Research and analysis

Hepatitis B in the East Midlands: 2025 report

Published 14 May 2026

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 National Strategic Group on Viral Hepatitis, a cross-agency expert advisory body supported by the UK Health Security Agency (UKHSA) provides strategic guidance on viral hepatitis in England, and supports progress toward achieving the WHO goal of HBV elimination.

The 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 report and presents further information on HBV disease surveillance, trends in HBV diagnosis and testing and related diseases in East Midlands UKHSA region with data up to end of 2024. 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:

• 675 new laboratory reports of hepatitis B in residents of East Midlands, representing a rate of 13.3 reports per 100,000 population in 2024 
• the number of new laboratory reports has not changed between 2023 and 2024, but has increased by 140.2% over the past 10 years 
• in 2024, the number of new laboratory reports in males was 414 (61.3%) and in females was 260 (38.5%) 
• in 2024, the highest number of new laboratory reports was in males aged 35 to 44 and females aged 25 to 34 
• in 2024, the number of new positive laboratory reports by upper tier local authority of residence ranged from 31 in Derbyshire to 132 in Nottingham; rates were highest in Nottingham at 39.9 new laboratory reports per 100,000 population and lowest in Derbyshire with 3.8 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.4 per 100,000 population. This was lower than the England average of 0.5 per 100,000 
• there have been 53,687 individuals tested for hepatitis B surface antigen (HBsAg) in sentinel laboratories in East Midlands UKHSA region in 2024, of which 0.58% tested positive - the proportion positive was higher for tests referred through GP surgeries, lower for tests through sexual health services, lower for tests through drug services and lower for tests through emergency departments; the total number of tests conducted has likely increased since 2022 as a result of a new ‘opt-out’ blood-borne virus testing programme at selected emergency departments

Monitoring HBV-related morbidity

Main trends are:

• there have been 630 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in East Midlands UKHSA region in 2024 which was higher than in 2023 
• 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 2024 

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in East Midlands UKHSA region was 93.5% for financial year (FY) 2024 to 2025
• vaccine coverage of 3 doses at 24 months has decreased by 1.1 percentage points between FY 2023 to 2024 and 2024 to 2025.
• the reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in East Midlands UKHSA region was 58.0% for 2023 (the most recently reported data)
• the reported level of hepatitis B vaccine uptake among PWID has decreased by 2.3 percentage points between 2022 and 2023

Trends in HBV testing and diagnosis in the general population and risk groups

Estimated prevalence of HBV

Table 1. Estimated hepatitis B prevalence and number of people living with chronic hepatitis B, UKHSA regions and England, 2024

Region	Estimated number of individuals with chronic hepatitis B, (95% confidence interval (CI))	Estimated HBsAg prevalence (%), (95% CI)	Estimated SSBBV coverage (%)
England	268,767 (227,896 to 314,004)	0.58 (0.50 to 0.68)	45
East of England	19,584 (6,282 to 48,679)	0.38 (0.12 to 0.95)	40
East Midlands	7,584 (3,633 to 15,369)	0.19 (0.09 to 0.38)	64
London	99,067 (78,415 to 120,263)	1.39 (1.10 to 1.69)	75
North East	7,950 (2,700 to 20,289)	0.36 (0.12 to 0.93)	32
North West	25,406 (17,060 to 37,303)	0.42 (0.28 to 0.62)	43
South East	25,678 (12,326 to 53,207)	0.34 (0.16 to 0.70)	34
South West	15,978 (8,336 to 32,977)	0.34 (0.18 to 0.70)	30
West Midlands	24,756 (14,343 to 41,647)	0.52 (0.30 to 0.87)	35
Yorkshire and Humber	16,720 (9,012 to 29,921)	0.37 (0.20 to 0.67)	39

Data source: Modelling based on Sentinel Surveillance of Bloodborne Virus Testing. For further information, see information on data sources and Hepatitis B in England national report.

