Research and analysis

Hepatitis B in Yorkshire and Humber: 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 Yorkshire and Humber 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:

• 735 new laboratory reports of hepatitis B in residents of Yorkshire and Humber, representing a rate of 13.3 reports per 100,000 population in 2022 
• the number of new laboratory reports has increased by 32.9% between 2021 and 2022, and decreased by 14.8% over the past 10 years 
• in 2022, the number of new laboratory reports in males was 465 (63.4%) and in females was 268 (36.6%) 
• in 2022, the highest number of new laboratory reports was in males aged 25 to 34 and females aged 25 to 34 
• in 2022, the number of new positive laboratory reports by upper tier local authority of residence ranged from 7 in North East Lincolnshire to 164 in Leeds; rates were highest in York at 30.4 new laboratory reports per 100,000 population and lowest in East Riding of Yorkshire with 4.3 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 34,606 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in Yorkshire and Humber UKHSA region in 2022, of which 0.69% tested positive - the proportion positive was higher for tests referred through GP surgeries, higher for tests through sexual health services and higher for tests through drug services

Monitoring HBV-related morbidity

Main trends are:

• there have been 675 (to the nearest 5) hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in Yorkshire and Humber 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 30 and 10 (to the nearest 5) respectively in 2022 

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in Yorkshire and Humber UKHSA region was 93.8% for 2022
• vaccine coverage of 3 doses at 24 months has decreased by 0.7 percentage points between 2021 and 2022
• reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in Yorkshire and Humber UKHSA region was 48.5% for 2022
• reported level of hepatitis B vaccine uptake among PWID has decreased by 23.3 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 Yorkshire and Humber UKHSA region, 2013 to 2022

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

There were 735 new laboratory-confirmed reports of hepatitis B (acute and chronic) in Yorkshire and Humber residents (Figure 1). This is similar to the number reported prior to the COVID-19 pandemic in 2019 (766 reports) and 32.9% higher compared to 2021 (553 reports) when reports were substantially lower due to the impact of pandemic restrictions and disruption in services. Over the past 10 years, the number of new laboratory-confirmed reports have decreased by 14.8%.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of Yorkshire and Humber UKHSA region and England, 2013 to 2022

Data sources: SGSS and Office for National Statistics (ONS) mid-year population estimates (MYE). For further information, see Information on data sources.

Note 1: the error bands represent 95% confidence intervals

In 2022, the rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) in Yorkshire and Humber residents was 13.3 reports per 100,000 population and remained below that for England as a whole (16.4 per 100,000 population) (Figure 2). In 2022, the rate in Yorkshire and Humber residents was comparable to the pre-pandemic rates in 2018 and 2019.

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

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

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

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

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

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

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

In 2022, the Yorkshire and Humber region had the fifth highest number and third highest rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) (735 reports and rate of 13.3 reports per 100,000 population) (Table 1 and 2). London reports (3,882 reports) accounted for 41% of all reports in England and was significantly higher than the rate for all other regions (43.8 per 100,000 versus 7.8 to 14.4). This is potentially impacted by a higher proportion of London residents being born outside of the UK (where hepatitis B prevalence can be higher).

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of Yorkshire and Humber 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. 2 hepatitis B cases in Yorkshire and Humber region in 2022 had no age and/or sex data and have not been included in this age-sex pyramid.

Age and sex information was known for 733 (99.7%) of the 735 new laboratory-confirmed reports of hepatitis B (acute and chronic) in Yorkshire and Humber residents in 2022. Of these, 465 (63.4%) were male and 268 (36.6%) were female (Figure 3). In 2022, the highest number of laboratory-confirmed reports in males and females was in those aged 25 to 34 (142 of 465, 31% and 82 of 268, 31%, respectively). Males accounted for a higher proportion of reports in all age groups except the 65 and over group in 2022.

Figure 4. Ethnicity distribution of laboratory reports of new diagnoses of HBV [note 4], residents of Yorkshire and Humber UKHSA region, 2013 to 2022

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

Note 4: this figure excludes cases of unknown ethnicity.

