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Blood-borne viruses (BBV)

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Introduction

Blood-borne viruses (BBVs) are viruses that some people carry in their blood and can be spread from one person to another. Those infected with a BBV may show little or no symptoms of serious disease, but other infected people may be severely ill. You can become infected with a virus whether the person who infects you appears to be ill or not - indeed, they may be unaware they are ill as some persistent viral infections do not cause symptoms. An infected person can transmit blood-borne viruses from one person to another by various routes and over a prolonged time period.

The most prevalent BBVs are:

    • human immunodeficiency virus (HIV) - a virus which causes acquired immunodeficiency virus (AIDS), a disease affecting the body's immune system;
    • hepatitis B (HBV) and hepatitis C; BBVs causing hepatitis, a disease affecting the liver. (There are also further types of hepatitis spread by other means)

Facts, figures and trends

The UK falls into the lowest category of prevalence for Hepatitis B, as determined by the World Health Organisation (the prevalence rate is believed to be between 0.1% and 0.5% of the UK population) but liver disease is one of the top causes of death in England and people are dying from it at younger ages. Most liver disease is preventable and much is influenced by the prevalence of hepatitis B and hepatitis C infections, which are both amenable to public health interventions1.

Figure 1: Trend in incidence of acute/probable acute hepatitis B, England and the North West

Figure 1
Source: PHE, Health Protection Report, Acute hepatitis B (England): annual report for 2014

In the UK around 214,000 individuals have long-term (chronic) infection with hepatitis C, and not surprisingly hepatitis C-related end-stage liver disease is continuing to rise2. It is estimated there are over 87,000 people who inject drugs in England and data from the Unlinked Anonymous Monitoring (UAM) survey of people who inject drugs suggest that levels of hepatitis C infection in this group is approximately 50%. This proportion has remained relatively stable over recent years.

Figure 2: Trend in anti-HCV prevalence among people who inject drugs in England: 2003-2013

Figure 2
Source: PHE, Hepatitis C in the UK 2014 report

There is limited local data on Hepatitis B and C in Blackpool but information from Public Health England shows that:-

    • There are an estimated 1,397 people with Hepatitis C in Blackpool3
    • in 2011/12 there were an estimated 794 people aged 15-64 who inject drugs in Blackpool, a rate of 8.7 per 1,000 population which is significantly higher than the England average of 2.49 per 1,000
    • Of the people in substance misuse treatment who inject drugs, 87.8% have received the hepatitis C test compared to 81.5% nationally
    • Under 75 mortality from hepatitis C related end-stage liver disease/hepatocellular carcinoma is significantly higher than the England average

Figure 3: Blackpool health indicators relating to hepatitis from Public Health England Profiles

BBV-Fig3
Source: Public Health England Profiles, December 2015

Information on HIV/AIDS can be found in the Sexual Health section

National and local guidance

Preventing the spread of blood-borne viruses (BBVs) is a key public health issue, and a key outcome in the Drug Strategy 2010.

Hepatitis C: guidance, data and analysis provides information on the characteristics, diagnosis, management and epidemiology of hepatitis C (Hep C, HCV).

Hepatitis B: guidance, data and analysis provides information on the characteristics, diagnosis, management and epidemiology of hepatitis B

Risk factors

Throughout the UK, injecting drug use continues to be the most important risk factor for hepatitis C infection therefore monitoring infection among this important risk group remains a UK priority.

Hepatitis B infection is by exposure to infected blood and body fluids, most often through sexual contact, blood to-blood contact and perinatal transmission from mother to child. HBV infection can be prevented by vaccination and in the UK immunisation is used for individuals at high risk of exposure to the virus e.g. people who inject drugs (PWID), healthcare workers. Immediate post-exposure vaccination is used to prevent infection, especially in babies born to infected mothers or following needle-stick injuries.

Prevention

Ensuring people who use drugs do not contract BBVs is one way of keeping them and their communities' safe before and during their recovery journeys. Preventing BBV transmission also has benefits for wider society, both in terms of reducing health harms, and reduced treatment costs. Effective local action to prevent BBVs will include a range of services. BBV transmission can be prevented by:

    • Needle and syringe programmes: pharmacy, specialist, outreach/mobile, in hostels and gyms
    • Comprehensive protocols to raise awareness of risks from BBVs which promote and deliver testing and appropriate pathways into treatment for hepatitis B, hepatitis C and HIV, and vaccination against hepatitis B
    • Provision of advice and materials to reduce harm from injecting drug use
    • Offers of testing and/or vaccination to all those at risk of contracting BBVs
    • Programmes that prevent the uptake of injecting drug use and promote switching from injecting drug use to other means of administration
    • Workforce and occupational health interventions for people working with those at risk of contracting BBVs

Vaccination against Hepatitis B would usually only be recommended for people in high-risk groups, such as:

    • people who inject drugs or have a sexual partner who injects drugs
    • people who change their sexual partner frequently
    • people travelling to or from a part of the world where hepatitis B is widespread
    • healthcare workers who may have come into contact with the virus

[1] PHE, Health Protection Profile

[2] PHE, Hepatitis C in the UK-2014 report

[3] PHE, Hepatitis C: commissioning template for estimating disease prevalence