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NICE guidelines launched on risks and causes of hepatitis B and C

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NICE has issued guidelines highlighting the need to tackle ignorance about the risk factors and causes of hepatitis B and C, and misconceptions about its treatment if barriers to effective testing of those at increased risk of infection are to be overcome.

Hepatitis B and C affect approximately half a million people in the UK, making them the second most common cause of liver disease in the UK, after alcohol misuse. Transmission is by contact with infected blood, primarily as a result of exposure through the skin to contaminated blood and through mother-to-child transmission. A hepatitis infection is manifested firstly as an acute infection (the first 6 months following initial infection). If the virus is not cleared from the body, either naturally or through the use of drugs to treat the infection, the infection can progress to a chronic state. Although often asymptomatic, particularly in the early stages, chronic hepatitis B or C infection increases the risk of chronic liver damage, cirrhosis and primary liver cancer.

A report from the Health Protection Agency (HPA)i has found that half of people who inject drugs are infected with hepatitis C.

Out of a total of 12,642 hepatitis C infections diagnosed in the UK in 2011, around nine in ten of these infections were acquired through injecting drugs. The report also found that one in six people who inject drugs were found to have been infected with the hepatitis B virus at some point in their lives. Those at increased risk of infection with hepatitis B or C also include migrants from countries with high/medium prevalence of the disease, people who travel to countries where there is a high incidence of the disease, people who have heterosexual contact with someone who is infected, mother to child transmission and men who have sex with men. People from some minority ethnic groups in the UK may also be at higher risk, with estimates suggesting that the rate of acute infection within the South Asian population in England and Wales is twice the estimated average, largely as a result of mother-to-child transmission that occurs outside the UK. Statistics also suggest a higher than average prevalence of hepatitis C among people in prison.

The guidance sets out how services, organisations and practitioners can promote testing and reach people at increased risk. The recommendations comprise: awareness-raising among the general population and people at increased risk of hepatitis B and C infection; developing the knowledge and skills of healthcare professionals and others providing services for people at increased risk of hepatitis B or C infection; testing in primary care, prisons and youth offender institutions, immigration removal centres, drugs services, genitourinary medicine and sexual health clinics; contact tracing; providing and auditing neonatal hepatitis B vaccination; commissioning hepatitis B and C testing and treatment services; and laboratory services for hepatitis B and C testing.

Professor Mike Kelly, NICE director of public health, said: 'What seems to be a general ignorance about the diseases and the potentially serious consequences of not being tested and treated is contributing to both a lack of offer of testing by services and the low uptake of testing among those at increased risk of infection. It is also contributing to the stigma surrounding hepatitis B and C.

'Recommendations in this guidance therefore encompass general awareness raising for the population as a whole, for those at increased risk of infection and for healthcare professionals and others providing services for those at increased risk of hepatitis B and C. This is aimed at addressing any misconceptions about the risk of hepatitis B and C that can act as barriers to testing, including the belief that treatments are not effective and that treatment is not needed until the illness is advanced. It is also aimed at demystifying the risks of transmission among families, friends and colleagues of people diagnosed with chronic hepatitis B or C, and in doing so reducing much of the stigma attached to the diseases.'

Opal Greyson, a viral hepatitis specialist nurse, NHS Bedford & Luton, and member of the programme development group, added: 'This important new guidance will help ensure that people at risk and those at increased risk are tested and those with hepatitis B and C are identified earlier. It means that more people will be offered effective treatment and, in the case of hepatitis C, the opportunity of a cure. We can save lives while helping to reduce health inequalities and deliver cost savings. That's surely something to be proud of.'

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