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Dramatic fall in chronic hepatitis C cases in England

The latest data from the UK Health Security Agency (UKHSA) show that deaths due to the hepatitis C virus are at their lowest level in 10 years.

The Hepatitis C in England report found that the number of people aged over 16 in England living with chronic HCV has declined by 51.6% since 2015, from an estimated 129,400 to 62,600 in 2022. 

The decline in people living with the virus is largely due to increased testing and improved access to treatment. Substantial developments have been made to increase the numbers of individuals being tested for hepatitis C, including through NHS England’s opt-out bloodborne virus testing programme in Emergency Departments and an increase in people accessing antivirals. Since these very effective drugs became available in 2015, NHS England data indicate that 77,862 people have benefitted from treatment.  

These effective treatments have also helped to reduce HCV-related mortality, with deaths due to the virus at their lowest in 10 years (0.44 deaths per 100,000 population in 2022, compared to 0.69 per 100,000 in 2015). 

HCV is a bloodborne virus that can cause life-threatening liver disease and cancer. However, those infected often have no symptoms until many years later when their liver has been badly damaged. When symptoms do occur, they can often be non-specific, such as tiredness or loss of appetite, and be dismissed or mistaken for other conditions. Early detection and treatment can also reduce the risk of passing the virus onto others.

The virus is spread through blood-to-blood contact, most commonly in the UK by sharing needles, syringes or other non-sterile injecting equipment. Other people at risk of acquiring the infection are those who:

  • have been in prison
  • have experienced homelessness
  • have had a medical procedure or tattoo abroad
  • are from a country with a higher prevalence of HCV
  • have received a blood transfusion before September 1991 or a blood product (such as clotting factor) before 1986 in the UK 

Based on modelled estimates, 62,600 people were estimated to be living with HCV in 2022. Of them: 

  • 20.1% of infections are estimated to be in people who are currently or have recently injected drugs
  • 64.5% are in those who have previously injected drugs but are no longer injecting.

There are an estimated 9,600 people with chronic HCV infection who have never injected drugs. 

In order to help find the remaining cases, in May 2023, NHS England launched a website where people can order at-home self-testing kits. More than 16,000 testing kits have now been ordered from hepctest.nhs.uk helping to identify more cases of hepatitis C and start people on treatment sooner. 

Dr. Monica Desai, Hepatitis C lead at UKHSA, said: "Hepatitis C elimination is in reach if we can accelerate testing, support people to access effective treatment, reduce the stigma experienced by people living with hepatitis C and prevent people getting the infection in the first place - particularly for people who inject drugs.  

"The symptoms of hepatitis C can go unnoticed for years. But the sooner you are diagnosed, the quicker you can get access to effective treatments and prevent serious liver damage. So, if you have ever injected drugs, even if it was a long time ago, please get tested. The test is quick and free and can be ordered via an online portal if you would prefer that rather than visiting your GP. You should also get tested if you have ever had medical treatment abroad, or had condomless sex with someone who may have hepatitis C."

The latest data show that the prevalence of chronic HCV among people who inject drugs has declined substantially in recent years, and the proportion of people who have cleared a previous infection has almost doubled, from 23.0% in 2015 to 41.6% in 2022, likely due to improved treatment. However, almost 7 out of 10 PWID (people who inject drugs) who are still living with HCV are thought to be unaware of their HCV infection or awaiting a testing result. People who inject drugs are still becoming newly infected or re-infected with hepatitis C and more needs to be done to prevent new infections, including provision of safe injecting equipment. Currently, one-third of people injecting drugs report inadequate availability of safe needles and syringes to meet their needs. 

Minister for Women’s Health Strategy, Maria Caulfield said: "The decline in people living with hepatitis C is testament to the brilliant work of the NHS and UKHSA. We want to go even further and I urge people most at risk, like those who have injected drugs, to get tested so that if they do need treatment they can get it as soon as possible. By increasing testing and giving people access to effective treatment, we will continue to protect the public’s health."

John Stewart, National Director for Specialised Commissioning at NHS England said: "The NHS is leading the world in the drive to eliminate hepatitis C through pioneering programmes like our testing portal, opt-out testing in Emergency Departments and community outreach to those most at risk, as well as landmark commercial deals securing access to the latest treatments.This data proves that our ambitions are within reach, as we work to eliminate hepatitis C as a public health threat ahead of the 2030 WHO commitment."

Rachel Halford, CEO of The Hepatitis C Trust, said: "The progress towards eliminating hepatitis C in this country is nothing short of astounding. Investment in initiatives that meet people where they are and link them up with health services has been a very successful way of reducing the number of people living with the virus.

"The success of this progress has been thanks to incredible multi-stakeholder partnership work that has kept people with lived experience at the centre. Peer support provided by people who have experience of hepatitis C has proven vital and supported thousands of people to get educated, tested and treated. 

"Moving forward we need to develop a national strategy which will ensure we reach elimination, and maintain this over the long term. This will require clear goals, strong disease surveillance, and a balanced approach to tackling the virus."

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Upcoming Events

Infection Prevention & Control

National Conference Centre, Birmingham
23rd - 24th April 2024

ESGE Days 2024, Symposium – ‘Elevating Endoscopy: Inspiring Progress and Innovation’

Estrel Congress Center (room 15), Berlin, Germany
25th April 2024, 16:30 – 17:30 CEST

National DERS and SMART pump conference

BCEC, Birmingham
29th April 2024

World Hand Hygiene Day

Worldwide
5th May 2024

Theatres & Decontamination Conference 2024

Coventry Building Society Arena
16th May 2024

The AfPP Roadshow - Birmingham

Millennium Point, Birmingham
18th May 2024

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

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