Surveillance of hepatitis B in Scotland
Update to 31 December 2024 - progress on elimination of hepatitis B as a major public health concern

About this release

This annual release by Public Health Scotland (PHS) follows the hepatitis B virus (HBV) surveillance report published in June 2025 and includes the most up-to-date surveillance data available up to 31 December 2024. The report also presents evidence, where available, on progress towards the World Health Organization (WHO) hepatitis B elimination targets as set out in the Background section below.

Main points

The latest surveillance findings, up to and including 2024, show that Scotland has achieved several WHO hepatitis B elimination targets:

• Infant vaccination: 94.7% coverage for timely birth-dose vaccination among at-risk infants (i.e. infants born to mothers with hepatitis B infection) and 94.4% coverage for third-dose routine childhood hepatitis B vaccination in 2024.
• Antenatal screening: 97% of eligible women received hepatitis B surface antigen (HBsAg) testing in pregnancy in the financial year 1 April 2023 to 31 March 2024, exceeding the WHO target of ≥90%.
• HBV-related mortality: an average of 0.17 liver-related deaths per 100,000 population annually among people diagnosed with chronic HBV infection during 2015-2024, well below the WHO target of ≤4 per 100,000.

Important evidence gaps remain:

• Data on all newly acquired HBV infections, including undiagnosed infections, are not available, although the rate of probable acute diagnoses (0.27 per 100,000 population) in 2024 was below the WHO target (≤2 per 100,000).
• National data are currently insufficient to assess progress towards WHO targets for: reducing chronic HBV infection among children aged under 5 years; achieving a high proportion of infected individuals diagnosed; achieving high treatment coverage among those diagnosed; and reducing mother-to-child transmission of HBV.

Analysis of hepatitis B surveillance data in Scotland revealed the following additional findings:

• The overall number of HBV tests is increasing. In 2024, 124,084 individuals were tested for HBV infection, the highest annual number recorded in the past ten years.
• However, HBV testing coverage remains low for key settings and populations (prisons and people receiving opioid agonist therapy (OAT)). In 2024 only 20% of people were tested within six weeks of prison entry and 36% of those prescribed OAT had an HBV test recorded in the previous year.
• The overall number of HBV diagnoses is increasing. In 2024, 531 people were diagnosed with chronic HBV infection, the highest number in the last 10 years, while 15 probable acute infections were reported.
• As of 31 December 2024, an estimated 5,656 people ever diagnosed with chronic HBV infection were known to be alive and living in Scotland and had engaged with services in recent years (i.e. they were not known to have died, migrated or been lost to follow-up).
• In 2024, among people ever diagnosed with chronic HBV infection, there were 10 first-time hospitalisations and five deaths due to decompensated cirrhosis (DC) and/or hepatocellular carcinoma (HCC), both below the respective 10-year averages of 12.2 and 9.2.

Delivery strategy

To continue progress towards hepatitis B elimination, the Scottish Health Protection Network (SHPN) can support national and local partners in delivering the following priorities:

• Integrating hepatitis B elimination activities with wider HIV and viral hepatitis prevention, testing and care programmes, alongside hepatitis B vaccination initiatives to improve vaccine uptake among priority populations.
• Maintaining and strengthening essential surveillance to monitor and evidence progress towards elimination, including linked data sources and routine monitoring of new infections, treatment and care outcomes.
• Addressing key surveillance gaps by: 1) delivering the Needle Exchange Surveillance Initiative (NESI) survey in 2027-28, subject to funding; 2) supporting modelling and analytical studies, including updated prevalence estimates, in collaboration with academia; and 3) rolling out the Viral Hepatitis module within the National Sexual Health (NaSH) System across NHS Boards during 2026/27 to capture hepatitis B treatment and care data.
• Ensuring surveillance data are accessible, timely and actionable to support service improvement and targeted interventions.
• Expanding hepatitis B testing through initiatives such as emergency department opt-out testing, to improve case finding, reduce missed diagnoses and accelerate progress towards hepatitis B elimination.
• In the longer term, a structured review process, similar to the Re-engagement with Hepatitis C Diagnosed in Scotland (RECAST) initiative, could strengthen data validation, identify gaps in prevention, testing and care pathways, and provide additional assurance of progress towards hepatitis B elimination beyond 2030.
• Strengthening efforts to identify and address missed opportunities for HBV diagnosis, treatment and prevention through enhanced contact tracing, assertive outreach, and multidisciplinary cohort reviews, including reviews of individuals with late diagnosis or HBV-related harm.

Background

In 2024, an estimated 240 million people were living with chronic hepatitis B worldwide, with an estimated 1.1 million deaths, primarily due to severe liver disease. To address the global burden of viral hepatitis, in 2016 WHO launched its global strategy to eliminate viral hepatitis as a public health threat by 2030. This was followed by updated country guidance in 2023 on the targets and indicators required for validation of elimination. Hepatitis B elimination requires reduced transmission of new infection, reduced HBV-related morbidity and mortality, equitable access to prevention, testing and treatment and sustained programme with robust surveillance.

Scotland is considered a low-prevalence country, with an estimated 0.2% of people aged ≥15 years living with chronic hepatitis B in 2009. The Scottish Government’s Sexual Health and Blood Borne Virus (SHBBV) Action Plan 2023-2026 identifies hepatitis B as a public health priority in Scotland. In 2026, Public Health Scotland (PHS) published the second iteration of the Data Monitoring Plan (DMP), incorporating WHO hepatitis B elimination targets and indicators to monitor progress. The 2027-2032 SHBBV Action Plan will include hepatitis B.

Further information

The next release of this publication will be 2027/28 date to be confirmed.