On World Hepatitis Day NICE has issued a new quality standard aimed at preventing transmission of hepatitis B and improving the lives of those living with the condition.

In the UK, hepatitis B is thought to affect up to 325,000 people. Although the UK has been classified as low prevalence, hepatitis B is between 50 and 100 times more infectious than HIVⁱ, making it a considerable public health concern.

Hepatitis B is a viral infection which affects the liver. It is spread by contact with blood or body fluids (i.e. saliva, semen, vaginal fluid) and is also transmitted from mother to child during childbirth.

The majority of new cases arise in those born overseas who became infected in their country of birth. The standard highlights that people who are at increased risk should be a main focus for testing for hepatitis B – such as migrant populations. Other at risk groups include people who inject drugs or have had unprotected sex with someone who is infected with the hepatitis B virus.

The standard includes a statement to ensure that testing strategies are made available in places visited by or accessible to those at risk groups. Testing and vaccination should be offered at sexual health clinics, drug services, immigration centres and GP practices taking new registrations.

Chronic hepatitis B infection can cause serious health problems if left untreated. The standard stresses that anyone who tests positive for hepatitis B should be referred immediately to a specialist for further assessment and to make sure they get the right treatment.

Hepatitis B is also spread from mother to child. The disease can have a devastating effect on newborns, with well over three quarters (85%) developing chronic disease compared to just 4% of adults.

Some people with chronic hepatitis B will have no symptoms, however in others the infection will lead to long-term liver damage or in some cases liver cancer. Even if they have no symptoms people with chronic hepatitis infection can still spread the virus to others.

The standard includes two statements specifically for pregnant women with hepatitis B and their babies. It states that pregnant women who test positive for hepatitis B at antenatal screening should have specialist assessment within 6 weeks. This will allow use of antiviral treatment (tenofovir) if needed which can help reduce the risk of the baby becoming infected.

Vaccination of babies is highly effective in preventing transmission of hepatitis B. The standard also states that babies born to hepatitis B positive mothers, whether delivered at home or in hospital, receive a complete course of hepatitis B vaccination. The first vaccine should be given within 24 hours of birth and then periodically up to 12 months, with a booster at preschool age.

The quality standard includes further statements around providing personalised care plans and regular monitoring to ensure those with hepatitis B are able to live better with the condition.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: “In some people hepatitis B develops as an acute infection which clears quickly, whereas in others the infection progresses to become a chronic disease, leading to long-term liver damage or even liver cancer. However, we know that hepatitis B is both preventable and curable. This new quality standard sets out prioritised statements for the NHS to ensure appropriate services are available to identify and treat people with hepatitis B.”

Ends

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

References

1. i.     Public Health England. Hepatitis B epidemiology in London 2012 data. April 2014
2. The quality standard for hepatitis B will be available at http://www.nice.org.uk/guidance/QS65 from Monday 28 July 2014.
3. NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. They are derived either from NICE guidance or guidance from other sources that have been accredited by NICE, and apply right across the NHS in England.
4. The draft quality standard is different to the NICE hepatitis B (chronic) guideline which was published last year and gives recommendations across broad areas of care of young children with feverish illness.

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.