HPR volume 16 issue 3: news (8 March 2022)
Updated 30 December 2022
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Hepatitis C in England annual report
Steady reductions in the prevalence of chronic hepatitis C (HCV) infection, and in hepatitis-C-related mortality, have been achieved in England in recent years.
According to the UK Health Security Agency’s (UKHSA) latest annual report, Hepatitis C in England 2022 report (data to end of December 2020), the estimated prevalence of chronic HCV infection in the general population in England declined 37% between 2015 (when an estimated 129,000 people were living with the infection) and 2020 (when the figure was 81,000).
HCV-related mortality also continued to fall, dramatically, in England: from 482 to 314 between 2015 and 2020 – far exceeding the World Health Organization (WHO) target for a mortality reduction of 10% over that period. Indeed, the most recently promulgated WHO ‘absolute impact target rate’ for HCV-related mortality – an annual rate of less than 2 per 100,000 population to be reached by 2030 – has already been achieved in England.
However, as in previous years, the new annual report notes that encouraging trends in mortality and prevalence of chronic disease have most likely been achieved largely through increased HCV treatment rather than improved prevention of infections.
The report notes that monitoring incidence of infection remains a challenge as incident HCV infection is difficult to measure directly: ‘It is difficult to select a sentinel population of people who inject drugs [who are the main driver of HCV transmission in England] for monitoring that is representative of PWID as a whole as not all PWID are engaged with services or healthcare …. ‘.
Latest modelled estimates suggest a decrease in prevalence of chronic HCV infection among the general population of 37.2% between 2015 and 2020; and among PWID, provisional data suggest that a relative percentage fall in prevalence of chronic HCV infection of 39.7% was observed between 2015 and 2020, the annual report notes.
But data from the UKHSA’s annual unlinked anonymous monitoring survey of HIV and viral hepatitis among people who inject drugs (UAM-PWID) ‘currently provides little convincing evidence of a fall in HCV incidence since 2015’, the report states. ‘This data provides further support to the view that falls in chronic HCV prevalence among PWID are more likely to be the result of increased HCV treatment rather than improved prevention of infections due to improved harm reduction. … Preliminary estimates of reinfection following treatment, using linked national testing and treatment surveillance data, suggest conservative reinfection rates of 8.1% in England, which are higher among those with a known history of injecting (10.9%).’
Impact of COVID-19
The annual report acknowledges the impact of the COVID-19 pandemic on HCV surveillance, testing, prevention and treatment activity.
‘[T]he COVID-19 pandemic poses a serious threat to the UK’s ability to (i) meet, and (ii) demonstrate that we have met, WHO HCV elimination goals. This includes, in particular, the impact on service delivery and access for key populations, plus the quality and timeliness of surveillance data that allows us to monitor changes in service capacity and effectiveness, and our ability to monitor progress to elimination.
‘Previous analyses …. highlighted a reduction in testing for viral hepatitis in drug services, prisons, general practice and SHSs, and also in the number of individuals initiating HCV treatment, which were 30% lower, between January and August 2020, than in the same period in 2019. Whilst an improvement in testing, diagnoses and treatment initiation has been observed following the easing of national lockdown restrictions, this only reflected a partial recovery in service provision and demand, as numbers of tests, diagnoses, and treatment initiations in the summer of 2020 remained considerably lower than in the corresponding months in 2019’.
At the same time, the annual report notes that, ‘Whilst there has been a loss of capacity across all UK public health agencies as staff have been diverted to the COVID-19 response, COVID-19 has also accelerated the development of innovations in service delivery, including telemedicine, expanded community outreach testing and linkage into care. While many of these innovations have enabled access to services during the COVID-19 response, there is a critical need to evaluate the impact of these changes on health inequalities, since HCV predominantly affects socially disadvantaged and/or marginalised groups including PWID, those who experience homelessness, and populations who have close links to countries where HCV is endemic, who already experience poor health outcomes’.
Additional resource
A 40-slide PowerPoint slide-set presentation is available for download from the 2022 report host page; this covers: the report’s conclusions, key data charts and graphs, infographics, and references.
New Lyme disease indicator and seasonal tick-bite reminder
A new analysis of data on acute laboratory-confirmed cases of Lyme disease reported to UKHSA’s Rare and Imported Pathogens Laboratory in England has been added to the Office for Health Improvement and Disparities (OHID) Fingertips database of selected health protection indicators.
The new indicator presents data on annual incidence, and rates per 100,000 population, of acute cases of Lyme disease infection in 2021, broken down by UKHSA Centre and by local authority; the trend in incidence rate between 2017 and 2020 is also shown in each case. The overall incidence in England against a deprivation scale is also presented.
The new indicator was published on 1 March – ahead of the expected, seasonal springtime increase in case reporting – in response to public interest about the infection in high-incidence parts of the country. It should enable local authorities, health protection teams and other services to provide appropriate tick awareness and Lyme disease prevention guidance locally.
The guidance is available from the UKHSA Tick bite risks and prevention of Lyme disease: resources webpages on GOV.UK and the corresponding NICE Lyme disease guidance resource.
A number of caveats apply to the data underpinning the new indicator. For example, only laboratory-confirmed cases are covered and the indicator likely underestimates the true incidence of acute infection in England as Lyme disease is not a notifiable infection.
Also, awareness of tick bites and Lyme disease may vary across the country; in areas where there is greater awareness of the potential risks, individuals may be more likely to seek medical attention for symptoms and clinicians may be more likely to suggest Lyme disease as a differential diagnosis.
A summary slide-set, Health Protection Profile: Acute Lyme disease laboratory confirmed incidence rate per 100,000 population, is available illustrating the different incidence rates across the country.
Green Book chapter 14a updated
Chapter 14a of the UKHSA’s ‘Green Book’ Immunisation against infectious disease, dedicated to COVID-19 disease, was republished on 28 February, bringing it up to date with current arrangements for the administration of the 4 vaccines authorised for supply in the UK, including their dosing and scheduling, and the state of knowledge about their effectiveness and safety.
In particular, new information has been included about:
- the forthcoming ‘non-urgent’, one-off programme for all children aged 5 to 11 years (even those not in a clinical risk group), as recently recommended by the JCVI
- the spring 2022 booster campaign for over-75 year-olds (and some younger risk groups), and expectations for an autumn 2022 booster programme also recently recommended by JCVI
- clarification of the management of individuals with a history of allergic reactions.
Infection reports in this issue
Laboratory confirmed cases of measles, rubella and mumps, England: October to December 2021.
Laboratory reports of hepatitis C in England and Wales: July to September 2020.