Research and analysis

Hepatitis B in the South West: 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 the South West UKHSA region with data up to the 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

The main trends are:

• 656 new laboratory reports of hepatitis B among residents of the South West, representing a rate of 11.1 reports per 100,000 population in 2024 
• the number of new laboratory reports has increased by 11.2% between 2023 and 2024, and increased by 70.4% over the past 10 years. Increases in laboratory-confirmed reports of HBV infection may reflect improvements in awareness, diagnostics, reporting, and targeted testing
• in 2024, the number of new laboratory reports in males was 370 (56.4%) and in females was 274 (41.8%) 
• in 2024, the highest numbers of new laboratory reports were, for males, in those aged 35 to 44, and for females in those aged 25 to 34 
• in 2024, the number of new positive laboratory reports by upper tier local authority of residence ranged from 10 in Torbay to 144 in Bristol; rates of new laboratory reports per 100,000 population were highest in Bournemouth, Christchurch and Poole (30.3) and lowest in Cornwall and the Isles of Scilly (3.1)
• 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 
• 56,757 individuals were tested for hepatitis B surface antigens (HBsAg) at sentinel laboratories in the South West UKHSA region in 2024, of which 0.71% tested positive - the proportion positive was higher than this for tests referred through GP surgeries, but lower for tests through sexual health services, drug services and emergency departments; the total number of tests conducted has increased since 2022, likely as a result of a new ‘opt-out’ blood-borne virus testing programme at selected emergency departments

Monitoring HBV-related morbidity

The main trends are:

• there have been 470 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in South West 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) were 20 and 15 respectively in 2024 

Prevention of infection by immunisation

The main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in South West UKHSA region was 95.1% for financial year (FY) 2024 to 2025
• the vaccine coverage of 3 doses at 24 months increased by 0.1 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 the South West UKHSA region was 63.8% for 2023 (the most recently reported data)
• the reported level of hepatitis B vaccine uptake among PWID has increased by 0.1 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 hepatitis B 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. Additional analysis this year has allowed for regional estimates to be made (Table 1) showing the variation in prevalence across the country. London is estimated to have the highest prevalence of 1.39% (95% confidence interval 1.10% to 1.69%) while the East Midlands has the lowest estimated prevalence of 0.19% (95% confidence interval 0.09% to 0.38%). However, 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) programme, the accuracy of regional estimates may be influenced by the coverage of SSBBV in that region. The South West has the lowest estimated SSBV coverage out of all English regions, at 30%, and there is only one SSBV sentinel laboratory located in the region, whereas an estimated 75% of hepatitis B cases in London are linked to laboratories participating in the programme.

In 2024, the number of individuals estimated to be living with chronic hepatitis B in the South West was 15,978, with 95% confidence intervals at 8,336 to 32,977 individuals. This results in an estimated regional prevalence of 0.34%, one of the lowest prevalences nationally, alongside the East Midlands (0.19%), the South East (0.34%), and the North East (0.36%). There were no statistically significant differences between the estimated prevalences of any English region except London.

New laboratory-confirmed diagnoses of HBV

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

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

Figure 1 shows that regional counts of hepatitis B laboratory reports increased from 2020 to 2021 (348 to 547), after a sustained decrease between 2017 and 2020 (569 to 348). Between 2021 and 2024, annual case counts have remained elevated in the South West relative to the previous 6-year period. In 2024, the number of annual HBV laboratory reports increased by 11% from 590 in 2023, to 656 in 2024.

Within the last 20 years, laboratory-confirmed reports of HBV infection have risen steadily, driven by improvements in awareness, diagnostics, reporting, and targeted testing. Decreases in laboratory reports may reflect progress made in relation to the introduction of the hexavalent HBV vaccine in the routine childhood immunisation schedule starting in 2017.

In 2022, a new bloodborne virus (BBV) testing programme was introduced in selected emergency departments (ED) in areas of high HIV diagnosed prevalence across England. 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 in England were made in emergency departments (where testing location was known).

