Epidemiology of

hepatitis B in Ireland
Last updated March 2017
 Hepatitis B virus (HBV) (1)
• Hepatitis B is a viral infection, which causes inflammation of the liver
• It is transmitted through contact with semen, blood or other body fluids
from an infected person
• Most common means of transmission: unprotected sex, sharing
needles when injecting drugs, from mother to baby around the time of
birth
• Less common means of transmission: unscreened blood or blood
products (outside Ireland), accidental needlestick/blood exposure in
healthcare settings, household/close contact particularly in early
childhood, sharing razors or toothbrushes
• 50-100 times more infectious than HIV
• Incubation period (time from infection to onset symptoms) is 6 weeks to
6 months, average 2-3 months
 Hepatitis B virus (HBV) (2)
• Acute (new infection): <10% children and 30-50% adults develop
symptoms when first infected
• Symptoms include: loss appetite, nausea, vomiting, abdominal
discomfort, joint pain, fever, fatigue, dark urine, pale stools, jaundice
• Chronic (long-term) infection develops in 80-90% of those infected as
infants, 30-50% of children <6 years and <10% of those infected as adults
• Chronic infection can lead to chronic liver disease, cirrhosis, liver cancer
or liver failure, usually over 20-30+ years
• World Health Organization (WHO) estimates that approximately 240
million people are chronically infected worldwide
• Vaccine preventable – universal infant vaccination introduced in Ireland
in 2008. Vaccine also recommended for high risk groups
 Worldwide prevalence hepatitis B
(Source: CDC http://www.cdc.gov/travel-static/yellowbook/2016/map_3-04.pdf)
 Number of notifications of hepatitis B, 1997-2016
1000
899
900 849 845
Number of notifications

787 782
800
700
702
639
600 545 560 548
517 489
500 452
423 442
400 341
300
200 157 158 188
100 31
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Year
Acute Chronic Unknown
 Hepatitis B notification rates per 100,000 population, by HSE
area, 2004-2016
40

35
Notification rate per 100,000

30
HSE E
25 HSE M
HSE MW
20
HSE NE
15 HSE NW
HSE SE
10
HSE S
5 HSE W

0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Year
 Trends in acute hepatitis B notifications by sex and median
age, 2004-2016
100 50
95 90
90 45
81
Number of notifications

80 40

Median age (years)

70
70 55 35
60 53 30
50
50 45 25
40 37 20
32
30 29
30 26 15
20 10
10 5
0 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Number of males Number of females Median age males Median age females
Mean annual notification rates per 100,000 for acute cases of
hepatitis B by age and sex, 2004-2016
4.5
Mean annual notification rate per

4.0
3.5
3.0
2.5
100,000

2.0
1.5
1.0
0.5
0.0
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Male Female
 Notification rates per 100,000 for acute cases of hepatitis B
by age and sex, 2016
3
Notification rate per 100,000

2.5

1.5

0.5

0
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Male Female
Trends in chronic hepatitis B notifications by sex and median
age, 2004-2016
900 40
800 769 35
Number of notifications

731

Median age (years)

700 687 647 669
30
600 553
498 513 25
501
500 452
411 418 20
400 387
15
300
200 10

100 5

0 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year

Number of males Number of females Median age males Median age females
Mean annual notification rates per 100,000 for chronic cases
of hepatitis B by age and sex, 2004-2016
35
Mean notification rate per 100,000

30

25

20

15

10

0
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Male Female
Notification rates per 100,000 for chronic cases of hepatitis B
by age and sex, 2016
30
Notification rate per 100,000

25

20

15

10

0
0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+

Age group (years)

Male Female
 Most likely risk factor for acute cases, 2004-2016
(data available for 61%, n=424)
Vertical transmission, Other, 4%
1%
People who inject No known risk factor,
drugs, 1% 15%

