Hepatitis B transmission from mothers to babies has been eliminated in England, thanks to universal screening and targeted infant immunisation.
An estimated 206,000 people in England live with chronic hepatitis B, a viral infection that affects the liver and is passed on through blood, semen and vaginal fluids. One of the commonest routes of infection is through pregnant women with hepatitis B passing it onto their babies around the time of birth. If untreated, it can lead to serious liver damage including cirrhosis, cancer and death.
Since the late 1990s all pregnant women in England have been offered an antenatal blood test for hepatitis B. For those who test positive, their babies are offered a course of hepatitis B vaccination starting at birth. In 2017 the UK introduced universal infant hepatitis B immunisation within the six-in-one vaccine at eight,12 and 16 weeks of age. In 2021 quarterly coverage for these three doses was 91 to 92 per cent, exceeding the WHO target of 90 per cent.
As a result, England has now met the World Health Organisation criteria for elimination of mother to child transmission – a key milestone in its strategy for the elimination of viral hepatitis as a public health threat by 2030.
Pamela Healy OBE, Chief Executive, British Liver Trust, said: “It is excellent news that England has met the ambitious target set by the World Health Organisation and eliminated the transmission of Hepatitis B between mothers and children. The challenge now is for us to find the thousands of people living in England who have hepatitis but are completely unaware of it. Both hepatitis B and hepatitis C usually have no symptoms in the early stages, so it is vital to get tested if you have ever been exposed. To find out if you are at risk, take the British Liver Trust’s simple questionnaire."
The majority of cases of hepatitis B are in migrants who have acquired infection overseas in endemic countries before arriving in the UK. Communities at higher risk of getting Hepatitis B in the UK also include people who inject drugs, gay, bisexual and men who have sex with men who are having sex with multiple partners, sex workers and people detained in prisons or immigration detention centres.
Progress towards eliminating hepatitis C by 2030 in England continues. It is passed on in similar ways to hepatitis B, but there is no vaccine. Some 92,900 people were living with hepatitis C in the UK at the end of 2021 – a decline of 47.2 per cent since 2015. Thanks to increased testing and curative treatments, the UK is currently on track to achieve the 2030 WHO elimination goal for Hep C.
Dr Sema Mandal, Deputy Director for Blood Borne Viruses at the UK Health Security Agency said: “With the elimination of mother to child transmission of hepatitis B, very low hepatitis related death rates and continued reduction of chronic hepatitis C levels, we are on our way to our goal of eliminating hepatitis B and C in England by 2030.
“Testing, vaccination for hepatitis B and curative treatments for hepatitis C, have all played a significant role in driving down these infections.
“Many people are unaware they have hepatitis because the viruses can be symptomless – meaning they aren’t getting the treatments they need and are possibly passing the virus on to others without knowing.
“We continue to urge all those who have ever injected drugs, gay, bisexual and men who have sex with men, sex workers and people who have immigrated to the UK from countries where hepatitis B or C is common to come forward for free testing, treatment or hepatitis B vaccination.”
Secretary of State for Health and Social Care Steve Barclay said: “We are paving the way for the elimination of hepatitis B and C, with England set to be one of the first countries in the world to wipe out these viruses.
“Deaths and prevalence of hepatitis C have fallen consistently thanks to improvements in diagnosis and access to highly effective treatments that are available on the NHS.
“This is another example of how we’re at the forefront of tackling serious diseases, through swiftly procuring the best treatments and tackling inequalities through testing and vaccination.”
A new initiative to provide testing for HIV, hepatitis B and hepatitis in emergency departments has been successful in finding many patients who were previously unaware that they had been infected. The British Liver Trust is campaigning with other charities to call on the government to extend this programme of work. You can support this campaign by signing the open letter here.