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

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

Figure 2 compares trends in regional and national annual HBV (acute and chronic) laboratory reporting as incidence rates. Since 2015, trends in the South West have largely mirrored the rest of England, although at lower levels. In 2024, the incidence rate in the South West (11.1 laboratory reports per 100,000 residents) was 48% lower than that of England (21.4).

In the South West, HBV incidence rates increased by 59% in the previous 10 years, from 7.0 to 11.1 in 2025. Compared with the previous year, the regional rate increased by 10% in 2024, from 10.1 in 2023 to 11.1 in 2024.

Table 2. Number of new laboratory reports of hepatitis B (both 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.

Table 2 compares annual counts of new laboratory reports of HBV (acute and chronic) by UKHSA region of residence over the previous 10-year period. There are certain caveats to note when interpreting data in regional laboratory reports. If the patient postcode or GP information is unavailable, the patient will be assigned to the postcode of the testing laboratory and therefore reported for that UKHSA region. All UKHSA regions other than London have reported an increase in laboratory cases of hepatitis between 2015 and 2024. Between 2023 and 2024, changes in the number of new HBV reports ranged from a 9% decrease in the West Midlands to a 53% increase in the North West, compared to an 11% increase in the South West.

Table 3. Rate per 100,000 population of new laboratory reports of hepatitis B (both 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.

Table 3 compares annual incidence rates of new laboratory reports of HBV (acute and chronic) by UKHSA region of residence, where available, over the previous 10-year period. In 2024, the regions with the lowest rates of new HBV reports were the North East (10.0), the South West (11.1), and the South East (11.5), while those with the highest rates were London (59.0), the North West (22.4), and the West Midlands (17.5). Compared to 2023, decreasing rates were seen in the West Midlands (-10%), East Midlands (-1%), and the South East (-1%). Small increases were seen in London (0.3%) and the North East (+1%) while larger increases occurred in Yorkshire and the Humber (+9%), the South West (+10%), the East of England (+11%), and the North West (+50%). Over the previous 10 years, London has consistently reported the highest HBV rate among English regions.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (both acute and chronic) [note 3], residents of South West 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. 12 Hepatitis B cases in South West region in 2024 had no age and/or sex data and have not been included in this age-sex pyramid.

The age and sex distribution of laboratory-confirmed HBV (acute and chronic) cases is shown in Figure 3. 57% of cases were male (370), with a more pronounced skew towards males in the 65 and over (66%) and 55 to 64 (63%) age groups. The groups with the highest number of cases were men aged 35 to 44 (110), men aged 25 to 34 (101), and women aged 25 to 34 (94). Those aged between 25 and 44 made up over half of new diagnoses among both men and women.

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

Figure 4 shows the relative proportion of laboratory-confirmed HBV (acute and chronic) cases within certain ethnic groups within the previous 10 years. Since 2016, the highest proportion of cases in the South West have been observed among the White British ethnic group, making up 38% of cases in 2024. Following a large increase between 2015 and 2017 and a subsequent decrease from 2017 to 2019, the proportion of White British cases has remained largely stable. The proportion of those of any other White background has declined steadily since 2019, from 24% of cases in 2019 to 14% in 2024. The proportion of Black or Black British cases has been increasing since 2022, from 15% in 2022 to 22% in 2024. The distribution of cases in the Mixed and Asian ethnic groups as well as all other ethnic groups have remained stable within the previous 10 years.

These trends are similar to those in England as a whole, although a higher proportion of cases reported nationally in 2024 were Asian (28%) or Black or Black British (27%). Compared to the distribution of ethnic groups in the South West reported in the 2021 census, HBV cases occur disproportionately among those who are not White British.

