Surveillance Report
Surveillance of known hepatitis C antibody positive
cases in Scotland: Results to 31 December 2013
Prepared by: Allan McLeod, Sharon Hutchinson and David Goldberg
In Scotland
During January to December 2013, 1903 new cases of hepatitis C antibody-positivity were
diagnosed.1 See Table 1-6 and Figure 1 for more details on the cases of antibody-positivity to 31
December 2013.
This figure compares with 2327 and 2009 for 2011 and 2012, respectively, and an average of
1716 in the years 2003-2010.
FIGURE 1: Persons in Scotland reported to be hepatitis C antibody positive by year and quarter of
earliest positive specimen; to 31 December 2013
2500
Annual No. of diagnoses
2000
1500
1000
500
13
20
11
20
09
20
07
20
05
20
03
20
01
20
99
19
97
19
95
19
93
19
19
91
0
Year of earliest positive specimen
Quarter 1
Quarter 2
Quarter 3
Quarter 4
• 33% (623) resided in the Greater Glasgow and Clyde NHS board area, 12% (235) in Lothian,
11% (218) in Tayside, 10% (193) in Grampian, and ≤10% each in the other NHS board areas.
• 65% (1229) were male and 35% (662) female. Gender was not reported in fewer than 1% (12)
of cases.
• 23% (432) are known to have injected drugs, representing 97% of those with a known risk
factor.
• At the time of diagnosis, 19% (356) were aged 20-29 years, 39% (749) were aged 30-39
years, 24% (464) were aged 40-49 years, 11% (213) were aged 50-59 years and 4% (82)
were aged over 60 years.
• Source of referral was known in 81% (1600) of cases. 33% (533) were diagnosed in the
hospital setting (including infectious disease and gastroenterology units) and 30% (473) were
diagnosed by general practitioners. 1.Data for 2013 are provisional and may be subject to change
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
243
• 19% (300) were known to have been diagnosed in specialist drug services, where dry blood
spot testing for hepatitis C was introduced in 2009.2
A total of 35474 cases of hepatitis C antibody-positivity had been diagnosed as at 31 December
2013.
• 67% (23675) are male and 32% (11452) female; gender was not known in 1% (347) of cases.
• 55% (19644) are known to have injected drugs, representing 90% of those with a known risk
factor, while 1% (362) of all cases were associated with the receipt of blood factor.3 For the 5%
(1711) who were placed in the ‘Other’ category, risk information such as ‘blood transfusion’,
‘sexual intercourse’ and ‘tattoo’ were indicated.
• At the time of diagnosis, 33% (11533) were aged 20-29 years, 36% (12765) were aged 30-39
years, 18% (6298) were aged 40-49 years, 6% (2191) were aged 50-59 years and 3% (1222)
were aged over 60 years. Age was not known in 1% (406) of cases.
• 40% (14076) of cases resided in the Greater Glasgow and Clyde NHS board area, 14%
(4876) in Lothian, 11% (3816) in Grampian, 8% (2898) in Tayside, 7% (2486) in Lanarkshire,
7% (2305) in Ayrshire & Arran and 5% (1712) in Forth Valley.
• Source of referral was known in 80% (28351) of cases. Of these, 35% (9836) were diagnosed
in the hospital setting (including infectious disease and gastroenterology units), 29% (8234) by
general practitioners, 7% (2116) in genito-urinary medicine clinics, 7% (2064) in prisons, and
6% (1837) in specialist drug services.
• 39% (13828) were known to have had a genotype test for hepatitis C. Of these, 48% (6606)
were genotype 1, 5% (697) were genotype 2, 46% (6413) were genotype 3, and fewer than
1% were genotype 4 (102) and genotype 5 or 6 (10).
• 16% (5522) of cases were known to have died, as at 31 December 2013.
• Of the 29952 cases not known to have died, 6% (1893) were aged 20-29 years, 32% (9707)
were aged 30-39 years, 37% (10958) were aged 40-49 years, 17% (4945) were aged 50-59
years and 6% (1919) were aged over 60 years as at 31 December 2013. Age was not known
in 1% (400) of cases.