Tattooing/body Possible sexual

piercing, 2% exposure -
Household contact heterosexual, 37%
with case, 2%

Non-occupational Possible sexual

needlestick or blood exposure - MSM, 32%
exposure, 3% Possible sexual
exposure - orientation
unknown, 3%

Approximately one fifth of acute cases were born in an endemic country or were asylum seekers
 Most likely risk factor for chronic cases, 2004-2016
(data available for 49%, n=3570)
No known risk factor,
2%

Vertical transmission,
4% Other, 8%
Possible sexual
exposure - orienation Born in endemic
unknown, 2% country/asylum
seeker, 77%
Possible sexual
exposure - MSM, 3%

Possible sexual
exposure -
heterosexual, 4%

Born in endemic country/asylum seeker is used as a proxy for risk factor when no other risk factor has been identified.
A significant proportion of the cases with risk factor data were also born in endemic countries – 89% of all chronic
cases with information on country of birth or asylum seeker status were born in endemic countries or were asylum
seekers.
 Region of birth, 2004-2016
Acute cases with region of birth Chronic cases with region of birth
data (80%, n=556) data (43%, n=3123)
 Hepatitis B notifications (acute & chronic) and CSO
immigration numbers from EU16-28 & non EU/EEA countries
(excl North America & Australia), 2004-2016
1000 120000

Immigration (number of people)

900
Number of notifications

800 100000
700 80000
600
500 60000
400
300 40000
200 20000
100
0 0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Year
Hepatitis B notifications Immigration from EU 16-28 and non EU/EEA countries
 Summary of acute hepatitis B in Ireland, 2004-2016
• 9% of cases notified 2004-2016 were acute infections
• 695 acute HBV notifications in this time period (annual average: n= 53)
• 32 acute cases of hepatitis B were notified in 2016. This was a 23% increase
compared to 2015 (n=26), but was similar to other recent years
• 82% of acute cases notified 2004-2015 were male (M:F = 5:1)
• Mean ages at notification: 37 for males, 34 for females, 37 for both
• Median ages at notification: 34 for males, 30 for females, 33 for both
• Where risk factor data available, 73% of cases were sexually acquired
•

• Sexual orientation available for 95% of sexually acquired cases: 54%

heterosexual, 46% men who have sex with men
• Where country of birth was available, 73% of acute cases were born in Ireland
 Summary of chronic hepatitis B in Ireland, 2004-2016
• 91% of cases notified 2004-2016 were chronically infected
• 7289 chronic HBV notifications in this time period (annual average: n= 557)
• 418 chronic cases of hepatitis B were notified in 2016
• 55% of chronic cases notified 2004-2016 were male
• Mean ages at notification: 35 for males, 31 for females, 33 for all
• Median ages at notification: 33 for males, 29 for females, 31 for all
• 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 mirror trends in immigration
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-HBc 0.51%
• Blood donors (1997-2015)3: HBsAg 0.011%
• Antenatal, Rotunda 1998-20004: HBsAg 0.03% Irish, 4.2% non-
EU, 0.35% overall
• 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)
• Prisoners, 20112: HBsAg 0.3%
• IDU 2001-23: HBsAg 2%, anti-HBc 17%
• Homeless, Dublin 1999-20004: anti-HBc 9%
• Asylum seekers, HSE East 1999-20035: HBsAg 5%
• Asylum seekers, Screening in Balseskin6, 2004-2012: HBsAg 3.6%
1Allwright S et al. BMJ 2000;321(7253):78-82.
2National Advisory Committee on Drugs and Alcohol. Study on the prevalence of drug use,

including intravenous drug use, and blood-borne viruses among the Irish prisoner population. 2011
3Grogan L et al. Ir J Med Sci 2005;174(2):14-20.

4Immunisation Guidelines for Ireland 2008.

http://www.immunisation.ie/en/HealthcareProfessionals/ImmunisationGuidelines2008/.
5Doyle S. Thesis submitted for MFPHMI, RCPI; 2006.

6Brennan M et al. ICGP Forum. 2013