The modelling methodology used to calculate these estimates has been published in the Journal of Viral Hepatitis. It is important to note that there is less confidence in the regional estimates compared to the national estimate and, as the estimates are based on data from the Sentinel Surveillance of Blood Borne Viruses (SSBBV), the accuracy of regional estimates may be influenced by the coverage of SSBBV in that region.

New laboratory-confirmed diagnoses of HBV

Figure 1. Number of new laboratory reports of hepatitis B (acute and chronic), residents of East Midlands UKHSA region, 2015 to 2024

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

In 2022, a new bloodborne virus (BBV) testing programme was introduced in selected emergency department (ED) sites in areas of very high and high HIV diagnosed prevalence across England. The East Midlands region was included in the second phase of the implementation of this programme, starting in 2024. This ‘opt-out’ programme may have led to increases in new diagnoses, however since the start of the ED opt-out programme, only approximately 11% of new hepatitis B diagnoses nationally where testing location is known have been made in ED.

The number of new laboratory reports of hepatitis B in the East Midlands has continued to rise, with 2024 showing the highest counts in the past decade. This upward trend likely reflects increases in case detection through expanded testing initiatives, including the ED opt-out programme.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of East Midlands UKHSA region and England, 2015 to 2024

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.

Rates of newly reported hepatitis B infections in the East Midlands have increased steadily since 2020. The year‑on‑year rise mirrors the national picture, although England overall continues to have higher rates than the East Midlands. Observed increases are likely to be driven by improvements in awareness, diagnostics, reporting and targeted testing.

Table 2. Number of new laboratory reports of hepatitis B (acute and chronic) by UKHSA region of residence, 2015 to 2024

Area	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
East Midlands	281	407	574	590	535	339	426	556	675	675
East of England	636	674	616	513	616	495	511	650	721	809
London	5,581	6,666	4,875	2,851	3,302	2,531	2,703	3,830	5,291	5,359
North East	155	192	228	199	206	112	144	205	271	275
North West	780	761	715	830	1,123	750	794	771	1,137	1,736
South East	712	684	830	726	966	533	734	978	1,072	1,077
South West	385	431	569	445	371	348	547	697	590	656
West Midlands	858	889	890	850	868	557	627	860	1,188	1,081
Yorkshire and Humber	864	699	683	755	764	451	548	731	804	886
England [note 2]	10,252	11,406	9,991	7,829	8,806	6,149	7,107	9,427	11,910	12,566

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

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

In 2024, the East Midlands continues to report moderate levels of hepatitis B diagnoses compared with other UKHSA regions. For 2024, the East Midlands had the second lowest count of new diagnoses but had the fifth highest rate per 100,000 population. While the region’s total of 675 new reports in 2024 represents a substantial increase from 556 in 2022, this growth is proportionate to trends observed in several other regions and appears broadly consistent with increased BBV testing activity. London consistently contributes the highest number of new diagnoses nationally, likely reflecting differences in its population size and composition when compared to other regions.

Table 3. Rate per 100,000 population of new laboratory reports of hepatitis B (acute and chronic) by UKHSA region of residence, 2015 to 2024

Area	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
East Midlands	6.0	8.6	12.0	12.3	11.0	7.0	8.7	11.3	13.5	13.3
East of England	10.0	10.5	9.5	7.9	9.4	7.5	7.7	9.7	10.6	11.8
London	64.4	76.2	55.5	32.3	37.1	28.5	30.7	43.2	58.8	59.0
North East	5.9	7.3	8.7	7.6	7.8	4.2	5.4	7.6	9.9	10.0
North West	10.9	10.5	9.8	11.3	15.3	10.2	10.7	10.2	14.9	22.4
South East	8.2	7.8	9.4	8.2	10.8	6.0	8.1	10.7	11.6	11.5
South West	7.0	7.8	10.2	7.9	6.6	6.1	9.6	12.1	10.1	11.1
West Midlands	14.9	15.3	15.2	14.4	14.7	9.4	10.5	14.3	19.5	17.5
Yorkshire and Humber	16.1	12.9	12.6	13.9	14.0	8.2	10.0	13.2	14.3	15.6
England	18.7	20.6	18.0	14.0	15.7	10.9	12.6	16.5	20.6	21.4

