Laboratory reports of hepatitis A infections in England and Wales: July to September 2021
Published 23 January 2024
Applies to England and Wales
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A total of 81 laboratory reports of new patients with hepatitis A were reported to the UK Health Security Agency (UKHSA) from the Second Generation Surveillance System during the third quarter of 2021 (July to September 2021) (see table 1 and figure 1).
This total was calculated after:
- exclusion of patients with samples sent to the Virus Reference Department (VRD) that were not confirmed as having had a recent hepatitis A virus infection (‘corrections’), as well as
- inclusion of additional patients confirmed by VRD
This was a 1% decrease on the reports in the second quarter of 2021 (n=82) (figure 2); 72 cases were reported through SGSS, after removing the duplicates and samples not confirmed to be positives by VRD, and before including the additional 10 confirmed cases identified by the VRD (figure 1).
Table 1. Laboratory reports of hepatitis in England and Wales, July to September 2021
| Age group | Females | Males | Total |
|---|---|---|---|
| Less than 1 year | 0 | 0 | 0 |
| 1 to 4 years | 6 | 2 | 8 |
| 5 to 9 years | 7 | 3 | 10 |
| 10 to 14 years | 2 | 3 | 5 |
| 15 to 24 years | 6 | 8 | 14 |
| 25 to 34 years | 1 | 5 | 6 |
| 35 to 44 years | 4 | 5 | 9 |
| 45 to 54 years | 3 | 5 | 8 |
| 55 to 64 years | 2 | 4 | 6 |
| 65 years and over | 9 | 6 | 15 |
| Total | 40 | 41 | 81 |
Note: Since Q1 2020, these reports have presented the number of cases excluding false positives and including additional cases identified by the VRD. Hence, numbers are not directly comparable to quarters prior to Q1 2020. It should be noted that false positives are more likely in older age groups.
The London region accounted for 24% (n=19) of reports, followed by 16% (n=13) from both East of England and West Midlands. Age group and sex were well reported (no missing values, Table 1): there were 15 (19%) reports among those aged over 65, followed by 14 (17%) among those in the 15 to 24 years age group. Males and females accounted for a similar number of reports (n=41 and n=40, respectively).
The following flowchart shows there were 106 reports of new patients with hepatitis A reported through SGSS. There was 1 correction (laboratories informing the VRD that reports were false positives or due to reporting issues, or quality controls), leaving 105 laboratory reports of new patients through SGSS.
Samples from 68 patients were sent to VRD for confirmation and 34 cases were not confirmed. After excluding non-confirmed cases, 71 cases remained. Ten cases were confirmed in VRD but not reported through SGSS, giving a total of 81 new cases identified through SGSS or VRD in Q3 2021.
Figure 1. Flowchart of laboratory reports of hepatitis A, by confirmation status (England and Wales), July to September 2021
Figure 2. Laboratory reports of hepatitis A by age and sex in England and Wales, July 2007 to September 2021
Notes:
- All figures are provisional and subject to change as records are updated.
- From Q1 2020, the central number of cases presented excludes false positives and includes additional cases identified by VRD. Hence, numbers are not directly comparable to previous quarters.
- It should be noted that false positives are more likely in older age groups.
Reference laboratory confirmation and phylogeny of hepatitis A infections
Of the 71 patients notified as having acute hepatitis A virus (HAV) infection during the third quarter of 2021, 35 had samples forwarded to the Virus Reference Department for genotyping. In addition, 10 patients were confirmed to have acute HAV infection that had not been reported through the laboratory reporting system although all the English cases were recorded in HPZone.
A total of 45 patient samples could be genotyped over this period: 11 were genotype IA (24%), 21 were genotype IB (47%) and 13 were genotype IIIA (30%). Of these samples, 23 were associated with travel (51%), 20 had no travel history (44%) and 2 had no information (4%).
This information is presented below as a phylogenetic tree (figure 3) where each sequence is represented by a dot followed by the patient region, and the week of sampling in brackets.
Figure 3. Phylogenetic tree of genotype IA, IB, and IIIA sequences July to September 2021 (n=45)
