This quality standard covers testing, diagnosis and management of hepatitis B in children (from birth), young people and adults. For more information see the topic overview.

Why this quality standard is needed

Hepatitis B is a viral infection that is transmitted by contact with the blood or body fluids of an infected person and is also transmitted perinatally from mother to child (vertical transmission). Some adults have an acute infection, in which the virus is cleared from the body naturally, whereas other people develop a chronic infection. Rates of progression from acute to chronic infection vary according to age at the time of infection. About 85% of hepatitis B infections in newborn babies become chronic compared with 4% in adults (Hepatitis B and C [NICE public health guidance 43]).

The UK has been classified as a low incidence and prevalence country for hepatitis B infection. However, mortality and morbidity associated with chronic hepatitis B could be prevented in a significant number of people (Standards for local surveillance and follow up of hepatitis B and C [Health Protection Agency]). There is considerable uncertainty over the number of people with chronic hepatitis B infection in the UK. In 2002, the Department of Health estimated that chronic hepatitis B affected 180,000 people in the UK. Other estimates put the figure for the UK as high as 325,000 (Hepatitis B Foundation UK 2007).

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 horizontal transmission between adults or through vertical transmission from mother to child.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality from liver disease attributable to hepatitis B virus

  • vertical transmission from hepatitis B surface antigen (HBsAg)-positive mother to child: babies identified as being hepatitis B-positive after 1 year

  • enabling people to live better with this condition.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014/15


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare i adults ii children and young people

Improvement areas

1.3 Under 75 mortality rate from liver disease*

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Reducing time spent in hospital by people with long-term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

Alignment across the health and social care system

* Indicator complementary with Public Health Outcomes Framework (PHOF)

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Table 2 Public health outcomes framework for England, 2013–2016


Objectives and indicators

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities


4.6 Mortality from liver disease*

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework (NHSOF)

Coordinated services

The quality standard for hepatitis B specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole hepatitis B care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high‑quality care to people with hepatitis B in primary and secondary care settings.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality hepatitis B service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and public health practitioners involved in assessing, caring for and treating people with hepatitis B in primary and secondary care settings should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting people with hepatitis B. If appropriate, health and public health practitioners should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.