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

The East Midlands continues to show an HBV diagnosis rate that is moderate relative to other English regions, rising from 11.3 per 100,000 in 2022 to 13.3 per 100,000 in 2024, consistent with increasing case detection through expanded testing. This places the region above those which have historically recorded lower rates of new laboratory reports of hepatitis B such as the South West and East of England, but still well below London, which remains the outlier with far higher rates than other UKHSA regions.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of East Midlands UKHSA region, 2024

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

Note 3: cases reported in children under one year old have been removed. One hepatitis B case in the East Midlands region in 2024 had no age and/or sex data and has not been included in this age-sex pyramid.

The age–sex distribution of newly diagnosed hepatitis B cases in 2024 shows a clear predominance among males aged 35 to 44 and females aged 25 to 34, consistent with trends seen nationally. The greater number of cases seen in males relative to females aligns with historical trends and likely reflects behavioural, demographic and migration-related factors influencing HBV acquisition and testing pathways. The number of new diagnoses seen in females aged between 25 and 44 may partially 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 East Midlands UKHSA region, 2015 to 2024

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

Note 4: this figure excludes cases of unknown ethnicity.

The ethnicity distribution of newly diagnosed hepatitis B cases in the East Midlands broadly aligns with the picture seen nationally, and continues to highlight disparities in disease burden across population groups. Data for 2024 shows that individuals from minority ethnic backgrounds remain disproportionately represented among new diagnoses. For 2024, the highest percentage of new laboratory reports of new diagnoses of hepatitis B amongst residents of East Midlands was from those of Black or Black British ethnicity (25.96%) and the second highest from those of White British (25.26%) ethnicity.

Table 4. Number of new laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence [note 5], East Midlands UKHSA region, 2015 to 2024

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Derby	45	19	46	81	59	25	39	47	55	79
Derbyshire	24	15	14	30	41	15	18	27	31	31
Leicester	5	97	110	118	85	72	64	87	134	108
Leicestershire and Rutland	10	36	40	40	42	21	33	58	75	61
Lincolnshire	56	74	59	48	49	30	45	61	67	60
North Northamptonshire	8	42	68	43	36	15	20	35	39	46
Nottingham	99	74	78	79	74	57	77	76	85	132
Nottinghamshire	27	39	65	45	35	23	40	70	77	89
West Northamptonshire	5	8	80	106	114	81	90	95	112	69

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

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

Geographical variation in new hepatitis B diagnoses persists across upper tier local authorities within the East Midlands. As in previous years the data for 2024 shows that urban areas continue to report markedly higher numbers than more rural counties. For 2024 Nottingham is the UTLA with the highest number of new laboratory reports of hepatitis B. Differences by UTLA are likely reflect to variation in population demographics, healthcare access, migration intensity, and the uptake of testing initiatives such as the ED opt‑out testing programme.

Year‑to‑year fluctuations should also be interpreted in light of changing testing coverage across healthcare providers. Issues with reporting from some laboratories over the earlier years presented in Table 4 resulted in unusually low figures for some local authorities, notably those seen in North and West Northamptonshire, but also Derby, Derbyshire, Leicester and Leicestershire. Work with these laboratories since then has meant reporting has now improved.