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

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Bath and North East Somerset	9	16	21	16	16	17	19	33	23	28
Bournemouth, Christchurch and Poole	27	20	39	35	16	19	103	128	58	124
Bristol	83	94	171	148	127	125	93	148	118	144
Cornwall and Isles of Scilly	19	9	47	18	13	10	14	24	16	18
Devon	21	13	18	10	10	36	134	45	48	55
Dorset	8	5	22	19	8	12	26	27	25	23
Gloucestershire	25	38	29	27	24	20	17	42	61	47
North Somerset	11	15	31	22	16	9	12	29	23	19
Plymouth	17	28	16	18	19	13	14	37	33	36
Somerset	23	30	37	47	20	10	27	37	38	36
South Gloucestershire	12	29	34	25	28	21	31	64	56	45
Swindon	17	10	25	18	19	17	20	29	26	34
Torbay	10	7	4	9	6	8	4	11	9	10
Wiltshire	17	25	32	33	48	31	32	42	55	36

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

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

Table 4 shows the distribution of laboratory-confirmed HBV (acute and chronic) cases by local authority in the South West from 2015 to 2024. Consistent with previous years, the local authorities with the highest numbers of cases were Bristol (144), Bournemouth, Christchurch and Poole (124) and Devon (55), while Torbay (10), Cornwall and the Isles of Scilly (18), and North Somerset (19) recorded the lowest counts. There is considerable year-on-year variation in the number of cases among local authorities, which may be due to changes to laboratory reporting, updating historical data, and local testing or screening initiatives. Large shifts in the number of cases between years should be treated with caution.

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

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Bath and North East Somerset	4.9	8.6	11.2	8.4	8.4	8.9	9.9	16.9	11.6	14.0
Bournemouth, Christchurch and Poole	6.9	5.0	9.8	8.7	4.0	4.8	25.7	31.8	14.3	30.3
Bristol	18.4	20.5	36.9	31.7	27.0	26.5	19.7	30.9	24.3	29.1
Cornwall and Isles of Scilly	3.5	1.6	8.4	3.2	2.3	1.8	2.4	4.2	2.8	3.1
Devon	2.7	1.7	2.3	1.3	1.3	4.5	16.5	5.4	5.8	6.5
Dorset	2.2	1.3	5.9	5.1	2.1	3.2	6.8	7.0	6.5	5.9
Gloucestershire	4.0	6.1	4.6	4.3	3.8	3.1	2.6	6.4	9.2	7.0
North Somerset	5.2	7.1	14.5	10.3	7.4	4.2	5.5	13.2	10.4	8.5
Plymouth	6.5	10.6	6.0	6.8	7.2	4.9	5.3	13.8	12.2	13.2
Somerset	4.2	5.4	6.6	8.4	3.5	1.8	4.7	6.4	6.5	6.1
South Gloucestershire	4.4	10.5	12.2	8.9	9.8	7.3	10.7	21.7	18.6	14.7
Swindon	7.7	4.5	11.0	7.8	8.2	7.3	8.6	12.3	10.8	13.9
Torbay	7.4	5.1	2.9	6.5	4.3	5.8	2.9	7.9	6.4	7.1
Wiltshire	3.5	5.1	6.4	6.6	9.5	6.1	6.2	8.1	10.6	6.9

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

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

Table 5 presents the information included in Table 4 as annual incident rates, calculated using mid-year local authority population estimates. The local authorities with the highest rates per 100,000 population of new laboratory-confirmed hepatitis B in 2024 were Bournemouth, Christchurch and Poole (30.3), Bristol (29.1), and South Gloucestershire (14.7), with Cornwall and the Isles of Scilly (3.1), Dorset (5.9), and Somerset (6.1) having the lowest rates.

Trends in most local authorities followed regional and national patterns, with decreasing rates observed between 2017 and 2020 followed by year-on-year increases up to 2024. In certain local authorities, including Plymouth, Devon, South Gloucestershire, and Bournemouth, Christchurch and Poole, incidence rates following the 2020 to 2021 COVID-19 pandemic have exceeded previous peak levels recorded in 2016 to 2017. In Bristol, Torbay, Somerset, North Somerset, and Cornwall and the Isles of Scilly, recent rates have remained stable or show a decreasing trend relative to pre-pandemic peaks. Large shifts in incidence rates between years should be treated with caution due to changes to laboratory reporting and local testing or screening initiatives.