As at 31 December 2013, approximately 0.9% (27543/3212202) of Scotland’s population aged 1559 years had been diagnosed hepatitis C antibody-positive.
Methods
For details of methods see SCIEH Weekly Report vol.33 no.99/29 (at http://www.hps.scot.nhs.uk/
ewr/redirect.aspx?id=14870).
In collaboration with the Scottish National Blood Transfusion Service (SNBTS), records of hepatitis
C antibody positive cases diagnosed through their screening programme have been added to the
national surveillance database.
2.Diagnoses made on dry blood spot samples were confirmed at NHS testing laboratories
3.Persons who acquired their hepatitis C infection In Scotland through blood factor will have
become infected prior to the time, in the mid 1980’s, when heat treatment was introduced to
prevent blood borne infection. (See Tables 2 and 3)
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
244
Principal Investigators
The following are the principal investigators:
Dr Celia Aitken2; Mr Glenn Codere3; Prof David Goldberg3; Dr Rory Gunson2; Dr Sharon
Hutchinson3; Dr Lisa Jarvis8; Dr Paul McIntyre7; Mr Allan McLeod3; Dr Pamela Molyneaux4; Dr
Kirsty Roy3; Dr Christian Schnier3, Ms Louise Shaw3 and Dr Kate Templeton1.
Co-workers
We are very grateful to the following staff who have put an enormous amount of effort into
collecting and collating the data:
Mr Keith Appleyard7; Ms Lesley Cairns3, Mr Ian Collacot4; Ms Joan Findlay4; Ms Liz McCann5;
Ms Hazel Paterson2; Ms Hannah Robertson6; Ms Dorothy Ross7; Ms Morag Taylor7; Ms Carol
Thompson1; Dr Andrew Todd5 and Mr John Wallace7.
Support
The work is supported by the Scottish Government Health and Wellbeing Directorate.
Locations
1. East of Scotland Specialist Virology Centre, Royal Infirmary of Edinburgh
2. West of Scotland Specialist Virology Centre, Gartnavel General Hospital, Glasgow
3. Health Protection Scotland, Meridian Court, Glasgow
4. Dept of Medical Microbiology, University Medical School, Foresterhill, Aberdeen
5. Lanarkshire HIV/AIDS and Hepatitis Centre, Monklands Hospital, NHS Lanarkshire
6. Microbiology Department, Monklands District General Hospital, NHS Lanarkshire
7. Department of Medical Microbiology, Ninewells Hospital & Medical School, Dundee
8. SNBTS, National Microbial Reference Unit, Ellen’s Glens Road, Edinburgh
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
245
TABLE 1: Persons in Scotland reported to be hepatitis C antibody positive; Number and
rate/100000 population1 by NHS board and year of earliest positive specimen to 31 December
NHS
Board
Number
Rate/100000
Number
BR
Rate/100000
Number
DG
Rate/100000
Number
Fife
Rate/100000
Number
FV
Rate/100000
Number
GR
Rate/100000
Number
GG&C
Rate/100000
Number
HG
Rate/100000
Number
LN
Rate/100000
Number
LO
Rate/100000
Number
TY
Rate/100000
Number
Scotland3
Rate/100000
AA
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total2
147 126 104 135
99 126 145 182 147 147 163 2305
40.0 34.3 28.3 36.8 27.0 34.4 39.5 49.6 40.1 39.4 43.7
11
12
11
15
18
19
18
15
26
25
30
308
10.2 11.0 10.0 13.6 16.2 17.1 16.0 13.3 23.0 22.0 26.4
50
51
66
48
44
54
52
57
36
43
36
862
34.0 34.6 44.6 32.3 29.7 36.5 35.2 38.4 24.3 29.0 23.9
26
64
63
48
84
47
52
46
30
72