Table 5. Rate per 100,000 population of new laboratory reports of hepatitis B (acute and chronic) by upper tier local authority of residence [note 6], East Midlands UKHSA region, 2015 to 2024

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Derby	17.5	7.3	17.6	30.9	22.4	9.5	14.9	17.8	20.4	28.8
Derbyshire	3.1	1.9	1.8	3.8	5.2	1.9	2.3	3.4	3.8	3.8
Leicester	1.4	27.2	30.4	32.1	23.0	19.5	17.4	23.3	35.0	27.8
Leicestershire and Rutland	1.4	5.0	5.5	5.4	5.7	2.8	4.4	7.6	9.7	7.8
Lincolnshire	7.6	9.9	7.8	6.3	6.4	3.9	5.8	7.9	8.5	7.6
North Northamptonshire	2.4	12.3	19.6	12.2	10.1	4.2	5.5	9.6	10.6	12.3
Nottingham	31.6	23.3	24.3	24.5	22.9	17.7	24.1	23.3	26.0	39.9
Nottinghamshire	3.4	4.8	8.0	5.5	4.3	2.8	4.8	8.4	9.1	10.4
West Northamptonshire	1.3	2.0	19.4	25.4	27.0	19.2	21.1	22.1	25.6	15.7

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.

Rates of hepatitis B diagnoses per 100,000 population show geographic heterogeneity, with Nottingham recording the highest rate of new laboratory reports of hepatitis B with nearly 40 per 100,000 in 2024. Lower rates in rural areas such as Derbyshire are likely to reflect both smaller at‑risk populations and lower testing activity. The observed rise in local authorities including Nottingham and Derby between 2023 and 2024 is consistent with the regional trend and should be interpreted whilst taking into account changes in case identification.

Figure 5. Test location of new laboratory reports of hepatitis B (acute and chronic), residents of East Midlands UKHSA region, 2018 to 2024

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

The distribution of new laboratory reports of hepatitis B by test location between 2018 and 2024 have remained broadly stable across the period, with general practice and hospital settings being the most frequent location reporting new cases of hepatitis B. The data for 2024 suggests that testing in EDs may be trending upwards, which is likely to be reflective of the expansion of the BBV opt‑out testing programme. Lower case detection in sexual health and drug services may reflect reduced testing volumes and data completeness issues in 2023 to 2024.

Acute or probable acute diagnoses of HBV

Figure 6. Estimated incidence of acute or probable acute hepatitis B per 100,000 population by UKHSA region [note 7], 2024

Data sources: SGSS, UKHSA Case and Incident Management System (CIMS) and ONS MYE. For further information, see information on data sources.

Note 7: UKHSA transitioned to a new case management system for notifiable diseases in 2024 which has impacted the identification of people with acute hepatitis B and likely resulted in underreporting.

Estimated incidence of acute or probable acute hepatitis B remains low across the UKHSA regions, with the East Midlands broadly aligned with the national pattern. As set out in note 7, interpretation of this latest data should be made with caution due to known under‑ascertainment following the 2024 transition to the Case and Incident Management System (CIMS), which has had an impact on the ability to identify acute presentations of acute hepatitis B in the surveillance data.

Figure 7. Estimated incidence of acute or probable acute hepatitis B per 100,000 population [note 8], East Midlands UKHSA region and England, 2015 to 2024

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

Note 8: UKHSA transitioned to a new case management system for notifiable diseases in 2024 which has impacted the identification of people with acute hepatitis B and likely resulted in underreporting.

Long‑term trends in acute hepatitis B incidence show a reducing burden of cases across the East Midlands and England.

Estimated incidence of acute or probable acute hepatitis B remained below one case per 100,000 population throughout the period 2015 to 2024. The East Midlands followed a similar pattern to England overall, with modest year‑to‑year variation. Data for 2024 are likely influenced by changes to case management systems and reporting processes, therefore, should be interpreted with caution.

HBV testing in the wider population

Figure 8. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive in sentinel laboratories [note 9] in East Midlands UKHSA region, 2015 to 2024

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

Note 9: the error band represents 95% confidence intervals.

From 2022 to 2024, the opt-out ED BBV testing programme was scaled-up, leading to increased numbers of tests being conducted in these sentinel surveillance sites.

Despite rising test volumes, the proportion testing positive has remained relatively stable at under 1%, suggesting that expanded testing is reaching a broader population with a broadly comparable underlying risk. This pattern is consistent with national trends following the rollout of ED testing initiatives.