Figure 5. Test location of new laboratory reports of hepatitis B (both acute and chronic), residents of South West UKHSA region, 2024

Data sources: SGSS. Data extracted from the Sentinel Surveillance of Blood Borne Virus Testing (SSBBV) programme and SGSS will vary for several reasons and should not be compared. For further information, see information on data sources.

Figure 5 shows trends in the proportions of new HBV laboratory reports among South West residents according to testing location. In 2024, 67% of new HBV reports originated from hospitals, followed by 27% from general practices, 2% from sexual health clinics, and less than 1% reported from emergency departments, prisons, drug treatment and community outreach services, and other sources. Information on testing location was not available for 2% of cases.

A national BBV ED opt-out testing programme was launched in 2022 for 34 selected sites in areas of high diagnosed HIV prevalence. Consequently, 11% of new HBV diagnoses in England in 2024 with known testing locations were reported from emergency departments, although none of these sites were in located the South West. In 2024, the programme was expanded to 46 additional sites, including 5 hospitals in Bournemouth, Poole, Bristol, and Weston-super-Mare.

In 2024, the highest proportion of cases to date in the South West were reported from sexual health clinics (SHSs). However, compared to England, a relatively low share of regional reports originate from SHSs, whereas this proportion has increased nationally since 2016. Regional trends in the proportions of GP and hospital diagnoses mirror those of England, with a decrease in GP-associated diagnoses during the COVID-19 pandemic followed by an increase in 2022 and a stable trend thereafter.

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.

Acute infectious hepatitis is a notifiable disease. Data on incidence of reported acute hepatitis B infection is available from 1980 based on laboratory reports and reconciliation with clinician reporting of acute viral hepatitis. An acute hepatitis B infection is defined as test results positive for HBsAg and IgM from a person with abnormal liver function tests with a clinical pattern consistent with acute viral hepatitis. As part of enhanced molecular surveillance of acute hepatitis B, diagnostic laboratories are requested to submit blood samples from people diagnosed with acute hepatitis B to the UKHSA Blood Borne Virus Unit (BBVU) for confirmation and sequencing.

Figure 6 compares the 9 UKHSA regions according to their estimated 2024 incidence of acute or probable acute HBV per 100,000 population. In 2024, the estimated incidence rate in the South West was 0.37, down from 0.46 in 2023. The South West remains a lower-incidence region in comparison to England, where the national rate was 0.47 in 2024. London had the highest rate among English regions, at 0.80, followed by the West Midlands (0.60), the North West (0.59), and the North East (0.54). The East of England had the lowest rate (0.16), followed by the South East (0.26), the South West, the East Midlands (0.40), and Yorkshire and Humber (0.42).

Figure 7. Estimated incidence of acute or probable acute hepatitis B per 100,000 population [note 8], South West 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.

Figure 7 describes trends in acute and probable acute HBV incidence between the South West and England over the previous 10 years. Unlike Figure 2, Figure 7 excludes chronic cases, and includes probable acute cases without laboratory confirmation which are recorded on the UKHSA case management system.
Compared to Figure 2, Figure 7 shows that regional and national incidence trends for acute HBV have closely mirrored each other since 2019. Similarly to Figure 2, incidence rates in England generally decreased between 2015 and 2021 and rebounded over the next 2 years. In 2024, estimated acute HBV rates declined regionally and nationally, from 0.46 to 0.37 cases per 100,000 population in the South West, and from 0.52 to 0.47 cases per 100,000 population in England. This trend contrasts with the large increase in combined acute and chronic diagnoses displayed in Figure 2, although counts of probable acute HBV cases in 2024 are likely to be underreported (Note 8).

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 South West 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.