Figure 4 shows the proportion of laboratory-confirmed reports of new diagnoses of HBV in Yorkshire and Humber residents over the past 10 years by ethnicity. In 2022, individuals with ethnicity reported as Black or Black British accounted for the largest proportion of reports (26.5%), followed by Asian or Asian British (23.9%) and then White British (17.0%).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Barnsley	25	17	12	17	25	21	12	10	21	17
Bradford	193	115	112	65	46	65	80	48	57	86
Calderdale	11	10	6	14	9	14	13	4	6	14
Doncaster	19	20	22	15	20	24	26	20	15	23
East Riding of Yorkshire	2	4	3	11	12	13	20	16	14	15
Kingston upon Hull	6	2	1	7	8	23	32	17	33	48
Kirklees	56	61	51	40	42	53	42	24	41	43
Leeds	326	198	176	124	198	248	233	106	106	164
North East Lincolnshire	13	7	5	8	4	10	4	6	10	7
North Lincolnshire	12	4	9	8	8	12	14	14	10	11
North Yorkshire	13	34	49	57	71	71	53	43	50	70
Rotherham	34	25	19	20	7	14	28	8	16	23
Sheffield	106	57	95	80	99	90	122	62	95	132
Wakefield	41	19	28	13	20	21	25	22	16	19
York	5	8	42	78	85	81	61	53	61	62

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

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

When looking across the Yorkshire and Humber region local authorities, the number of new laboratory-confirmed reports of hepatitis B (acute and chronic) ranged from 7 in North East Lincolnshire to 164 in Leeds in 2022 (Table 3).

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

Upper tier local authority	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Barnsley	10.6	7.2	5.0	7.1	10.4	8.7	4.9	4.1	8.6	6.9
Bradford	36.5	21.6	20.9	12.1	8.5	12.0	14.7	8.8	10.4	15.6
Calderdale	5.3	4.8	2.9	6.7	4.3	6.8	6.3	1.9	2.9	6.7
Doncaster	6.3	6.6	7.2	4.9	6.5	7.8	8.4	6.5	4.9	7.4
East Riding of Yorkshire	0.6	1.2	0.9	3.3	3.6	3.9	5.9	4.7	4.1	4.3
Kingston upon Hull	2.3	0.8	0.4	2.6	3.0	8.6	11.9	6.4	12.4	17.9
Kirklees	13.1	14.2	11.8	9.2	9.7	12.2	9.7	5.5	9.5	9.8
Leeds	42.6	25.7	22.6	15.8	25.0	31.1	29.0	13.1	13.1	20.0
North East Lincolnshire	8.2	4.4	3.1	5.0	2.5	6.3	2.5	3.8	6.4	4.4
North Lincolnshire	7.1	2.4	5.3	4.7	4.7	7.0	8.2	8.2	5.9	6.5
North Yorkshire	2.2	5.6	8.1	9.4	11.7	11.7	8.7	7.0	8.1	11.2
Rotherham	13.1	9.6	7.3	7.6	2.6	5.3	10.5	3.0	6.0	8.6
Sheffield	19.1	10.3	17.1	14.4	17.8	16.2	21.9	11.2	17.1	23.4
Wakefield	12.4	5.7	8.4	3.9	5.9	6.1	7.2	6.3	4.5	5.3
York	2.5	4.0	20.7	38.4	41.8	39.7	29.9	26.2	30.2	30.4

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

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

The rate of new laboratory-confirmed reports of hepatitis B (acute and chronic) ranged from 4.3 per 100,000 in East Riding of Yorkshire to 30.4 per 100,000 in York in 2022 (Table 4).

Acute or probable acute diagnoses of HBV

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

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

In 2022, the Yorkshire and Humber region had the second lowest estimated incidence of acute or probable acute hepatitis B (0.31 per 100,000 population) of all UKHSA regions and was lower than the England average of 0.42 per 100,000 (Figure 5). The acute hepatitis B number and rates for Yorkshire and Humber will be an underestimate due to difficulties in reporting of serologic markers into the Second Generation Surveillance System.

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

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

In line with the England trend, the estimated incidence of acute or probable acute hepatitis B shows a general downward trajectory in Yorkshire and Humber with the estimated incidence in 2022 (0.31 per 100,000 population) below that of 2019 and 2013 (0.40 and 0.81 per 100,000 population, respectively) (Figure 6). The substantially lower numbers reported in 2021 were likely due to the impact of pandemic restrictions and disruption in services.