Figure 9. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through GP surgeries in sentinel laboratories [note 9] in East Midlands UKHSA region, 2015 to 2024

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

Note 9: the error band represents 95% confidence intervals.

Testing in general practice remains a key contributor to HBV case identification. The higher proportion of positive results observed in GP‑requested tests compared to other test locations, reflects more targeted testing among individuals with clinical indications or known risk factors. Test volumes have remained broadly stable, indicating consistent engagement of primary care in hepatitis B testing and surveillance.

Testing and diagnoses in sexual health services (SHS)

Figure 10. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through sexual health services in sentinel laboratories [note 9] in East Midlands UKHSA region, 2015 to 2024

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

Note 9: the error band represents 95% confidence intervals.

Figure 10 shows testing volumes in sexual health services tested in sentinel laboratories have decreased in recent years, particularly since 2019 when there was a sharp decline. The fall in testing seen since 2016 and sustained low levels from 2019 onwards is unlikely to be a true picture of the level of testing that has been taking place in the local sexual health services. We are investigating possible reasons for the pattern that is shown which may be due to changes in reporting or processing of data.

Positivity remains low across the period from 2015, broadly under 1%, with greater uncertainty in the estimate (and wider confidence intervals) as the number of individuals tested in sexual health services declines from 2019 onwards.

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

Figure 11. Number of individuals tested for HBsAg by year (excluding antenatal testing) and proportion positive, through drug services in sentinel laboratories [note 9] [note 10] in East Midlands UKHSA region, 2015 to 2024

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

Note 9: the error band represents 95% confidence intervals.

Note 10: Between 2023 and 2024, there was underreporting of hepatitis testing data from a sentinel laboratory which undertakes a large proportion of testing for drug treatment services, making it difficult to monitor trends in drug treatment services over this period.

Interpretation of testing trends in drug services is limited by underreporting from one of the major laboratories serving these services in 2023 to 2024. Apparent declines in testing volumes and positivity may therefore not reflect true underlying trends.

Positivity shows levels below 0.5% until 2019 where positivity peaked in 2020 which may reflect less but more targeted testing. With the exception of 2020, the percentage positive has remained below 1% across the period 2015 to 2024.

Testing and diagnoses in people attending emergency departments

Figure 12. Number of individuals tested for HBsAg by year and proportion positive, through emergency departments in sentinel laboratories [note 9] in East Midlands UKHSA region, 2015 to 2024

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

Note 9: the error band represents 95% confidence intervals.

The notable increase in HBsAg testing within emergency departments reflects the continuing scale‑up of opt‑out BBV testing, which has broadened access to HBV screening among those who have not historically been offered testing through other routes. Positivity rates are lower than in primary care or drug services, which is expected given the universal nature of testing in EDs. As the evaluation of the programme concluded ED testing contributes significantly to case finding and reduces missed opportunities for diagnosis.

Coverage of maternal hepatitis B surface antigen (HBsAg) testing

Figure 13. Coverage of hepatitis B antenatal screening by NHS region - Screening Standard IDPS-S02, NHS Midlands region, financial years 2021/2022 to 2023/2024

Data source: Infectious Disease in Pregnancy Screening (IDPS) (for further information, see information on data sources)

NHS regions may not be the same as UKHSA regions. The NHSE region being used for this plot is Midlands.

Coverage of hepatitis B antenatal screening in the NHS Midlands region remained consistently high between financial years 2021 to 2022 (99.8%) and 2023 to 2024 (99.8%), in line with the national expectation that all pregnant women are offered screening as part of routine antenatal care. The sustained high uptake reflects the good integration of the Infectious Diseases in Pregnancy Screening (IDPS) programme within maternity pathways, where early identification of hepatitis B is critical to preventing vertical transmission. Minor fluctuations observed across the 3 financial years are likely to reflect operational variation between maternity providers rather than changes in underlying demand.