Data from sentinel laboratories can provide limited information on trends in testing activity in the South West. Figure 8 indicates that, excluding antenatal tests, the number of individuals tested for HBsAg annually at sentinel sites has more than doubled over the previous 10 years, from 19,396 tests in 2015 to 56,757 in 2024. The largest increase in testing occurred between 2023 and 2024, rising by 40%. This has coincided with a decrease in test positivity, from 0.97% in 2023 to 0.71% in 2024.

From 2022 to 2024, the opt-out ED BBV testing programme was scaled up, leading to increased numbers of tests being conducted at sentinel surveillance sites. Opt-out BBV testing at emergency departments was introduced in the South West in 2024, and an increase in HBsAg testing in the region is likely to be linked in large part to this programme (Figure 12). An increase in testing at EDs located at sentinel sites in the South West has not corresponded with a proportional increase in diagnoses being recorded at emergency departments (Figure 5).

Regional sentinel surveillance trends should be interpreted in context, as there is currently only one site located in the South West (Bristol Royal Infirmary), and trends in the Bristol area may not apply to other parts of the region.

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 South West 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 9 shows patterns in testing and test positivity through GP surgeries in sentinel laboratories in the South West, excluding antenatal testing. These trends are similar to those in Figure 8, with a steady increase in the number of HBsAg tests recorded over the previous 10 years, from 5,780 in 2015 to 14,158 in 2024. Compared to the previous figure, a more modest rise in testing is reflected from 2023 to 2024 (+6%), which is consistent with trends related to the rollout of ED HBV opt-out testing described above and in Figure 12.

Test positivity at GPs linked to sentinel sites decreased from 0.95% in 2015 to 0.42% in 2021, before increasing to a peak of 0.99% in 2022. In the previous 2 years, test positivity at GPs has declined again, from 0.85% in 2023 to 0.79% in 2024. These trends are mirrored in the proportions of new HBV diagnoses recorded at GPs across the South West within the last 10 years (Figure 5).

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 South West 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 at sexual health services (SHSs) linked to sentinel sites in the South West decreased markedly from 3,990 tests in 2019 to 1,944 tests in 2020, reflecting a fall in face-to-face SHS consultations and changes to service provision resulting from the COVID-19 pandemic (Figure 10). Following the pandemic, HBsAg test counts at these SHSs have increased, stabilising at a lower level compared to pre-pandemic years. Between 2023 and 2024, the number of individuals tested at SHSs linked to sentinel sites increased by 15%, from 2,698 tests to 3,162 tests.

Test positivity remained stable from 2015 to 2019 and throughout the pandemic, decreasing to 0.1% in 2022. In recent years, test positivity has increased above 2019 levels. In 2024, the percentage of positive tests increased to 0.66% from 0.63% in 2023. However, these percentages must be interpreted in the context of wide confidence intervals, which indicate that there is no statistically significant difference in test positivity before and after the COVID-19 pandemic.

Please note that there is currently only one BBV sentinel site located in the South West (Bristol Royal Infirmary), and testing practices at SHSs in the Bristol area may differ from other providers within the South West.

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 South West 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.

People who inject drugs (PWID) are a group at particular risk of acquiring hepatitis B infection. Figure 11 shows testing and test positivity through drug services linked to sentinel laboratories in the South West. 

Testing at drug services linked to sentinel laboratories in the South West decreased by over half between 2022 and 2023, from 1,894 tests to 689 tests (-64%). Test counts decreased by a further 46% between 2023 and 2024, from 689 to 372 tests, although these trends may reflect an underreporting artefact (Note 10). Prior to 2022, annual test counts largely increased at these services, with a notable 29% decrease from 2019 to 2020, possibly reflecting interruptions to services related to the COVID-19 pandemic.

Test positivity remained under 1% from 2015 to 2018 before increasing to 1.15% in 2019. Test positivity decreased during the COVID-19 pandemic before rebounding in 2021 and 2022. There were no positive tests recorded from drug services linked to sentinel laboratories in 2023 or 2024, although these figures may be affected by underreporting issues (Note 10).

