Research and analysis

Hepatitis B in the West 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 the West 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:

• 1,081 new laboratory reports of hepatitis B in residents of the West Midlands, representing a rate of 17.5 reports per 100,000 population in 2024 
• the number of new laboratory reports has decreased by 9% between 2023 and 2024, and increased by 26% over the past 10 years 
• in 2024, the number of new laboratory reports in males was 613 (56.7%) and in females was 450 (41.6%) 
• 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 6 in Herefordshire to 375 in Birmingham; rates were highest in Coventry at 35.2 new laboratory reports per 100,000 population and lowest in Herefordshire with 3.1 per 100,000 population 
• the estimated incidence of acute (or probable acute) infection was 0.6 per 100,000 population. This was higher than the England average of 0.5 per 100,000 
• there have been 36,569 individuals tested for hepatitis B surface antigens (HBsAg) in sentinel laboratories in West Midlands UKHSA region in 2024, of which 0.93% tested positive - the proportion positive was higher for tests referred through GP surgeries, higher 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 960 hospital admissions for individuals with a diagnosis code for acute or chronic hepatitis B in West 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 45 and 15 respectively in 2024 

Prevention of infection by immunisation

Main trends are:

• routine hepatitis B vaccine coverage of 3 doses at 24 months in West Midlands UKHSA region was 93.6% for financial year (FY) 2024 to 2025
• vaccine coverage of 3 doses at 24 months has increased by 0.1 percentage points between financial years 2023/2024 and 2024/2025
• the reported level of hepatitis B vaccine uptake among people who inject drugs (PWID) in West Midlands UKHSA region was 65.1% for 2023 (the most recently reported data)
• the reported level of hepatitis B vaccine uptake among PWID has increased by 12.9 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 West 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 HIV diagnosed prevalence across England, phase 1, with the first cities to take part being London, Blackpool and Manchester. West Midlands was part of phase 2, the introduction of testing in areas of high prevalence of HIV, with Birmingham’s Queen Elizabeth Hospital being the first site in the West Midlands to introduce ED opt-out testing in September 2024, followed by Walsall Manor and New Cross Hospital joining in October 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 EDs.

The number of new laboratory reports of hepatitis B among residents of the West Midlands increased between 2021 and 2023, followed by a modest decrease in 2024 but remain higher than before the COVID-19 pandemic. The increase from 2022 onwards coincides with the recovery of routine services.

Figure 2. New laboratory reports of hepatitis B (acute and chronic) rate per 100,000 population [note 1], residents of West Midlands UKHSA region and England, 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 new laboratory reports of hepatitis B in the West Midlands broadly followed national trends over the period shown, with slightly lower rates than the England average from 2019 onwards. After a decline in 2020, rates increased steadily to a peak in 2023 before decreasing slightly in 2024, while the England rate continued to increase.

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.

Across England, the number of new laboratory reports of hepatitis B increased substantially from 2021 onwards in most regions, reflecting increased testing activity. London continued to account for the largest absolute number of diagnoses, while the West Midlands remained one of the regions with a comparatively higher burden, underlining the importance of continued prevention and care initiatives locally.

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.

Regional rates of new laboratory reports varied considerably across England, with London reporting the highest rates throughout the period. In the West Midlands, rates were similar to the England average between 2018 and 2022, peaking in 2023 before declining slightly in 2024.

Figure 3. Age group and sex of new laboratory reports of hepatitis B (acute and chronic) [note 3], residents of West 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. 18 Hepatitis B cases in West Midlands region in 2024 had no age and/or sex data and have not been included in this age-sex pyramid.

In 2024, new laboratory reports of hepatitis B in the West Midlands were more common among males than females. The highest number of diagnoses occurred in working‑age adults, particularly among males aged 35 to 44 years and females aged 25 to 34 years. This pattern reflects long‑standing trends and highlights opportunities for prevention and early diagnosis through routine healthcare contacts.

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

Where ethnicity was known, the majority of new hepatitis B diagnoses in the West Midlands occurred among people from ethnic groups other than White British. This reflects known patterns of hepatitis B infection in England and underlines the importance of culturally appropriate testing, vaccination and engagement with affected communities. Since 2021 the proportion of diagnoses amongst White British individuals increased reaching proportions similar to those of Black or Black British and Asian or Asian British ethnicities. It is important to note that a substantial proportion of records had missing ethnicity information and are not shown.

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

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Birmingham	282	283	382	389	337	183	196	278	352	375
Coventry	78	92	121	148	156	69	106	134	211	130
Dudley	17	10	5	30	22	20	16	19	52	44
Herefordshire	4	4	11	10	4	5	10	19	17	6
Sandwell	31	60	70	57	61	31	39	38	74	74
Shropshire	3	9	11	5	8	8	9	11	20	19
Solihull	9	12	11	11	10	4	9	20	26	19
Staffordshire	47	42	44	35	35	51	32	49	49	44
Stoke-on-Trent	29	27	38	38	60	36	59	66	86	91
Telford and Wrekin	11	11	11	16	17	18	14	19	22	14
Walsall	25	25	17	23	23	18	28	32	41	53
Warwickshire	48	45	38	31	41	23	29	56	78	83
Wolverhampton	39	35	47	44	59	67	51	67	123	98
Worcestershire	24	21	16	13	34	24	28	50	37	31

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

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

The number of new laboratory reports varied widely by upper tier local authority. Birmingham continues to report the highest number of hepatitis B diagnoses, reflecting its larger population and likely also to reflect the testing being undertaken under the Fast-Track Cities+ initiative. Numbers remain much lower in smaller and more rural local authorities.