Monitoring HBV-related morbidity

Hospital admissions with HBV

Figure 14. Number of hospital admissions [note 11] and admission rate per 100,000 population [note 12] for individuals with a diagnosis code for acute or chronic hepatitis B [note 13], residents of East Midlands UKHSA region [note 14], 2015 to 2024

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2025, re-used with the permission of NHS England. All rights reserved. For further information, see information on data sources.

Note 11: data has been suppressed in accordance with NHS disclosure control guidance for sub-national breakdowns. Numbers between 1 and 7 (inclusive) are suppressed and (where applicable) 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 12: rates have been calculated using ONS mid-year population estimates.

Note 13: 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.

Note 14: there is a high proportion of data missingness in the HES data for the geographies of residence for people admitted to hospital with acute and chronic hepatitis B (approximately 25% for 2024 admissions). This means that the regional admission counts and rates are likely an underestimate of the true number.

The number of hospital admissions and the admission rate for individuals with an HBV diagnosis code increased in 2024, though year‑to‑year comparisons are complicated by missing geographical identifiers and changes in HES data processing as noted above.

The admission rate for the East Midlands is lower than that for England as a whole for the years where data is shared in the chart.

Figure 15. Number of hospital admissions [note 15] 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 16] [note 17], residents of East Midlands UKHSA region [note 18], 2015 to 2024

Data source: Hospital Episode Statistics (HES), NHS England. Produced by the UK Health Security Agency. Copyright © 2025, re-used with the permission of the NHS England. All rights reserved. For further information, see information on data sources.

Note 15: data has been suppressed in accordance with NHS disclosure control guidance for sub-national breakdowns. Numbers between 1 and 7 (inclusive) are suppressed and (where appropriate) 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 16: 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).

Note 17: the methodology used to calculate hepatitis B-related ESLD and HCC admissions has been updated for this report, as the previous method of only using HES data may under report hepatitis B as it relies on a diagnosis of hepatitis B being recorded in HES. The updated methodology, which follows the ‘upper bound’ methodology outlined in Hepatitis B in England 2025 report, links HES data to laboratory diagnoses of hepatitis B from SGSS and SSBBV from any year.

Note 18: there is a high proportion of data missingness in the HES data for the geographies of residence for people admitted to hospital with ESLD and/or HCC (approximately 23% for ESLD admissions in 2024 and approximately 26% for HCC admissions in 2024). This means that the regional admission counts are likely an underestimate of the true number.

Admissions for HBV‑related end‑stage liver disease and hepatocellular carcinoma remain low across the East Midlands and relatively steady across the period 2015 to 2024. As noted above, persistent data missingness in geographical identifiers means that regional estimates are likely to undercount the true burden.

Monitoring HBV-related mortality

Figure 16. Rate of deaths with ESLD [note 19] or HCC in those with HBV mentioned on their death certificate [note 20] by UKHSA region, 2020 to 2024

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

Note 19: 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 20: the methodology used to calculate hepatitis B-related mortality has been updated for this report, as the previous method of only counting deaths where ESLD and/or HCC and hepatitis B were reported in ONS death registrations may lead to underreporting. The updated methodology, which follows the ‘upper estimate’ methodology outlined in Hepatitis B in England 2025 report, links ONS deaths registrations data to HES hospital admissions data and laboratory diagnoses of hepatitis B from SGSS and SSBBV from any year to yield a maximum number of deaths attributable to hepatitis B-related ESLD and/or HCC.

Mortality from HBV‑related ESLD or HCC remains infrequent in the East Midlands. The East Midlands is one of the regions with the lowest rates of deaths (0.18 per 100,000 population) with ESLD or HCC in those with HBV mentioned on their death certificate and has a lower rate than the rate for England as a whole (0.33 per 100,000 population). To note, the updated ‘upper estimate’ methodology provides a more complete assessment of HBV‑related mortality but may produce values that differ from previous surveillance outputs.

