Hepatitis B Surveillance in Ireland

 

Hepatitis B vaccination programmes working to eliminate hepatitis B in children

The Health Protection Surveillance Centre (HPSC) has published the , in advance of World Hepatitis Day 2024.

Notification data indicate that antenatal screening for hepatitis B, with appropriate care for mothers to prevent infection in infants, and universal hepatitis B vaccination as part of the primary immunisation schedule are working. There have been no notifications of hepatitis B in children under 16 born in Ireland in the past five years.

The notification rate for acute cases (recent infections) of hepatitis B was low in Ireland in 2023, similar to EU/EEA countries in 2022.

Background

Hepatitis B is a viral infection, which causes inflammation of the liver. Severe acute hepatitis can lead to liver failure, but this is very rare, and most people recover from acute illness without complications. A small proportion of people infected as adults (<10%) and up to 90% of those infected with hepatitis B as infants develop chronic (long-term) infection. Chronic infection can cause cirrhosis and liver cancer after many years of infection. Antiviral treatments are available that are very effective in reducing liver disease progression and improving survival.

Hepatitis B is transmitted through contact with blood, semen, or other body fluids from an infected person, or from an infected mother to her baby during delivery.

Hepatitis B infection is a vaccine preventable disease. Universal infant vaccination was introduced in Ireland in 2008. Vaccination is also recommended by the National immunisation Advisory committee (NIAC) for groups at higher risk of infection. These include people who inject drugs, sexual and household contacts of cases, gay, bisexual and other men who have sex with men, individuals who change sexual partner frequently, travellers to areas with a high or intermediate prevalence of hepatitis B and healthcare workers.

Key Points

• The notification rate for acute cases (recent infections) of hepatitis B was low in Ireland in 2023, 0.3 per 100,000 population (14 cases) similar to EU/EEA overall in 2022 ECDC hepatitis B AER 2022
• Most cases of hepatitis B in Ireland are chronically infected at notification: In 2023: 98% were chronic infections and 2% were acute
• There was a 16% increase in notification rate (2023 v 2022) for chronic cases (11.1 per 100,000 population v 9.5 per 100,000 population)
• The higher hepatitis B notification rates in Ireland in 2022 and 2023 should be interpreted with caution. Chronic cases may have been infected for years or decades without symptoms before being detected in targeted screening programmes among groups at higher risk of infection
• Country of birth data (available for 54% of chronic cases in 2023) show that 2% were born in Ireland, with most cases notified in persons from endemic countries with higher rates of hepatitis B infection: 37% in eastern or central Europe, 30% in sub-Saharan Africa and 26% in Asia
• Ireland is likely to have achieved some of the WHO 2030 targets to eliminate viral hepatitis as a public health threat. More work is needed to improve monitoring of hepatitis B prevention and mitigation measures so that Ireland can demonstrate its progress to reach the goal of making hepatitis B a rare disease and no longer a public health threat.

 Public health implications and actions

• Notification data show that infant and childhood vaccination programmes are very successful. They are preventing infection in children, an important achievement, as those who become infected in early childhood are likely to develop chronic infection. There have been no notifications of hepatitis B in children under 16 years, who were born in Ireland, in the past five years
• Vaccination is also recommended by NIAC for those at higher risk of infection.

• In addition to vaccination, other harm reduction interventions reduce the risk of spreading infection.
• do not share needles, tooters or other drug paraphernalia
• use condoms to prevent sexual transmission
• Hepatitis B testing in settings attended by those at higher risk of infection, for example addiction centres, STI clinics, and for people from countries where hepatitis B infection rates are higher, are important
• Most chronic cases of hepatitis B in Ireland are in people coming from an endemic country. For these cases, linkage to care and, if clinically appropriate, antiviral treatment to suppress viral replication and reduce the risk of disease progression, are key interventions.

Resources

Primary childhood vaccines (includes hepatitis B) at Immunisation Schedule - HSE.ie

Adult hepatitis B vaccines at Hepatitis B - HSE.ie

• HSE Addiction services
• HSE sexual health and wellbeing
• Provides free supports for preventing sexually transmitted infections (STIs) including condoms and vaccinations
• STI testing, including hepatitis B, is provided free of charge in public sexual health or GUM clinics
• National free home STI testing, including hepatitis B for unvaccinated gbMSM, is also available from the HSE
• Resources for gbMSM are available at Hepatitis B - Man2Man.ie
• Information on where to access addiction support, including free screening for hepatitis B, hepatitis C and HIV and vaccination against hepatitis A and B
• https://drugs.ie/ provides information about drugs, advice on harm reduction and information on treatment
• Bloodborne virus screening is available in a range of addiction treatment settings

HSE Intercultural health

• Health services include voluntary communicable disease screening for International Protection Applicants and Beneficiaries of Temporary Protection

• Safetynet primary care https://www.primarycaresafetynet.ie/ provides medical services, including infectious disease testing to those without access to healthcare, including homeless people, people who use drugs and migrants