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], West Midlands UKHSA region, 2015 to 2024

Upper tier local authority	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024
Birmingham	25.3	25.0	33.5	33.9	29.3	15.9	17.1	24.1	30.1	31.7
Coventry	23.6	27.3	35.6	43.2	45.4	20.0	30.8	38.1	58.7	35.2
Dudley	5.4	3.1	1.6	9.3	6.8	6.2	4.9	5.8	15.8	13.3
Herefordshire	2.2	2.1	5.9	5.4	2.1	2.7	5.3	10.1	8.9	3.1
Sandwell	9.5	18.2	21.0	16.9	17.9	9.1	11.4	11.0	21.2	20.9
Shropshire	1.0	2.9	3.5	1.6	2.5	2.5	2.8	3.4	6.1	5.7
Solihull	4.3	5.6	5.1	5.1	4.6	1.8	4.2	9.2	11.8	8.6
Staffordshire	5.5	4.9	5.1	4.0	4.0	5.8	3.6	5.5	5.5	4.9
Stoke-on-Trent	11.4	10.5	14.7	14.7	23.1	13.9	22.9	25.3	32.4	33.7
Telford and Wrekin	6.4	6.3	6.2	8.9	9.3	9.8	7.5	10.1	11.4	7.1
Walsall	9.1	9.0	6.0	8.1	8.1	6.3	9.8	11.2	14.1	17.9
Warwickshire	8.5	7.9	6.6	5.4	7.0	3.9	4.8	9.2	12.6	13.1
Wolverhampton	15.2	13.5	18.0	16.8	22.4	25.5	19.3	24.9	44.6	34.8
Worcestershire	4.1	3.6	2.7	2.2	5.7	4.0	4.6	8.2	6.0	5.0

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 new laboratory reports differed markedly between local authorities. Coventry reported some of the highest rates in the West Midlands region over recent years, while Herefordshire and other rural authorities had consistently low rates, which may reflect accessibility to testing or services. Year‑to‑year fluctuations, particularly in areas with small populations, should be interpreted with caution.

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

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

In 2024, new hepatitis B diagnoses in the West Midlands were identified across a range of healthcare settings most of which were made in hospitals (52%) and general practices (35%). This was the same pattern seen over the whole 7-year period with hospitals, ranging between 30% to 52% of diagnoses, and general practice, between 25% and 50% of diagnoses.

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 or newly acquired hepatitis B infection remains rare across all UKHSA regions, including the West Midlands. The West Midlands reported an estimated incidence, 0.60 per 100,000, higher than the England average (0.47 per 100,000). Interpretation of these estimates should take account of likely under‑ascertainment following the transition to a new national case management system in 2024

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

Estimated incidence of acute or probable acute hepatitis B remained below one case per 100,000 population throughout the period 2015 to 2024. The West Midlands followed a similar pattern to England overall, with modest year‑to‑year variation. Apparent reductions in 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 West 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 nationally, leading to increased numbers of tests being conducted in the sentinel surveillance sites where the opt-out ED BBV tests were being submitted.

Within the West Midlands the first emergency department to introduce opt-out ED BBV testing was Birmingham Queen Elizabeth in September 2024, part of University Hospitals Birmingham NHS Foundation Trust which was already a sentinel surveillance site, having been the only sentinel site in the West Midlands since 2002. Following this, 3 further sites began ED opt-out testing before the end of 2024 and started to submit their data to sentinel surveillance also before the end of 2024.

The number of individuals tested for hepatitis B surface antigen remained consistent between 2015 and 2023, after which numbers increased substantially. There was an overall steady decline in positivity during the whole period but after a small peak in 2023 there was a small sharp decline, suggesting that testing is reaching less targeted, broader population groups.

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 West 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.

Similar to the overall pattern of testing from sentinel surveillance, the testing for hepatitis B through general practice showed a relatively stable level of testing from 2015 to 2023 followed by a sharp increase. The proportion of positive tests also remained relatively stable, suggesting ongoing identification of people with chronic infection through primary care.

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 West 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.

In sexual health services, both testing volume and the proportion testing positive fluctuated over time. These trends likely reflect changes in service use, how much the sentinel laboratory was used to process BBV tests from sexual health services, testing practices, and the characteristics of people accessing sexual health services.

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 West 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.

Testing activity in drug services increased in recent years; however, interpretation of trends between 2023 and 2024 is limited due to underreporting from a sentinel laboratory providing a large proportion of tests to drug treatment services.