Prevention of infection by immunisation

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

Figure 17. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 12 months, East Midlands UKHSA region and England, FY 2019/2020 to FY 2024/2025

Data source: NHS Childhood Vaccination Coverage Statistics (COVER). For further information, see information on data sources.

Routine hepatitis B vaccination coverage at 12 months in the East Midlands has remained relatively stable over the period 2019/2020 to 2024/2025. Over this period the East Midlands remained above the England average but coverage figures have shown a small decrease over this time period. The East Midlands had a coverage of 93.3% in 2019 to 2020 and 92.8% in 2024 to 2025, compared to 92.6% and 91.3% for England. Changes in coverage may reflect broader national patterns of small declines in routine childhood vaccination.

Figure 18. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, East Midlands UKHSA region and England, financial years 2020/2021 to 2024/2025

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

Coverage of the 3‑dose hexavalent vaccine at 24 months in the East Midlands has decreased slightly and is either slightly higher or equivalent to the coverage for England each year. The East Midlands had a coverage of 94.6% in 2020 to 2021 and 93.5% in 2024 to 2025, compared to 93.9% and 92.5% in England. Continued targeted efforts will be required to maintain high coverage and ensure equitable access to vaccination across all local authorities.

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

Table 6. Children born to mothers positive for hepatitis B vaccinated against hepatitis B by their first birthday by upper tier local authority: vaccine coverage (5 doses routine and selective combined [note 21]) and eligible population, East Midlands UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Derby	8	7	87.50%
Derbyshire	6	5	83.30%
Leicester	17	13	76.50%
Leicestershire and Rutland	5	5	100.00%
Lincolnshire	8	8	100.00%
North Northamptonshire	14	13	92.90%
Nottingham	20	18	90.00%
Nottinghamshire	12	10	83.30%
West Northamptonshire	20	19	95.00%

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

Note 21: babies received 2 monovalent vaccines (at birth and at 4 weeks), and 3 doses of hexavalent vaccines (at 8, 12 and 16 weeks).

Note 22: denotes that data is suppressed due to potential disclosure issues associated with small numbers.

Table 7. Children born to mothers positive for hepatitis B vaccinated against hepatitis B by their second birthday by upper tier local authority: vaccine coverage (6 doses routine and selective combined [note 23]) and eligible population, East Midlands UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Derby	7	7	100.00%
Derbyshire	6	[note 24]	35% to 69%
Leicester	19	19	100.00%
Leicestershire and Rutland	13	13	100.00%
Lincolnshire	7	6	85.70%
North Northamptonshire	15	13	86.70%
Nottingham	14	9	64.30%
Nottinghamshire	14	11	78.60%
West Northamptonshire	33	28	84.80%

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

Note 23: 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 24: denotes that data is suppressed due to potential disclosure issues associated with small numbers.

Coverage of hepatitis B vaccination among infants at high risk of maternal transmission in the East Midlands during FY 2024 to 2025 remains high across most upper tier local authorities. Variation between local authorities largely reflects small eligible population sizes, where even one unvaccinated infant can noticeably affect percentage coverage.

Overall, the consistently high uptake demonstrates effective coordination between maternity, screening, and child health services in the region, supporting timely follow‑up of infants born to hepatitis B‑positive mothers and contributing to prevention efforts outlined within the UKHSA’s guidance on the hepatitis B antenatal screening and selective neonatal immunisation pathway and the ‘Immunisation against infectious disease’ Green Book.

Vaccine uptake in people who inject drugs

Figure 19. Reported level of hepatitis B vaccine uptake among people who inject drugs (PWID), East Midlands UKHSA region, 2014 to 2023

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

Self-reported hepatitis B vaccine uptake among people who inject drugs (PWID) has decreased modestly since 2022 both in the East Midlands and England as a whole. The reported level of uptake of at least one dose of the hepatitis B vaccine among PWID in the East Midlands has shown a gradual decrease of 17.6 percentage points since 2014 (from 75.6% to 58.0%). Vaccine uptake amongst this population group is similar in the East Midlands to England as a whole.