Please note that there is currently only one BBV sentinel site located in the South West (Bristol Royal Infirmary). The demographics of people who inject drugs and the nature of services provided in the Bristol region may differ from other areas of the South West.

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 South West 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 12 shows patterns in testing and test positivity through emergency departments linked to sentinel laboratories in the South West. Fewer than 1,500 tests were performed annually in these settings prior to 2024, during which the national ED BBV opt-out testing programme was expanded to include sites in the South West. Between 2023 and 2024, the number of individuals tested increased from 1,102 to 17,565. The large increase in testing volume has corresponded with a significant decrease in test positivity, from 1.09% in 2023 to 0.33% in 2024.

Between 2015 and 2021, test positivity at emergency departments linked to sentinel laboratories declined from 1.36% to 0.1%. No positive tests were recorded from these settings in 2022. This decrease occurred despite a stable trend in the number of individuals tested during this period.

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 South West region, financial years 2021/2022 to 2023/2024

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

Infectious Diseases in Pregnancy Screening (IDPS) is an NHS programme offering screening for HIV, hepatitis B and syphilis in every pregnancy. Hepatitis B screening coverage in pregnancy is a key performance indicator to provide assurance that screening is offered and recommended to all eligible individuals in every pregnancy, and that each patient accepting screening has a confirmed screening result and is monitored and reported. This helps to ensure that pregnant individuals living with hepatitis B are diagnosed and interventions are implemented to prevent transmission of hepatitis B to their children.

Figure 13 shows trends in IDPS eligibility and testing coverage by financial year. Over 99% of eligible individuals have been screened for hepatitis B in the last 3 financial years, with 99.7% coverage in 2022 to 2023 and 99.6% in 2023 to 2024. These percentages exceed the 90% WHO target for maternal antenatal HBsAg testing and are in line with national testing coverage rates. The number of IDPS-eligible individuals declined by 14% between the 2022 to 2023 and 2023 to 2024 financial years, from 53,299 to 45,960 individuals.

Monitoring HBV-related morbidity

Hospital admissions from 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 South West 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 appropriate) represented in the figure by asterisks (*). All other numbers are rounded to the nearest 5. 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.

Figure 14 shows the number of admissions and admission rate per 100,000 population with a diagnosis code for acute or chronic hepatitis B between 2015 and 2022, in the South West and England. Data is not available for 2017 and 2018 (Note 11). 

The number of HBV-related admissions in the South West rose from 315 admissions in 2015 to 440 admissions in 2019 and has since remained stable. In 2024, the number of admissions increased by 10% from 425 in 2023 to 470 in 2024. Compared to national admissions, the South West reports a disproportionately low number of admissions relative to its population size. In 2024, the admission rate in the South West was 7.98 per 100,000 population, 40% of the rate in England (19.95). The admission rate in the South West rose by 9% in 2024, from 7.29 in 2023 to 7.98 in 2024. However, the true admission rate is likely to be higher, due to data missingness (Note 14).

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 South West 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 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 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.

Figure 15 shows the number of admissions with a diagnosis code for HBV-related end-stage liver disease and/or hepatocellular carcinoma between 2015 and 2022 in the South West. Data is not available for 2017 and 2018. Numbers of admissions between 1 and 7 have been suppressed and are represented as asterisks. 

HBV-related ESLD admissions have remained stable regionally within the previous 10 years, with annual admissions ranging between roughly 20 and 40. A decrease in admissions was reported between 2023 and 2024, although counts in 2024 are likely to represent an underestimate of the true number of admissions (Note 18).

Counts of HBV-related HCC were low in the South West over the previous 10 years and caution should be taken when interpreting trends in small numbers. In 2024, roughly 15 HBV-related HCC admissions were recorded in the South West region.

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.

