18 December 2012

Greater Awareness of Hepatitis B and C Needed

Greater awareness of hepatitis B and C is needed so that more people who are at risk can be tested and treated for the viruses, according to latest guidance from NICE.

Hepatitis B and C mainly affect the liver, and are the second most common cause of liver disease in the UK after alcohol misuse.

Hepatitis B is transmitted by contact with infected blood. It arises primarily from injecting drug use, heterosexual contact with someone who is infected, travel to countries of intermediate or high endemicity, homosexual contact, and contact with someone in the same household who is a carrier and mother-to-child transmission.

It is estimated that around 180,000 are affected by hepatitis B in the UK. Around 95 per cent of people with new chronic hepatitis B are migrants, most of whom acquired the infection in early childhood in their country of birth.

Hepatitis C is also a blood-borne viral infection that is transmitted through contact with infected blood. Around 216,000 people in the UK have chronic hepatitis C, and of these 87 per cent are current or past injection drug users. Almost half of the rest are from South Asian descent.

HIV-positive men who have sex with men are also at increased risk of hepatitis C infection.

Early diagnosis and treatment can clear infection, and can reduce the risk of long term complications such as cirrhosis and liver cancer.

In its new pathway on ways of promoting and offering testing for those at increased risk of hepatitis B and C, NICE says that greater awareness should be raised among the general population, and among those who are at increased risk of the viruses.

The knowledge and skills of healthcare professionals and others providing services for people at increased risk should be developed through ongoing training and education programmes.

People should be tested for hepatitis B and C in a range of settings, including primary care, prisons and youth offender institutions, immigration removal centres and drugs services.

NICE also recommends that Public Health England and primary care practitioners should take overall responsibility for tracing the close contacts of people with confirmed and chronic hepatitis B infection.

Furthermore, locally appropriate integrated services should be commissioned for testing and treatment of hepatitis B and C.

Professor Mike Kelly, NICE Director of Public Health, said: “There are effective treatments for hepatitis B & C which can significantly reduce the risks of developing long-term complications, such as cirrhosis and liver cancer.

“However, what seems to be a general ignorance about the diseases and the potentially serious consequences of not being tested and treated is contributing to both a lack of offer of testing by services and the low uptake of testing among those at increased risk of infection. It is also contributing to the stigma surrounding hepatitis B and C.

Professor Kelly added: "Recommendations in this guidance therefore encompass general awareness raising for the population as a whole, for those at increased risk of infection and for healthcare professionals and others providing services for those at increased risk of hepatitis B and C.

"This is aimed at addressing any misconceptions about the risk of hepatitis B and C that can act as barriers to testing, including the belief that treatments are not effective and that treatment is not needed until the illness is advanced."

Will Irving, Professor and Honorary Consultant in Virology, University of Nottingham and Nottingham University Hospitals NHS Trust, and member of the Programme Development Group, added: "It is estimated that around half of the individuals living in the UK with chronic hepatitis B or C infection are unaware of their diagnosis, but they are at risk of developing serious complications of their infection.

"This timely and highly relevant NICE guidance is aimed at finding ways of identifying those individuals, and getting them to clinic for appropriate assessment, so they can be offered highly effective therapies before their disease is too advanced."

A range of implementation tools have been created to help support the use of this pathway, including implementation advice, a costing report and a costing template.