Epidemiology of
hepatitis B in Ireland
Updated August 2014
Hepatitis B virus
• 50-100 times more infectious than HIV
• Chronic HBV infection develops in 90% of those infected as
infants and 1-10% infected as adults
• Chronic infection can lead to chronic liver disease, cirrhosis,
liver failure and liver cancer (usually over 20-30+ years)
• Premature death from liver disease occurs in 15-25% of
chronically infected people
• >350 million people chronically infected worldwide
• Vaccine preventable – universal infant vaccination introduced
in Ireland in 2008
Worldwide prevalence hepatitis B
(Source: CDC Health information for international travel 2014 http://wwwnc.cdc.gov/travel/content/yellowbook/2014/map_3-04.pdf)
Number of notifications of hepatitis B, 1997-2013
1000
849
Number of notifications
900
800
846
787
702
452
431
341
400
300
157 158 188
200
100
520 567
545
500
786
639
700
600
902
31
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year
Acute
Chronic
Unknown
Trends in acute hepatitis B notifications by sex and median
age, 2004-2013
Number of notifications
90
45
89
92
40
80
80
35
70
70
60
30
56
54
50
50
45
40
25
38
20
31
30
15
20
10
10
5
0
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
Number of males
Number of females
Median age males
Median age females
Median age (years)
100
Trends in chronic hepatitis B notifications by sex and median
age, 2004-2013
655
Number of notifications
700
615
700
40
739
666
548
600
500
35
481
30
510
447
381
25
400
20
300
15
200
10
100
5
0
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Year
Number of males
Number of females
Median age males
Median age females
Median age (years)
800
Mean annual notification rate per
100,000
Mean annual notification rates per 100,000 for acute cases of
hepatitis B by age and sex, 2010-2013
3.5
3
2.5
2
1.5
1
0.5
0
0-4
5-9
10-14
15-19
20-24
25-34
Age group (years)
Male
Female
35-44
45-54
55-64
65+
Mean annual notification rate per
100,000
Mean annual notification rates per 100,000 for chronic cases
of hepatitis B by age and sex, 2010-2013
30
25
20
15
10
5
0
0-4
5-9
10-14
15-19
20-24
25-34
Age group (years)
Male
Female
35-44
45-54
55-64
65+
Notification rate per 100,000
Hepatitis B notification rates per 100,000 population, by HSE
area, 2010-2013
30
25
20
25
22
20
16
14
15
10
9
9
9
6
5
10
8 8
5
5
1110
9
7
9
7
4 5
5
3 4
11
11
8 8
7
5
3
12
9
6
3
0
E
M
MW
NE
NW
SE
HSE area
2010
2011
2012
2013
S
W
National
Mean annual hepatitis B notification rates per 100,000
population by HSE area, 2010-2013
3.8
8.1
7.4
7.1
20.7
7.8
3.9
10.2
Most likely risk factor, 2010-2013
Acute cases with risk factor data
(90%, n=147)
Chronic cases with risk factor data
(50%, n=952)
Region of birth, 2010-2013
Acute cases with region of birth
data (92%, n=151)
Chronic cases with region of birth
data (46%, n=874)
Summary of acute hepatitis B in Ireland, 2010-2013
• 8% of cases notified 2010-2013 were acute infections
• 164 acute HBV notifications in this time period (annual average: n= 41)
• 31 acute cases of hepatitis B were notified in 2013. This is the lowest number
reported since acute/chronic case definitions were introduced in 2004
• 84% of acute cases notified 2010-2013 were male (M:F =5)
• Mean ages at notification: 39 for males, 34 for females
• Median ages at notification: 37 for males, 29 for females
• Where risk factor data available, 74% of cases were sexually acquired
•
• Sexual orientation available for 93% of sexually acquired cases: 57%
heterosexual, 43% men who have sex with men
• Where country of birth available, 70% of acute cases were born in Ireland
Summary of chronic hepatitis B in Ireland, 2010-2013
• 92% of cases notified 2010-2013 were chronically infected
• 1910 chronic HBV notifications in this time period (annual average: n= 478)
• 386 chronic cases of hepatitis B were notified in 2013. This is the lowest
number reported since acute/chronic case definitions were introduced in 2004
• 53% of chronic cases notified 2010-2013 were male
• Mean ages at notification: 36 for males, 32 for females
• Median ages at notification: 34 for males, 29 for females
• Data indicate that most chronic cases were born and infected outside of
Ireland, mostly in Central & Eastern Europe, Asia and Sub-Saharan Africa
• It is likely that most became infected at birth or in early childhood and have
been infected for decades
• Trends in chronic cases are heavily influenced by immigration trends
Hepatitis B prevalence data – Ireland
Low risk populations
•
•
•
•
•
General pop (residual sera, 2003)1: HBsAg 0.1%, anti-HBc 1.7%
Oral fluid, postal (1998-9)2: anti-HBs 0.51%
Blood donors (1997-2010)3: HBsAg 0.012%
Antenatal, Rotunda 1998-20004: HBsAg 0.03% Irish, 4.2% non-EU
Antenatal, West of Irl 2004-95: HBsAg 0.21%
1Nardone
A et al. Epidemiol Infect 2009;137(7):961-9.
2O ’Connell T et al. Epidemiol Infect 2000;125(3):701-4.
3Personal communication, Dr Joan O’Riordan, IBTS
4Healy CM et al. Ir Med J 2001;94(4):111-2,4.
5O ’Connell K et al. Ir Med J 2010;103(3):91-2.
Hepatitis B prevalence data – Ireland
High risk populations
•
•
•
•
Prisoners 19981: anti-HBc 8.7% (18.5% in IDU prisoners)
IDU 2001-22: HBsAg 2%, anti-HBc 17%
Homeless, Dublin 1999-20003: anti-HBc 9%
Asylum seekers, HSE East 1999-20034: HBsAg 5%
1Allwright
S et al. BMJ 2000;321(7253):78-82.
2Grogan L et al. Ir J Med Sci 2005;174(2):14-20.
3Immunisation Guidelines for Ireland 2008.
http://www.immunisation.ie/en/HealthcareProfessionals/ImmunisationGuidelines2008/.
4Doyle S. Thesis submitted for MFPHMI, RCPI; 2006.