Rates of death registrations mentioning HBV-related ESLD and/or HCC per 100,000 population varied between UKHSA regions in the previous 5-year period (Figure 16). The region with the highest HBV-related ESLD/HCC 5-year mortality rate was London (0.68, 95% confidence interval 0.61 to 0.77), which was significantly higher than the North West, the region with the second-highest rate (0.42, 95% confidence interval 0.35 to 0.49).

In the South West, the 5-year mortality rate was 0.20 (95% confidence interval 0.16 to 0.26), which was significantly lower than the national rate (0.33, 95% confidence interval 0.31 to 0.35). The region with the lowest rate was the North East (0.14), followed by the East Midlands (0.18), the South West, and the East of England (0.25).

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, South West UKHSA region and England, FY 2019 to 2020 to FY 2024 to 2025

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

The UK introduced universal hepatitis B vaccination in autumn 2017 for babies born on or after 1 August 2017 as the hexavalent (6 in 1) vaccine, which includes hepatitis B, replaced the pentavalent (5 in 1) vaccine. UKHSA monitors vaccine coverage for all 3 doses of the universal hexavalent childhood vaccination programme in England (and all other childhood immunisation programmes) through COVER. Details on the COVER programme and methodology are described in COVER reports. Figure 17 shows vaccine coverage percentages for children at 12 months of age within the previous 6 financial years. Coverage in the South West remained higher than the national figure over this time period. In 2023/2024, vaccination coverage in the South West was 94.5% compared to 91.3% in England. These percentages exceed the WHO 90% annual target for HepB3 vaccination in children.

Figure 18. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, South West UKHSA region and England, FY 2020 to 2021 to FY 2024 to 2025

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

Figure 18 shows hexavalent vaccine coverage in the South West and England at the time of a child’s second birthday over the previous 5 financial years. In the 2024 to 2025 financial year, 95.1% of children in the South West received the hexavalent vaccine at 24 months, meaning that an additional 0.5% of children received the vaccine after their first birthday. In England, 92.5% of children were vaccinated at 24 months, including an additional 1.2% vaccinated between 12 and 24 months. Vaccination at 24 months has remained consistently high since the 2020 to 2021 financial year, although coverage of 3 doses at 24 months decreased by 0.8 percentage points between 2023 and 2024.

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, South West UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bath and North East Somerset	[note 22]	[note 22]	70% to 100%
Bournemouth, Christchurch and Poole	7	7	100.00%
Bristol	20	20	100.00%
Cornwall and Isles of Scilly	[note 22]	[note 22]	35% to 69%
Devon	6	6	100.00%
Dorset	[note 22]	[note 22]	70% to 100%
Gloucestershire	20	19	95.00%
North Somerset	[note 22]	[note 22]	70% to 100%
Plymouth	[note 22]	[note 22]	70% to 100%
Somerset	7	7	100.00%
South Gloucestershire	[note 22]	[note 22]	70% to 100%
Swindon	12	11	91.70%
Torbay	[note 22]	[note 22]	70% to 100%
Wiltshire	6	6	100.00%

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 6 compares the 12-month HepB3 vaccine coverage by local authority among children in the South West born to mothers who have been identified as having a high risk of vertical transmission. Small numbers in this table have been suppressed (Note 22). Within this population group, all local authorities other than Cornwall and the Isles of Scilly achieved a vaccination rate between 70% and 100%, although fewer than 5 children were eligible for vaccination in Bath and North East Somerset, Cornwall and the Isles of Scilly, Dorset, North Somerset, South Gloucestershire, and Torbay. The overall numbers of eligible children in this programme are very low at the upper tier local authority level and therefore data should be interpreted with caution.