Work to understand the reasons why there is low uptake amongst individuals in this risk group will help to improve uptake in the future. Strengthening vaccination pathways within harm‑reduction settings will also be important in improving uptake among this population group.

Prevention of infection by harm reduction

Figure 20. Reported level of direct sharing of needles and/or syringes among people who inject drugs (PWID) in the preceding 4 weeks, East Midlands UKHSA region and England, 2014 to 2023

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

Reported levels of direct sharing of needles and syringes among PWID in the East Midlands remain broadly comparable to national levels, with an increase shown across the period from 2014. The percentage of people who reported the direct sharing of equipment in the East Midlands has increased overall from 14.4% in 2014 to 23.6% in 2023. These increases in self-reported sharing of equipment could be due to a number of factors including availability of needle and equipment exchanges.

Figure 21. Reported level of direct and indirect sharing of injecting equipment among people who inject drugs (PWID) in the preceding 4 weeks, East Midlands UKHSA region and England, 2014 to 2023

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

Direct and indirect sharing of injecting equipment, including cookers and filters among PWID represents an ongoing risk for HBV transmission. Trends in the East Midlands align with those observed nationally across the reporting period. The reported level of direct and indirect sharing of injecting equipment among PWID in the preceding 4 weeks in 2023 was 44.9% for East Midlands and 43.9% for England.

Interventions that improve access to sterile injecting equipment and provide behavioural support remain important interventions in reducing the harm associated with injecting drugs.

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

Data extracted from Sentinel Surveillance of blood borne virus testing (SSBBV) and SGSS will vary for several reasons and should not be compared: the 2 systems have collected data over different historical periods, with data reported to SGSS and predecessor systems since 1995, whereas SSBBV has been running since 2002. Data reported to SSBBV reflects the timeframe from when the laboratory joined the surveillance system, with laboratories joining more recently having less data available than laboratories who have been reporting since 2002. Furthermore, whilst SGSS collects national level data, SSBBV collects data from a subset of laboratories. There are 35 laboratories which report to SSBBV with an estimated 45% coverage testing in the GP registered population in England.

Data completeness for ethnicity within this dataset declines over time, due to changes in methodology. ONOMAP, an ethnicity estimator which classifies ethnicity based on name is no longer used. Ethnicity is assigned using data reported through the test request form and through linkage to healthcare datasets and represents ethnicity that is assigned rather than estimated. Data will improve over time as additional information is reported, older records are more likely to be more complete.

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/CIMS

Brief description

HPZone was a case and outbreak management system used by the health protection teams (HPTs) in UKHSA until mid-2024, when it was replaced by a new Case and Incident Management System (CIMS). Details related to cases of hepatitis A, B, C and E are stored on this system in addition to details of other infections reported to the HPTs. 

HPZone and CIMS are secure systems. Where acute hepatitis B cases are reported, HPTS used HPZone historically and CIMS currently to capture data about these cases and relevant risk factors to inform public health action. As a result of the transition from HPZone to CIMS in mid-2024, there is a known issue that has likely impacted the identification of people with acute hepatitis B and likely resulted in the underreporting of cases. 

Hepatitis B case definitions using SGSS and HPZone/CIMS 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/CIMS were extracted from 1 January 2015 to 31 December 2024 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/CIMS. A final reconciled data set including cases classified as acute or probable acute was used for this report. 

Technical notes

UKHSA transitioned to a new case management system for notifiable diseases in 2024 which has impacted the identification of people with acute hepatitis B and likely resulted in underreporting.

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 have provided legacy data if they were able to. 

Technical notes

See first technical note for SGSS.

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 is 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 © 2025, re-used with the permission of the NHS England. All rights reserved. 

Data is based on Hospital Episode Statistics as at October 2025. 

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 2nd 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 Epidemiology Data Science unit (part of the 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, and Field Epidemiology Training 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 FS.Central@ukhsa.gov.uk