HBV testing in the wider population

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

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

The number of individuals tested for HBsAg in sentinel laboratories has shown a general upward trajectory over the past 10 years in Yorkshire and Humber region (with a 58% increase from 21,888 individuals tested in 2013 to 34,606 in 2022). However, numbers in 2022 have not returned to those in 2019. Of the 34,606 individuals tested for HBsAg in 2022, 0.69% tested positive (Figure 7).

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

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

Of the 34,606 individuals tested for HBsAg in Yorkshire and Humber in 2022, 11,626 (34%) were referred through GP surgeries submitting samples to sentinel laboratories (Figure 8). Compared to all tests carried out as part of the sentinel surveillance system, the proportion positive was higher for tests referred through these GP surgeries. Specifically, 0.89% of tests referred through GP surgeries were positive for HBsAg in 2022.

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 Yorkshire and Humber UKHSA region, 2013 to 2022

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

Of the 34,606 individuals tested for HBsAg in Yorkshire and Humber in 2022, 3,080 (9%) were referred through sexual health services (SHS) (Figure 9). The proportion positive for tests coming from SHS was higher than the proportion positive for all sentinel laboratories tests in Yorkshire and Humber in 2022 (0.78% and 0.69% respectively).

Testing and diagnoses in people who inject drugs and/or attend drug services

Figure 10. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through drug services in sentinel laboratories in Yorkshire and Humber UKHSA region, 2013 to 2022

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

Of the 34,606 individuals tested for HBsAg in Yorkshire and Humber in 2022, 5,475 (16%) were from people who inject drugs and/or attend drug services (Figure 10). The number of individuals tested through drug services in Yorkshire and Humber has increased substantially over the last 10 years. The proportion positive was higher for tests referred through drug services (0.97%) compared to the proportion positive across all tests at sentinel laboratories in Yorkshire and Humber (0.69%).

Coverage of maternal hepatitis B surface antigen (HBsAg) testing

Due to the Infectious Disease in Pregnancy Screening (IDPS) programme recently changing how they report on regions, data is only available for the financial year (FY) 2021 to 2022. The coverage of hepatitis B antenatal screening in FY 2021 to 2022 is 88,973 eligible women, with 99.8% having been tested within the North East and Yorkshire NHS region, surpassing the WHO 2030 target of greater than or equal to 90%. (Note: NHS regions may not be the same as UKHSA regions.)

Monitoring HBV-related morbidity

Hospital admissions from HBV

Figure 11. Number of hospital admissions [note 7] and admission rate per 100,000 population [note 8] for individuals with a diagnosis code for acute or chronic hepatitis B [note 9], residents of Yorkshire and Humber UKHSA region, 2013 to 2022

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

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

Note 8: rates have been calculated using ONS mid-year population estimates.

Note 9: hepatitis B is defined by ‘International Statistical Classification of Diseases and Related Health Problems 10th Revision’ (ICD-10) codes B16.0, B16.1, B16.2, B16.9, B18.0 and B18.1.

There were 675 (rounded to nearest 5) hospital admissions for individuals for acute or chronic hepatitis B in Yorkshire and Humber UKHSA region in 2022 which was higher than in 2021 (550). Admission rates per 100,000 people increased from 10.03 in 2021 to 12.19 in 2022 (Figure 11). Rates are lower than England as a whole.

Figure 12. Number of hospital admissions [note 10] for individuals with a diagnosis code for hepatitis B-related end-stage liver disease (HBV-related ESLD) or hepatitis B-related hepatocellular carcinoma (HBV-related HCC) [note 11], residents of Yorkshire and Humber 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).

As shown in Figure 12, Hospital Episode Statistics (HES) identified 30 presentations (rounded to nearest 5) of hepatitis B-related end-stage liver disease (HBV-related ESLD) in Yorkshire and Humber in 2022. This is a slight increase on 2020 (25) and 2021 (25). In 2022, the number of admissions for hepatitis B-related hepatocellular carcinoma (HBV-related HCC) identified in HES in Yorkshire and Humber was 10 (rounded to nearest 5) which is the same as 2021. Admissions decreased by 50% between 2019 and 2021.

Monitoring HBV-related mortality

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

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

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

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

Rate of deaths with end-stage liver disease or hepatocellular carcinoma with hepatitis B mentioned on their death certificate between 2018 and 2022 was 0.120 per 100,000 people (Figure 13). This is lower than the overall rate in England which was 0.156 per 100,000 people.

