Hepatitis B

Background

Hepatitis B is a blood borne infection caused by the hepatitis B virus (HBV). The virus infects the liver causing inflammation and potentially further damage over many years. An estimated 257 million people are chronically infected worldwide and in the latest data from 2015, there were 887,000 deaths, mostly from cirrhosis and hepatocellular carcinoma.

Transmission of HBV is through percutaneous, that's through the skin, or mucosal exposure to infected blood or body fluids, including:

  • sex with an infected partner
  • sharing drug injecting and other drug preparation equipment
  • from mother to child at birth
  • a needle stick or contact with other infected sharp instruments
  • sharing of razors or toothbrushes with an infected person

It's a vaccine preventable infection and, in the UK, vaccination is recommended for groups of people who are at the highest risk of exposure to the virus. Since August 2017, a hexavalent vaccine which includes a hepatitis B component is now universally used in the infant vaccination schedule.

The virus can cause an acute infection and in some cases a chronic infection. Although many people show no symptoms during the acute phase, it can be characterised by symptoms such as:

  • general malaise
  • fatigue
  • nausea
  • jaundice
     

The infection becomes chronic in about 5% of adults. In contrast, however, 90% of babies and 30 to 50% of children under six years will develop chronic infection. People with chronic infection have an increased risk of developing liver cirrhosis and hepatocellular cancer (HCC). This increased risk is estimated to occur in about 30% of chronically infected adults. While treatment doesn't cure hepatitis B, it can be used to suppress the replication of the virus and, therefore, the person's infectivity.

Testing for hepatitis B infection is to detect the presence of a number of hepatitis B viral markers in a blood sample. In the UK there are two population-based screening programmes:

  • the blood donor population
  • women attending antenatal services

With an estimated 0.2% of the Scottish population chronically infected with HBV, Scotland is considered to be a low prevalence country.

Hepatitis B infection is notifiable in Scotland according to the Public Health etc. (Scotland) Act 2008.

For further information please visit the NHS inform website and for immunisation details, Public Health England (PHE) green book, chapter 18.

Guidance

Optimal management of HBV infection

The European Association for the Study of the Liver (EASL) Clinical Practice Guideline provides recommendations for the optimal management of HBV infection.

Assessment and management of chronic hepatitis B in children, young people and adults

The National Institute for Health and Care Excellence (NICE) guidance covers the assessment and management of chronic hepatitis B in children, young people and adults. It aims to improve care for people with hepatitis B by specifying which tests and treatments to use for people of different ages and with different disease severities.

Guidance for health clearance of healthcare workers (HCWs) and management of those infected with hepatitis B, hepatitis C and HIV

Guidance is available from Public Health England (PHE) for health clearance of healthcare workers (HCWs) and management of those infected with the following bloodborne viruses (BBVs):

  • hepatitis B
  • hepatitis C
  • human immunodeficiency virus (HIV)

The guidance has been approved for use in Scotland by the Scottish Health Protection Network Guidance Group (SHPN-GG) and should be used in conjunction with the SHPN addendum.

Read the addendum and access the guidelines on our website

Guidance to support opt-out blood borne virus (BBV) testing in Scottish prisons

The Scottish Government updated the Sexual Health and Blood Borne Virus Framework in 2015. The update recommended the introduction of opt-out BBV testing in the Scottish Prison Establishment. A Short Life Working Group produced this guidance to support the delivery and  monitoring of opt-out BBV testing in Scotland’s prisons. The guideline has been developed in line with national guidelines and policies.

View the Guidance to Support Opt-Out BBV Testing in Scottish Prisons

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Publications

The Blood borne viruses (BBV) and sexually transmitted infections (STI) report, produced by our BBV and STI team, describes the epidemiology of Hepatitis C, Hepatitis B, HIV and other STIs in Scotland to the end of December 2016. It also describes the impact of interventions in preventing infection and associated disease and highlights public health priorities. The report also directs readers to other existing Scottish reports and data sources available on our website. The commentary is structured around the outcome indicators detailed in the Scottish Government’s Sexual Health and Blood Borne Virus (SHBBV) Framework, 2015 to 2020

Read our Hepatitis B infection in Scotland - 2015 report

Data and surveillance

Hepatitis B database

From 1998 to 2013, the HBV database comprises data on all people tested and diagnosed positive for HBV in four NHS board areas:

  • NHS Greater Glasgow and Clyde
  • NHS Lothian
  • NHS Tayside
  • NHS Grampian

Since 2014, the HBV database has been expanded with data sent from laboratories using the Electronic Communication of Surveillance in Scotland (ECOSS) system and coverage has expanded to include people tested and diagnosed in:

  • NHS Ayrshire & Arran
  • NHS Borders
  • NHS Fife
  • NHS Highland

Enhanced surveillance of acute hepatitis B infection

Since 2014, enhanced surveillance of acute HBV infection has been performed. Survey forms are completed by NHS board health protection teams to confirm probable cases of acute HBV infection. Enhanced surveillance also provides additional information not collected by routine surveillance including routes of transmission and ethnicity.

Hepatitis B treatment survey

A survey questionnaire is distributed to clinicians at all of the treatment centres in Scotland including infectious disease, hepatology and gastroenterology units. The survey is performed every two to three years. For each clinic, clinicians are asked to estimate the numbers of patients:

  •  with chronic HBV attending the clinic
  •  on treatment according to EASL or the NICE guidelines
  • with an optimal response to treatment according to criteria set out in the guidelines

Sexual health and blood borne virus framework

The Sexual Health and Blood Borne Virus Framework, first published by the Scottish Government in August 2011 and updated in September 2015, brought together policy areas on sexual health and BBVs, namely HIV, hepatitis C virus (HCV) and HBV. The framework supports improvements in sexual health and wellbeing and addresses the impact of blood borne virus infection in Scotland. The framework seeks to strengthen and improve multi-agency partnerships to address the five high-level outcomes:

  1. Fewer newly acquired BBVs and STIs; fewer unintended pregnancies.
  2. A reduction in the health inequalities gap in sexual health and BBVs.
  3. People affected by BBVs lead longer, healthier lives.
  4. Sexual relationships are free from coercion and harm.
  5. A society whereby the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and BBVs are positive, non-stigmatising and supportive.  

Sexual health and blood borne virus (SHBBV) open access data portal

The Sexual Health and Blood Borne Virus (SHBBV) open access Data Portal contains a wealth of information together in a format which allows users to easily monitor Scotland’s progress nationally and locally against the Scottish Government’s SHBBV framework outcomes.