Hepatitis B - NICE guideline

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The Hepatitis B quality standard guideline covers testing, diagnosis and management of hepatitis B in children (from birth), young people and adults.

Why this quality standard is needed

Hepatitis B is a viral infection that is transmitted by contact with the blood or body fluids of an infected person and is also transmitted perinatally from mother to child (vertical transmission). Some adults have an acute infection, in which the virus is cleared from the body naturally, whereas other people develop a chronic infection. Rates of progression from acute to chronic infection vary according to age at the time of infection. About 85% of hepatitis B infections in newborn babies become chronic compared with 4% in adults.

The UK has been classified as a low incidence and prevalence country for hepatitis B infection. However, mortality and morbidity associated with chronic hepatitis B could be prevented in a significant number of people (Standards for local surveillance and follow up of hepatitis B and C [Health Protection Agency]). There is considerable uncertainty over the number of people with chronic hepatitis B infection in the UK. In 2002, the Department of Health estimated that chronic hepatitis B affected 180,000 people in the UK. Other estimates put the figure for the UK as high as 325,000 (Hepatitis B Foundation UK 2007).

About 85% of hepatitis B infections in newborn babies become chronic compared with 4% in adults.

Migrant populations are now the main focus for identifying and testing for hepatitis B infection in the UK. It is estimated that 95% of people with newly diagnosed chronic hepatitis B infection are immigrants, who predominantly become infected in early childhood in the country of their birth. Most of the remaining 5% of people with UK-acquired chronic hepatitis B infection acquired it either through horizontal transmission between adults or through vertical transmission from mother to child.

The quality standard is expected to contribute to improvements in the following outcomes:

  • mortality from liver disease attributable to hepatitis B virus
  • vertical transmission from hepatitis B surface antigen (HBsAg)-positive mother to child: babies identified as being hepatitis B-positive after 1 year
  • enabling people to live better with this condition.

Endorsing bodies

This Quality standard is endorsed by NHS England as required by the Health and Social Care Act (2012).

Supporting organisations

A number of organisations recognise the benefit of this Quality standard in improving care. They work with NICE to promote it to commissioners and service providers:

You can read the guideline on NICE's website.