A total of 2325 cases of hepatitis C infection were reported to HPA/CfI in the third quarter of 2008 (table 3). The majority of reports (60%, 1376/2301) were, as in previous quarters, amongst those aged 25-44 years. The ratio of males to females was 2.3:1.
Table 3. Laboratory reports of hepatitis C infection in England and Wales:
July to September 2008
| Age group | Male | Female | Unknown | Total |
| 1-4 years | 1 | 3 | | 4 |
| 5-9 years | 1 | 1 | | 2 |
| 10-14 years | 5 | 2 | | 7 |
| 15-24 years | 71 | 70 | 6 | 147 |
| 25-34 years | 424 | 208 | 36 | 668 |
| 35-44 years | 505 | 182 | 21 | 708 |
| 45-54 years | 347 | 124 | 23 | 494 |
| 55-64 years | 118 | 45 | 4 | 167 |
| ≥65 years | 56 | 41 | 7 | 104 |
| Unknown | 11 | 4 | 9 | 24 |
| Total | 1539 | 680 | 106 | 2325 |
In quarter 4, a total of 2027 cases of hepatitis C infection were reported, slightly lower that the 2325 cases reported in the third quarter of 2008 (table 4). The majority of reports (62%, 1246/2015) were, as in previous quarters, amongst those aged 25-44 years. The ratio of males to females is 2.1:1.
Table 4. Laboratory reports of hepatitis C infection in England and Wales:
October to December 2008
| Age group | Male | Female | Unknown | Total |
| 1-4 years | | 1 | | 1 |
| 5-9 years | 2 | | | 2 |
| 10-14 years | 1 | | | 1 |
| 15-24 years | 67 | 67 | 4 | 138 |
| 25-34 years | 395 | 200 | 29 | 624 |
| 35-44 years | 440 | 157 | 25 | 622 |
| 45-54 years | 256 | 105 | 20 | 381 |
| 55-64 years | 106 | 43 | 11 | 160 |
| ≥65 years | 44 | 38 | 4 | 86 |
| Unknown | 8 | 3 | 1 | 12 |
| Total | 1319 | 614 | 94 | 2027 |
Quarterly report from the sentinel surveillance study of hepatitis testing in England: data for October to December 2008 (quarter 4)
The sentinel surveillance study of hepatitis testing, which began in 2002, aims to supplement routine surveillance of hepatitis A, B and C infections in England by providing information on trends in testing, individual risk exposures and clinical symptoms. The study collects information on hepatitis A, B and C testing carried out in participating centres regardless of test result and therefore can also be used to estimate prevalence in those individuals tested.
During the last quarter of 2008, a total of 41894 individuals were tested at least once for hepatitis C-specific antibodies (anti-HCV) in 20 participating sentinel centres (table 6). This is the first time these individuals had been reported to the sentinel surveillance scheme.
Overall, 3.9% of individuals tested for anti-HCV were positive, though this varied by region with the highest proportion of positive tests in the North West (table 6). This may reflect more targeted testing of risk groups and/or genuinely higher prevalence in people being tested in this region.
It is important to note that no laboratory methods are currently available to distinguish between acute or chronic hepatitis C virus infections. These positive anti-HCV results do not therefore necessarily represent incident infections.
Table 6. Number of individuals tested, and testing positive, for anti-HCV in participating centres, October – December 2008
| Region (number of centres) | Number tested | Number positive (%) |
| East Midlands (1) | 3793 | 122 (3.2) |
| East of England (1) | 1924 | 55 (2.9) |
| London (5) | 12821 | 497 (3.9) |
| North East (1) | 425 | 20 (4.7) |
| North West (6) | 8106 | 455 (5.6) |
| South Central (1) | 1065 | 8 (0.8) |
| South East Coast (1) | 3658 | 62 (1.7) |
| South West (1) | 4209 | 186 (4.4) |
| Wales* | 21 | 1 (4.8) |
| West Midlands (1) | 1536 | 31 (2.0) |
| Yorkshire and Humberside (2) | 4336 | 200 (4.6) |
| Total, all regions (20) | 41894 | 1637 (3.9) |
Gender was reported for the majority of people tested. As in previous quarters, similar numbers of males and females were tested (table 7); the ratio of males to females tested was 1.1:1. The ratio of males to females testing positive was 2:1. The largest group tested were aged 25-34 years (n=10768). The percentage of individuals overall testing positive was highest among 45-54 year olds (6.6%). The high level of individuals with unknown age testing positive (5.3%) may reflect testing of individuals in settings such as prisons, drug services and GUM clinics where few demographic details on patients were available and where service users may be at high risk of hepatitis C infection.
Table 7. Age and sex of individuals tested for anti-HCV in participating centres, October – December 2008
| Age group | Female | Male | Unknown | Total |
| Number tested | Number positive (%) | Number tested | Number positive (%) | Number tested | Number positive (%) | Number tested | Number positive (%) |
| 1-14 | 279 | 2 (0.7) | 268 | 3 (1.1) | 5 | | 552 | 5 (0.9) |
| 15-24 | 4550 | 48 (1.1) | 3693 | 36 (1.0) | 166 | | 8409 | 84 (1.0) |
| 25-34 | 5043 | 174 (3.5) | 5569 | 272 (4.9) | 156 | 5 (3.2) | 10768 | 451 (4.2) |
| 35-44 | 3784 | 156 (4.1) | 5233 | 397 (7.6) | 111 | 6 (5.4) | 9128 | 559 (6.1) |
| 45-54 | 2122 | 86 (4.1) | 2963 | 250 (8.4) | 55 | 2 (3.6) | 5140 | 338 (6.6) |
| 55-64 | 1565 | 44 (2.8) | 1951 | 87 (4.5) | 29 | 1 (3.4) | 3545 | 132 (3.7) |
| ≥65 | 1926 | 22 (1.1) | 2308 | 39 (1.7) | 24 | 2 (8.3) | 4258 | 63 (1.5) |
| Unknown | 23 | 1 (4.3) | 34 | 4 (11.8) | 37 | | 94 | 5 (5.3) |
| Total, all age groups | 19292 | 533 (2.8) | 22019 | 1088 (4.9) | 583 | 16 (2.7) | 41894 | 1637 (3.9) |
To provide an indication of trends in testing, data from the 18 sentinel centres from which full data were available were compared for the fourth quarters of 2007 and 2008. In the period October to December 2008, 1355 of 34844 (3.9%) people tested were positive for anti-HCV, compared to 1462 of 30436 (4.8%) for the same period in 2007. This suggests a greater proportion of people at lower risk of infection were tested during the last quarter of 2008.
References1 Health Protection Agency. Quarterly report from the sentinel surveillance study of hepatitis testing in England: data for July to September 2008 (quarter 3). Health Protection Report [serial online] 2006; 3(4): immunisation. Available at: http://www.hpa.org.uk/hpr/archives/2009/hpr0409.pdf
