NICE consults on new public health guidance aiming to improve uptake of testing for hepatitis B and C
Ignorance about the risk factors and causes of hepatitis B and C, and misconceptions about its treatment need to be tackled if barriers to effective testing of those at increased risk of infection are to be overcome, according to draft guidance issued today (13 June) by NICE.
Affecting over half a million people in the UK, hepatitis B and C are blood-borne viruses that predominantly infect the liver. Transmission is by contact with infected blood, primarily as a result of exposure through the skin to contaminated blood. A hepatitis infection can be categorised into 2 stages: firstly an acute infection (the first 6 months following initial infection) and secondly a chronic infection. Chronic hepatitis B or C infection increases the risk of chronic liver damage, cirrhosis and primary liver cancer.
Those at increased risk of infection with hepatitis B or C include people who inject drugs, travel to countries where there is a high incidence of the disease, heterosexual contact with someone who is infected, mother to child transmission and homosexual contact. People from some minority ethnic groups in the UK may also be at higher risk, with estimates suggesting that the rate of acute infection within the South Asian population in England and Wales is twice the estimated average. Statistics also suggest a higher than average prevalence of hepatitis C among people in prison.
The draft guidance sets out how services, organisations and practitioners can promote testing and reach people at increased risk. The recommendations cover:
- Raising awareness of hepatitis B and C in: the general population; among those at increased risk; and among health professionals and others providing services for those at increased risk.
- Identifying people at increased risk of hepatitis B and C infection and the provision of testing.
- Testing through contact tracing.
- Implementation and auditing of Hepatitis B vaccination
- The provision of laboratory services for hepatitis B or C testing.
- Hepatitis B and C testing in prisons
- Testing for hepatitis B and C in drugs services.
- Commissioning viral hepatitis testing and treatment services.
Professor Mike Kelly, NICE Director of Public Health, said: "The people who are actually diagnosed with hepatitis B or C are just the tip of the iceberg. Despite the availability of effective treatments and the potentially serious consequences of not being tested and treated, there still seems to be a general ignorance among the whole population, including those promoting hepatitis testing, about hepatitis B and C. This lack of knowledge is undoubtedly contributing to both a lack of offer of testing by services and the low uptake of testing among those at increased risk of infection, and also to the stigma surrounding hepatitis B and C.
Professor Kelly continued: "Recommendations in the draft guidance therefore encompass general awareness raising for the population as a whole, for those at increased risk of infection and for healthcare professionals and others providing services for those at increased risk of hepatitis B and C. This is aimed at addressing any misconceptions about the risk of hepatitis B and C that can act as barriers to testing, including the belief that treatments are not effective and that treatment is not needed until the illness is advanced. It is also aimed at demystifying the risks of transmission among families, friends and colleagues of people diagnosed with chronic hepatitis B or C, and in doing so reducing much of the stigma attached to the diseases. I would urge anyone with an interest in this area to submit their comments on these draft recommendations via the NICE website."
Anyone wishing to submit comments on this draft guidance is invited to do so via the NICE website, www.nice.org.uk, until 8 August 2012. Final guidance is expected in December 2012.
Notes to Editors
About the draft guidance
1. The draft guidance will be available on the NICE website from 13 June 2012: http://guidance.nice.org.uk/PHG/Wave22/3.
2. In England and Wales between 1995 and 2000, an estimated 3780 people a year were infected with acute hepatitis B, about 7% of whom then went on to develop chronic hepatitis B.
3. According to the Chief Medical Officer, an estimated 180,000 people in the UK are now chronically infected with the hepatitis B virus although this figure may be closer to 360,000 when the estimated 6500-plus people with chronic hepatitis B who migrate to the UK each year are taken into account.
4. An estimated 216,000 people in the UK are chronically infected with the hepatitis C virus. However, only 85,565 diagnoses have been reported. By 2020 it is predicted that 15,840 people, in England alone, will be living with hepatitis C-related cirrhosis or hepatocellular carcinoma.
5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
6. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
7. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 12 June 2012