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 West 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 through emergency departments increased markedly in 2024 following implementation of opt‑out blood‑borne virus testing. Positivity remained lower than in most other settings, consistent with broader population testing, the narrower confidence interval for the positivity in 2024 reflects the increase in the number of tests. Emergency departments have become an increasingly important setting for hepatitis B testing following the introduction of routine blood‑borne virus testing, supporting earlier diagnosis among people who may not be regularly engaged with health services.

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.

The number of women eligible for hepatitis B antenatal screening declined over the 3-year period covering the financial years 2021/22 to 2023/24, however, the percentage of women screened has remained high across this period, between 99.7% and 99.8%.

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 West 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 the 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.

Hospital admissions for acute or chronic hepatitis B declined in 2020, likely reflecting reduced healthcare utilisation during the COVID‑19 pandemic, and increased again in subsequent years for both West Midlands and England, a steeper increase seen in the England rate compared to the West Midlands. Admission rates in 2024 were higher than in 2023, though counts are likely underestimated due to missing residence information.

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 West 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 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.

Admissions for hepatitis B‑related advanced liver disease and liver cancer remain relatively low. Improvements in how hospital and laboratory data is linked mean that recent figures are more complete than in earlier reports. Nationally, British Liver Trust figures show that increases have been seen in the death rate of liver disease since 1970 where other major infections have shown overall decreases, with a particularly sharp rise seen between 2019 and 2020.

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 rates associated with hepatitis B‑related end‑stage liver disease or hepatocellular carcinoma remained low across UKHSA regions, comparatively the West Midlands is in the second lowest range of rates of mortality, similar to the rate for England of 0.33 per 100,000 for 2020 to 2024. Regional comparisons are subject to uncertainty due to small numbers and changes in methodology over time.

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, West Midlands UKHSA region and England, financial years 2019/2020 to 2024/2025

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

Routine hepatitis B vaccine coverage at 12 months remained high in the West Midlands, between 92.2% and 93.1%, although a slight decline was observed in recent years, mirroring national trends.

Figure 18. Routine hepatitis B vaccine coverage of 3 doses of the hexavalent vaccine at 24 months, West 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 routine hepatitis B vaccination course at 24 months decreased slightly between over the whole period covering financial years 2020/2021 to 2024/2025 with a very small increase in the last year but remained above 90%, consistent with national patterns.

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, West Midlands UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Birmingham	106	102	96.20%
Coventry	40	39	97.50%
Dudley	8	8	100.00%
Herefordshire	[note 22]	[note 22]	70% to 100%
Sandwell	24	22	91.70%
Shropshire	[note 22]	[note 22]	70% to 100%
Solihull	[note 22]	[note 22]	70% to 100%
Staffordshire	11	10	90.90%
Stoke-on-Trent	8	8	100.00%
Telford and Wrekin	[note 22]	[note 22]	70% to 100%
Walsall	12	12	100.00%
Warwickshire	13	13	100.00%
Wolverhampton	17	15	88.20%
Worcestershire	[note 22]	[note 22]	70% to 100%

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.

Vaccine coverage among infants at higher risk of hepatitis B transmission by their first birthday was generally high across the West Midlands. Apparent variation between local authorities should be interpreted with caution due to small numbers and data suppression.

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, West Midlands UKHSA region, FY 2024 to 2025

Local authority	Eligible population	Number vaccinated	Percentage covered (%)
Birmingham	75	69	92.00%
Coventry	24	21	87.50%
Dudley	8	7	87.50%
Herefordshire	[note 24]	[note 24]	70% to 100%
Sandwell	13	12	92.30%
Shropshire	0	0	Not applicable
Solihull	[note 24]	[note 24]	70% to 100%
Staffordshire	12	12	100.00%
Stoke-on-Trent	13	13	100.00%
Telford and Wrekin	6	[note 24]	35% to 69%
Walsall	10	10	100.00%
Warwickshire	11	11	100.00%
Wolverhampton	11	11	100.00%
Worcestershire	5	[note 24]	70% to 100%

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.

Vaccine coverage among infants at higher risk of hepatitis B transmission by their second birthday was slightly lower than coverage by their first birthday (Table 6) for Birmingham, Coventry, Dudley and Telford and Wrekin local authorities, though this variation may be due to small numbers.

Vaccine uptake in people who inject drugs

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

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

Reported uptake of hepatitis B vaccination among people who inject drugs increased between 2022 and 2023. Improvements may reflect renewed service engagement following pandemic disruption, though coverage remains below optimal levels.

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, West Midlands UKHSA region and England, 2014 to 2023

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

Reported sharing of needles and syringes among people who inject drugs has fluctuated over time. Over the last year of data there was an increase seen in the West Midlands, at a similar level to the England average between 2022 and 2023. This indicates there is still need for work to encourage safer injecting behaviours.

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

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

Reported levels of direct and indirect sharing of injecting equipment shows a similar pattern to Figure 20, at higher levels, reinforcing the need to work towards improvements in harm reduction behaviours among people who inject 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