Hepatitis B virus is around 50 to 100 times more infectious than HIV. Hepatitis B can be transmitted through unprotected sex, sharing needles, or through direct contact with the smallest amount of blood.
Infection is often symptomless but can eventually lead to serious liver disease, including cirrhosis and liver cancer. While a blood test is the only way to diagnose it, there is a free vaccine available to protect those at high risk.
Since 2013 we have seen a number of acute hepatitis B clusters across England, associated with a particular strain of the virus. This cluster has involved men who engage in risky sexual behaviour, such as having casual, unprotected, anonymous sex with other men.
Some of these men do not necessarily consider themselves as being gay or bisexual and so do not identify themselves as ‘higher risk’ or seek sexual health advice. This presents a challenge for the health system as it is difficult for healthcare workers to encourage these men to take up free hepatitis B vaccination. It is also difficult to raise awareness among this group of the need for safer sex, including condom use and regular screening for sexually transmitted infections (STIs) including hepatitis B and HIV.
To address this, some local areas have established outreach services to advise on STI prevention and testing, to provide condoms, and to offer hepatitis B vaccination to those at risk. But there is a role for all health professionals and commissioners in tackling hepatitis B.
What can commissioners and health professionals in England do to tackle hepatitis B?
Healthcare professionals should consider hepatitis B testing and recommend vaccination for people who report high risk sexual behaviour or present with other STIs.
If acute (or chronic) hepatitis B is diagnosed, the patient should receive specialist care and, if thought to be sexually transmitted, be referred to GUM/sexual health services for contact tracing and testing for other sexually transmitted infections.
Commissioners of sexual health services should ensure that such services offer vaccination to those at higher risk in line with national guidance from the Green Book on Immunisation against Infectious Disease, particularly among MSM and others who have multiple sexual partners.
Monitoring levels of hepatitis B vaccination uptake is important to understand if they are reaching those most at risk in sexual health services. GUM clinics should also report acute hepatitis B cases to local health protection teams to ensure local clusters are identified and acted upon quickly.
Surveillance of acute hepatitis B is necessary to prevent and control its spread. Public Health England will continue to monitor emerging issues and support local action, and has produced a factsheet for professionals to download and display in health settings to help raise awareness of the risks and encourage people to get vaccinated against hepatitis B.
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