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, South West UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Bath and North East Somerset	[note 24]	[note 24]	70% to 100%
Bournemouth, Christchurch and Poole	8	8	100.00%
Bristol	12	11	91.70%
Cornwall and Isles of Scilly	[note 24]	[note 24]	70% to 100%
Devon	10	10	100.00%
Dorset	[note 24]	[note 24]	70% to 100%
Gloucestershire	8	5	62.50%
North Somerset	[note 24]	[note 24]	70% to 100%
Plymouth	[note 24]	[note 24]	70% to 100%
Somerset	7	7	100.00%
South Gloucestershire	5	5	100.00%
Swindon	14	11	78.60%
Torbay	[note 24]	[note 24]	70% to 100%
Wiltshire	7	7	100.00%

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.

Table 7 presents similar metrics as Table 6 for vaccination at a child’s second birthday, including the third monovalent vaccine dose at 12 months of age. Small numbers in this table have been suppressed (Note 22) and precise counts are not presented for Bath and North East Somerset, Cornwall and the Isles of Scilly, Dorset, North Somerset, Plymouth, and Torbay. All regions aside from Gloucestershire recorded vaccination coverage of greater than 70% in this high-risk population. Where precise percentages were available, Swindon (78.60% coverage) and Gloucestershire (62.50%) fell under the 90% vaccination benchmark, although numbers of eligible children across all local authorities were low.

Vaccine uptake in people who inject drugs

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

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

People who inject drugs are at increased risk of acquiring hepatitis B and vaccination is therefore recommended for them and their close contacts. Vaccination recommendations for individuals engaged in, or potentially transitioning to, injecting drug use have been in place since the 1980s. Immunisation efforts for people who inject drugs have historically played a pivotal role in reducing acute hepatitis B infections (the green book, chapter 18). Data in this figure was obtained from the Unlinked Anonymous Monitoring Survey and was therefore self-reported.

The percentage of PWID reporting vaccine uptake in the South West has consistently paralleled the percentage for England (Figure 19). From 2019 to 2020, vaccination rates for this population fell from 72% to 62% in the South West and from 71% to 66% in England before declining further in 2021. These trends may be influenced by interruptions to services providing care to PWID during the COVID-19 pandemic and are similarly reflected in a decline in testing from drug services linked to sentinel surveillance sites during this time period (Figure 11). In 2023, vaccination rates for PWID remained stable at 64% in the South West, and increased from 61% in 2022 to 62% in England. Vaccination coverage continues to fall beneath pre-pandemic rates, which reached 78% in the South West in 2017 and 75% in England in 2015.

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, South West UKHSA region and England, 2014 to 2023

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

Figure 20 describes increasing trends in the percentage of PWID directly sharing needles and/or syringes in the South West. In this figure, needle and/or syringe sharing has been self-reported by UAM survey respondents and is recorded only if it occurred in the 4-week period prior to the individual’s response.

Regionally and nationally, self-reported direct equipment sharing increased in the previous 10 years, from 23% in 2014 to 31% in 2023 in the South West and from 17% in 2014 to 25% in 2023 in England. From 2014 to 2023, the percentage of PWID sharing needles and/or syringes has been higher in the South West than in England.

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

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

Figure 21 describes trends in the percentage of PWID directly and indirectly sharing injecting equipment in the South West. In this figure, needle and/or syringe sharing has been self-reported by UAM survey respondents and is recorded only if it occurred in the 4-week period prior to the individual’s response. Indirect sharing involves the common use of drug preparation or injection equipment, such as mixing containers or filters, rather than the direct sharing of needles or syringes.

Regionally, total self-reported equipment sharing decreased continually from 55% in 2014 to 42% in 2018. This percentage remained at 43% during the COVID-19 pandemic before increasing to pre-pandemic levels at 48% in 2022 and 51% in 2023. Nationally, the percentage of PWID engaging in equipment sharing remained stable until 2020, where it rose to 43% from 38% in 2014. In 2023, total equipment sharing in England rose again from 39% in 2022 to 44% in 2023. Among UAM respondents, the prevalence of equipment sharing in the previous 4 weeks has remained higher in the South West than in England over the previous 10 years.

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 fes.southwest@ukhsa.gov.uk

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