12	100.00%
Telford and Wrekin	7	7	100.00%
Walsall	4	4	100.00%
Warwickshire	13	12	92.31%
Wolverhampton	12	12	100.00%
Worcestershire	5	5	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.

Tables 5 and 6 show the number of children at high risk of maternal transmission who were eligible and vaccinated by their first and second birthdays respectively, by upper tier local authority.

Birmingham had the highest number of eligible children. The vast majority of eligible children were vaccinated by their first and second birthdays. For those receiving vaccinations by their first birthday, only 5 local authorities did not meet 100% coverage, with the lowest coverage being in Worcestershire (80%) followed by Walsall (85.7%), Telford and Wrekin (88.9%), Coventry (96.3%) and Birmingham (96.9%) but the number not vaccinated was low for each area.

For those receiving vaccinations by their second birthday only 2 local authorities were below 100% coverage. Wolverhampton had an uptake of 92.3% and Birmingham of 94.3% and in total in the West Midlands only 7 eligible individuals were not vaccinated.

Vaccine uptake in people who inject drugs

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

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

The reported level of uptake of at least 1 dose of the hepatitis B vaccine among people who inject drugs (PWID) in the West Midlands has shown a decrease of 11.7 percentage points since 2013 (from 63.8% to 52.1%), mostly remaining below the level of uptake reported for England during this period, except during 2019 to 2021 where levels were similar to that of England. In 2022, uptake in the West Midlands dropped 12.5 percentage points (from 64.7% in 2021 to 52.2% in 2022, which is below the uptake reported for England of 60.6%).

Further work to understand the reasons why individuals in this risk group choose not to accept the vaccination could help to improve uptake in the future.

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, West Midlands UKHSA region and England, 2013 to 2022

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

Figure 17 shows the levels of sharing of needles and/or syringes (direct sharing), while Figure 18 shows the level of direct sharing and sharing of injecting equipment (indirect sharing) amongst PWID in the West Midlands. Sharing of injecting equipment is an important contributor to transmission of HBV.

The percentage of people who reported the direct sharing of equipment in the West Midlands has increased from 15.5% in 2013 to 20.3% in 2022. In 2020 and 2021 the proportion of people reporting direct sharing increased due to the reduction in harm reduction services during the COVID-19 pandemic.

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

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

Similar to Figure 17, Figure 18 also shows the increase in self-reported sharing of needles and/or syringe and injecting equipment during the COVID-19 pandemic. The West Midlands saw a larger increase during this time than England. In the West Midlands in 2022 34.6% of PWID reported sharing, which is similar to that seen in England, 38.9%. We need to achieve a combination of reversing the recent downward trend in vaccination uptake amongst PWID in the West Midlands as well as further reducing the sharing of injecting equipment within this risk group to reduce transmission.

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 first birthday
• the ‘number of children vaccinated’ by their second birthday is total number of children from the eligible population receiving 3 monovalent HepB vaccines at birth, 4 weeks and 12 months, and 3 doses of hexavalent vaccine (at 8, 12 and 16 weeks) before their 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 FSMidlands@ukhsa.gov.uk

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