Prevention of infection by immunisation

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

Figure 14. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 12 months, Yorkshire and Humber 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.

Yorkshire and Humber have consistently maintained over 90% coverage of children receiving 3 doses of HepB3 vaccine by their first birthday between FY 2019 to 2020 (94.2%) and FY 2022 to 2023 (92.8%) (Figure 14). However, similar to other infant immunisation programmes in the UK, a general decline in coverage has been occurring in Yorkshire and Humber as well as England as a whole.

Figure 15. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, Yorkshire and Humber UKHSA region and England, FY 2020 to 2021 to FY 2022 to 2023

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

Coverage of children receiving 3 doses of HepB3 vaccine improved by 24 months of age compared to coverage at 12 months, and ranged from 95.5% in FY 2020 to 2021, 94.5% in FY 2021 to 2022 and 93.8% in FY 2022 to 2023 (Figure 15). However, it was again showing a general downward trend over time.

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

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

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Barnsley	7	7	100.00%
Bradford	25	23	92.00%
Calderdale	[note 15]	[note 15]	[note 15]
Doncaster	8	7	87.50%
East Riding of Yorkshire	[note 15]	[note 15]	[note 15]
Kingston upon Hull	18	13	72.22%
Kirklees	8	8	100.00%
Leeds	44	37	84.09%
North East Lincolnshire	0	0	Not applicable
North Lincolnshire	3	3	100.00%
North Yorkshire	[note 15]	[note 15]	[note 15]
Rotherham	5	4	80.00%
Sheffield	18	17	94.44%
Wakefield	9	7	77.78%
York	[note 15]	[note 15]	[note 15]

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

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

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

Coverage of children in the high-risk selective programme receiving 3 doses of HepB3 vaccine by their first birthday varied across local authorities in Yorkshire and Humber in FY 2022 to 2023, ranging from 72% in Kingston upon Hull to 100% in Barnsley, Kirklees and North Lincolnshire. 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.

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, Yorkshire and Humber UKHSA region, FY 2022 to 2023

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Barnsley	6	5	83.33%
Bradford	19	18	94.74%
Calderdale	6	5	83.33%
Doncaster	9	7	77.78%
East Riding of Yorkshire	0	0	Not applicable
Kingston upon Hull	6	4	66.67%
Kirklees	15	10	66.67%
Leeds	43	36	83.72%
North East Lincolnshire	3	3	100.00%
North Lincolnshire	5	3	60.00%
North Yorkshire	3	2	66.67%
Rotherham	8	7	87.50%
Sheffield	16	15	93.75%
Wakefield	7	6	85.71%
York	[note 17]	[note 17]	[note 17]

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

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

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

Coverage of children in the high risk selective programme receiving 3 doses of HepB3 vaccine by their second birthday was lowest in North Lincolnshire (60%) and highest in North-East Lincolnshire (100%) and Bradford (94.74%).

Vaccine uptake in people who inject drugs

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

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

Hepatitis B vaccine uptake in people who inject drugs (PWID) has decreased from 81% in 2018 to 49% in 2022 in Yorkshire and Humber (Figure 16). There was a sharp decrease in uptake between 2021 (72%) and 2022, and in 2022 uptake was below England as a whole (61% in 2022).

Prevention of infection by harm reduction

Figure 17. Reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks, Yorkshire and Humber UKHSA region and England, 2013 to 2022

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

According to the UAM survey, the percentage of PWID in Yorkshire and Humber who reported direct sharing of needles and/or syringes in the preceding 4 weeks doubled from 10.0% in 2021 to 20.8% in 2022. This percentage is similar to 2019 (20.1%) and England as a whole (19.5%) (Figure 17).

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

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

The percentage of PWIDs in Yorkshire and Humber who reported direct and indirect sharing of injecting equipment in the preceding 4 weeks has increased slightly between 2021 (41.4%) and 2022 (45.8%). This percentage is higher than England as a whole in 2022 (38.9%) (Figure 18).

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, human immunodeficiency virus (HIV) and human T-lymphotropic virus (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

NHS England’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 and 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, accident & emergency (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 to an interruption 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 to 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 4 weeks) 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, suppress the number of children vaccinated and the coverage where the eligible population is greater than 2 and the number of children vaccinated is 0 or 1

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 charts and figures 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 YHREU@ukhsa.gov.uk

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