54 1002
7.4 18.2 17.8 13.4 23.4 13.0 14.3 12.7
8.2
8.2 19.6
66
79
63
82
83
68 105 107 137 149 141 1712
23.6 28.2 22.4 28.9 29.0 23.6 36.3 36.9 46.7 50.4 47.1
195 163 176 185 144 172 208 165 258 178 193 3816
37.3 31.1 33.6 35.2 27.2 32.2 38.7 30.6 46.9 32.1 33.7
725 651 597 556 600 615 839 851 830 660 623 14076
60.8 54.6 50.2 46.7 50.3 51.6 70.2 70.7 68.6 54.2 51.2
51
33
27
41
34
57
76
50
61
74
65 1026
17.0 10.9
8.9 13.4 11.0 18.4 24.5 16.1 19.6 23.1 20.3
138 136 158 103
95 117 147 141 189 173 138 2486
24.9 24.5 28.3 18.5 17.0 20.8 26.2 25.1 33.6 30.2 24.1
150 241 240 206 217 204 195 265 322 254 235 4876
19.2 30.6 30.2 25.7 26.8 25.0 23.8 31.7 37.9 30.1 27.9
81
97
98 106 127 127 179 228 274 227 218 2898
21.0 25.0 25.2 27.1 32.3 32.1 45.1 56.6 67.5 55.1 52.9
1642 1656 1606 1529 1549 1613 2020 2110 2327 2009 1903 35474
32.5 32.7 31.6 30.0 30.3 31.4 39.2 40.6 44.6 38.2 35.8
1. Based on population at 30 June of indicated year
2. Includes persons diagnosed prior to 2003
3. Includes persons diagnosed in Island Boards (NHS Orkney, NHS Shetland and NHS Western Isles)
‘NHS board’ refers to the persons NHS board of residence, or where this is not known, the NHS board of
source of referral
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
246
TABLE 2: Persons in Scotland reported to be hepatitis C antibody positive by NHS board and risk
group; to 31 December 2013
NHS Board
AA
BR
D&G
Fife
FV
GR
GG&C
HG
LN
LO
TY
All Islands
Scotland
IDU
861
122
572
580
653
2349
8562
399
1244
2620
1639
43
19644
Blood Factor
29
5
5
11
15
26
107
19
31
76
32
6
362
Other
74
14
27
32
47
141
757
59
100
304
145
11
1711
Not Known
1341
167
258
379
997
1300
4650
549
1111
1876
1082
47
13757
Total
2305
308
862
1002
1712
3816
14076
1026
2486
4876
2898
107
35474
Notes: ‘Other’ includes sexual contact, tattoo/body piercing, needlestick, bite, blood spillage, blood
transfusion, or perinatal risk
‘NHS board’ refers to the persons NHS board of residence, or where this is not known, the NHS board of
source of referral
All Islands refers to NHS Orkney, NHS Shetland and NHS Western Isles
TABLE 3: Persons in Scotland reported to be hepatitis C antibody positive by gender, risk group
and earliest positive specimen; to 31 December 2013
Risk
Prior
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Group to 2003
IDU
2806 339 322 302 229 257 231 300 348 345 269
Other
417
43
39
45
52
40
42
33
37
29
28
Female
Not
1555 199 192 220 184 190 255 304 271 438 429
known
Total
4778 581 553 567 465 487 528 637 656 812 726
IDU
6967 690 654 638 571 586 550 701 786 743 474
Other
753
47
43
60
73
54
55
50
45
30
36
Male
Not
2844 310 388 323 411 417 459 615 609 725 739
known
Total
10564 1047 1085 1021 1055 1057 1064 1366 1440 1498 1249
IDU
9838 1036 977 941 802 844 786 1005 1139 1093 751
Other
1173
90
82 105 125
94
98
85
82
59
66
All
Not
4499 516 597 560 602 611 729 930 889 1175 1192
known
Total
15510 1642 1656 1606 1529 1549 1613 2020 2110 2327 2009
Gender
2013 Total
144
7
5892
812
511
4748
662 11452
287 13647
7 1253
935
8775
1229 23675
432 19644
14 2073
1457 13757
1903 35474
All’ includes those for whom gender is not known
‘Other’ includes sexual contact, tattoo/body piercing, needlestick, bite, blood spillage, blood products, blood
