Surveillance of hepatitis B in Scotland
Update to 31 December 2023

About this release

This release by Public Health Scotland (PHS) provides an update on hepatitis B virus (HBV) surveillance activities across Scotland over a ten-year period from 2014 to 2023 and also presents evidence on progress towards the World Health Organization (WHO) elimination targets for hepatitis B where data are available.

Hepatitis B is a bloodborne infection caused by the hepatitis B virus (HBV) that infects the liver and can lead to liver damage. Transmission of HBV is via parenteral exposure to infected blood or body fluids most often through sexual transmission, blood-to-blood contact and perinatally from mother to child at birth. It is a vaccine preventable infection and can cause both acute and chronic infection.

Main points

Impact of the COVID-19 pandemic

The COVID-19 pandemic had a major impact on the delivery of HBV prevention, testing/diagnosis and treatment services, but there are now clear signs of recovery.

• The number of people tested for HBV surface antigen (and/or core antibody in sexual reproductive health (SRH) clinics) in Scotland was 11% higher in 2023 compared to 2019 highlighting the recovery made since the pandemic. Apart from prisons (where testing numbers were higher in 2017 compared to 2023), HBV testing numbers across all other referral settings have surpassed pre-pandemic levels.
• A total of 518 individuals were newly diagnosed HBV positive with acute or chronic infection in 2023, which was the highest total since 2014 (456).
• In 2023, a total of 22 probable acute HBV infections were diagnosed, with between 19 to 30 probable acute infections reported each year from 2014 to 2023. An increase of probable acute diagnoses among women aged under 30 years old was identified in 2023, and consequently the age and sex distribution of the total cases in 2023 was different to previous years, when most diagnoses were among males and those aged 50 years or older.
• In 2023, a total of 496 chronic HBV infections were newly diagnosed. An appreciable proportion of these diagnoses were identified in the general practice setting (46%); among males (63%); in those aged 30-49 years (64%); and among people residing in the most deprived areas (35%). The distribution of diagnoses was higher in older age groups ≥30 years compared to previous years, but all other population characteristics remained consistent with previous years.
• As of December 2023, a total of 5,206 individuals are estimated to be diagnosed and living with chronic HBV infection in Scotland. Most individuals with a current chronic HBV infection reside in the Greater Glasgow and Clyde and Lothian NHS Board areas (60%); are male (57%); aged 30-49 age group (55%); and reside in the most deprived (SIMD quintile 1) area (34%).
• Among babies born to hepatitis B infected mothers in 2023, the uptake of the hepatitis B vaccine at birth and at 12 months of age was 95% and 80%, respectively. The uptake of the hepatitis B vaccine was 52% in people who inject drugs surveyed in 2022-2023 which was the lowest uptake compared to previous years dating back to 2008.
• Between 2014 to 2023, among those diagnosed with chronic HBV, there have been a total of 91 liver-related deaths which equates to <1 liver-related death per 100,000 persons per year in Scotland across this ten-year period indicating that Scotland is meeting the WHO mortality target of 4 or less deaths per 100,000 persons by 2030.

Achieving and sustaining elimination

Achieving and sustaining elimination of HBV will be influenced strongly by service delivery in key settings where high risk individuals are likely to present. Current data suggest testing opportunities could be improved.

• Testing levels among the antenatal cohort have remained reasonably stable from 2019-2023 and do not appear to have been impacted by the COVID-19 pandemic. The number of women tested (49,516) in 2023 was slightly smaller than the average number of women tested between 2019-2022 (50,740).
• Despite reaching its highest level to date, only 1 in 4 (25%) admissions to the Scottish prison establishment from the community were tested for HBV surface antigen within six weeks of admission in 2023. The 2023 testing levels exceeded pre-pandemic levels, but overall levels remain low.
• Community drug services reported high levels of ever testing (86%) among people prescribed opioid agonist therapy (OAT) in 2023, but test uptake in the year prior to the most recent OAT prescription was low, at 36%.

Background

In 2016, the WHO published a global health sector strategy providing a roadmap to eliminate hepatitis B as a public health problem by 2030. Scotland is committed to achieving the WHO targets which include reducing the annual number of new HBV infections to 2 per 100,000 people, diagnosing 90% of those infected, treating 80% of those diagnosed and eligible for treatment, and reducing the annual number of HBV-related deaths to 4 per 100,000 people.

In November 2023, the Scottish Government published a Sexual Health and Blood Borne Virus (SHBBV) Action Plan which includes an action to review the epidemiology and data collection of HBV in Scotland to help reduce HBV-related illness and deaths. Public Health Scotland (PHS) has thus sought to re-establish surveillance of hepatitis B infection and its outcomes with HBV testing in various key settings such as prisons and drug services.

Further information

The next release of this publication will be 2026/27 date to be confirmed.