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Watchdog issues standard to cut spread of hepatitis B

NICE guidance says testing should be offered in GP practices

Adrian O'Dowd

Tuesday, 29 July 2014

NICE has published a new quality standard for hepatitis B designed to help reduce the spread of the infection by focusing on testing and vaccination for people who are at increased risk.

Testing should be offered in a range of settings, said NICE, such as at GP practices including new registrations, prisons or immigration removal centres, drug services, and sexual health and genitourinary medicine clinics.

Currently, it is estimated there are around 325,000 people in the UK with chronic hepatitis B, which is transmitted by contact with the blood or body fluids of an infected person and also from mother to child.

NICE said migrant populations were 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 often 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 got it through transmission between adults or passed on from mother to child.

NICE said other high-risk groups included people who inject drugs, men who have sex with men, people who may have been exposed to sexually acquired infections, and among prisoners where there is a growing problem.

More effort was needed to focus on the problem, said NICE, which highlighted information given earlier this year by health minister Norman Lamb who said the number of prisoners diagnosed with chronic forms of the virus has risen from just 22 in 2010 to 109 in 2013.

Figures compiled by Public Health England also show that over the same period, the number of vaccinations against the virus in prisons has fallen, despite the prison population increasing to a record 85,000.

NICE said that in 2010-11, 109,827 doses of the vaccine were administered, but this fell to 74,785 in 2012-13.

The new quality standard, consists of seven statements designed to:

  • reduce mortality from liver disease attributable to hepatitis B
  • limit the spread of the infection
  • enable people who already have hepatitis B to live better with the condition.

The standard recommends offering testing and vaccination to children, young people and adults in high risk groups, while also recommending that pregnant women who are identified as hepatitis B surface antigen (HBsAg)-positive at antenatal screening are assessed by a specialist within six weeks of receiving the screening test result.

People who test positive for hepatitis B surface antigen (HBsAg) should be referred to specialist care for further assessment as chronic hepatitis B infection affects the liver and can cause serious health problems if left untreated, says NICE.

The standard also covers people who already have hepatitis B and recommends they and their family members or carers, are offered a personalised care plan outlining the proposed treatment and long-term management of their infection.

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