1. Epidemiology of hepatitis B in Ireland Updated August 2014

2. 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 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

3. Worldwide prevalence hepatitis B (Source: CDC Health information for international travel

4. Number of notifications of hepatitis B, 1997-2013
Hepatitis B notifications increased steeply between 2000 and This was mostly attributable to large numbers of people migrating to Ireland from hepatitis B endemic countries, with chronic hepatitis B infections. Immigration to Ireland has decreased in recent years, correlating with a reduction in hepatitis B notifications. Notifications of chronic cases peaked in 2008 (n=902). 431 chronic cases were notified in 2013 (52% decrease compared to peak levels)
The number of acute cases (new infections) notified has generally been low, but has also decreased in recent years. Notifications of acute cases peaked in 2006 (n=95). 31 acute cases of hepatitis B were notified in 2013 (67% decrease compared to peak levels)

5. Trends in acute hepatitis B notifications by sex and median age, 2004-2013

6. Trends in chronic hepatitis B notifications by sex and median age, 2004-2013

7. Mean annual notification rates per 100,000 for acute cases of hepatitis B by age and sex, 2010-2013

8. Mean annual notification rates per 100,000 for chronic cases of hepatitis B by age and sex,

9. Hepatitis B notification rates per 100,000 population, by HSE area, 2010-2013
Highest rates in the HSE-E

10. Mean annual hepatitis B notification rates per 100,000 population by HSE area, 2010-2013
3.8
8.1
7.4
7.1
Highest rates in the HSE-E
20.7
7.8
3.9
10.2

11. Most likely risk factor, 2010-2013
Acute cases with risk factor data
(90%, n=147)
Chronic cases with risk factor data
(50%, n=952)

12. Region of birth,
Acute cases with region of birth data (92%, n=151)
Chronic cases with region of birth data (46%, n=874)

13. Summary of acute hepatitis B in Ireland, 2010-2013
8% of cases notified were acute infections
164 acute HBV notifications in this time period (annual average: n= 41)
31 acute cases of hepatitis B were notified in This is the lowest number reported since acute/chronic case definitions were introduced in 2004
84% of acute cases notified 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

14. Summary of chronic hepatitis B in Ireland, 2010-2013
92% of cases notified were chronically infected
1910 chronic HBV notifications in this time period (annual average: n= 478)
386 chronic cases of hepatitis B were notified in This is the lowest number reported since acute/chronic case definitions were introduced in 2004
53% of chronic cases notified 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

15. 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 ( )3: HBsAg 0.012%
Antenatal, Rotunda : HBsAg 0.03% Irish, 4.2% non-EU
Antenatal, West of Irl : 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.

16. Hepatitis B prevalence data – Ireland High risk populations
Prisoners 19981: anti-HBc 8.7% (18.5% in IDU prisoners)
IDU : HBsAg 2%, anti-HBc 17%
Homeless, Dublin : anti-HBc 9%
Asylum seekers, HSE East : 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
4Doyle S. Thesis submitted for MFPHMI, RCPI; 2006.