28 July 2014

Reducing the spread of hepatitis B

NICE’s quality standard for hepatitis B can help to reduce the spread of the infection by ensuring that people who are at increased risk are offered testing and vaccination.

Testing should be offered in a range of settings such as at GP practices including new registrations, prisons or immigration removal centres, drug services, and sexual health and genitourinary medicine clinics.

It is estimated that there are around 325,000 people in the UK with chronic hepatitis B - a viral infection that is transmitted by contact with the blood or body fluids of an infected person and is also transmitted from mother to child.

Migrant populations are now the main focus for identifying and testing for hepatitis B infection in the UK. It is estimated that 95% of people with newly diagnosed chronic hepatitis B infection are immigrants, who predominantly become infected in early childhood in the country of their birth.

Most of the remaining 5% of people with UK-acquired chronic hepatitis B infection acquired it either through transmission between adults or passed on from mother to child.

Other high risk groups include people who inject drugs, men who have sex with men, people who may have been exposed to sexually acquired infections, and among prisoners where there is a growing problem.

In a written answer to a parliamentary question earlier this year, Health Minister Norman Lamb said the number of prisoners diagnosed with chronic forms of the virus has risen from just 22 in 2010 to 109 in 2013.

Figures, compiled by Public Health England (PHE), also show that over the same period the number of vaccinations against the virus in prisons has fallen, despite the prison population increasing to a record 85,000. In 2010/11, 109,827 doses of the vaccine were administered, but this fell to 74,785 in 2012/13.

The quality standard, launched on World Hepatitis Day, consists of 7 statements designed to ultimately reduce mortality from liver disease attributable to hepatitis B, limit the spread of the infection, and enable people who already have hepatitis B to live better with this condition.

As well as offering testing and vaccination to children, young people and adults in high risk groups, the standard recommends that pregnant women who are identified as hepatitis B surface antigen (HBsAg)-positive at antenatal screening are assessed by a specialist within 6 weeks of receiving the screening test result.

People who test positive for hepatitis B surface antigen (HBsAg) should be referred to specialist care for further assessment as chronic hepatitis B infection affects the liver and can cause serious health problems if left untreated, says NICE.

Babies born to hepatitis B surface antigen (HBsAg)-positive mothers should receive a complete course of hepatitis B vaccination and a blood test for hepatitis B infection at age 12 months.

The quality standard also covers the care of people who already have hepatitis B and recommends that they, along with their family members or carers, are offered a personalised care plan outlining the proposed treatment and long-term management of their infection.

People with chronic hepatitis B infection who do not meet the criteria for antiviral treatment should be monitored regularly at intervals determined by their infection status and age.

Adults with chronic hepatitis B infection who have significant liver fibrosis or cirrhosis should be offered 6 monthly surveillance testing for hepatocellular carcinoma.