transfusion, or perinatal risk
Persons who acquired their hepatitis C infection In Scotland through blood factor will have become infected
prior to the time, in the mid 1980’s, when heat treatment was introduced to prevent blood borne infection
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
247
TABLE 4: Persons in Scotland reported to be hepatitis C antibody positive, by age group at time of
earliest positive specimen and year of earliest positive specimen; to 31 December 2013
Age
Prior
Group at
to
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
diagnosis 2003
Under 20
688
51
35
36
29
31
31
30
32
35
31
30
20-29
6219 620
571
543
436
428
457
506
474
536
387
356
30-39
5431 587
586
565
556
549
543
761
852
849
737
749
40-49
1833 232
315
292
325
360
366
497
504
601
509
464
50-59
515
89
102
118
136
128
146
160
185
201
198
213
60+
534
56
43
46
42
51
59
59
57
93
100
82
1
Total
15510 1642 1656 1606 1529 1549 1613 2020 2110 2327 2009 1903
Total
1059
11533
12765
6298
2191
1222
35474
1. Includes those for whom age at diagnosis is not known
Earliest positive specimens with specimen dates prior to 1991 were identified through retrospective testing
of stored sera
Children aged under 2 years at the time of diagnosis were included if they had two consecutive PCR
positive tests
TABLE 5: Persons in Scotland reported to be hepatitis C antibody positive by source of referral
and year of earliest positive specimen; to 31 December 2013
Source Prior
of
to
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total
Referral 2003
GP
3329
418
428
400
403
439
447
453
419
560
465
473 8234
Hospital
4823
470
451
421
370
412
443
454
452
510
497
533 9836
Patients
GUM
919
85
102
113
89
90
115
134
105
113
112
139 2116
Clinic
Prison
1201
95
62
60
35
72
55
92
96
104
94
98 2064
Drug
84
7
12
9
7
19
12
188
449
448
302
300 1837
Service
Other
2818
247
234
184
152
132
140
108
79
53
60
57 4264
Not
2336
320
367
419
473
385
401
591
510
539
479
303 7123
Known
Total
15510 1642 1656 1606 1529 1549 1613 2020 2110 2327 2009 1903 35474
Earliest positive specimens with specimen dates prior to 1991 were identified through retrospective testing
of stored sera
‘Other’ includes those diagnosed in Specialist Drug Services, Counselling Clinics, Renal Units,
Haemophilia Clinics, Occupational Health and Scottish National Blood Transfusion Service donor
screening.
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
248
TABLE 6: Persons in Scotland reported to be hepatitis C antibody positive and not known to be
dead by NHS board and current age group; to 31 December 2013
NHS
Board
Number
%
Number
BR
%
Number
D&G
%
Number
FF
%
Number
FV
%
Number
GR
%
Number
GG&C
%
Number
HG
%
Number
LN
%
Number
LO
%
Number
TY
%
Number
All Islands
%
Number
Scotland
%
AA
20-29
30-39
40-49
50-59
60+
149
7.4%
23
8.4%
81
10.4%
73
8.6%
165
10.8%
242
7.1%
377
3.2%
61
6.7%
119
5.6%
256
6.5%
339
14.1%
8
50.0%
1893
6.3%
814
40.4%
82
30.0%
337
43.2%
356
41.7%
564
36.8%
1463
43.2%
3443
29.6%
255
27.9%
742
35.2%
954
24.1%
682
28.4%
15
16.3%
9707
32.4%
659
32.7%
83
30.4%
190
24.4%
233
27.3%
467
30.5%
1025
30.3%
5149
44.3%
273
29.9%
767
36.4%
1336
33.7%
754
31.4%
22
23.9%
10958
36.6%
273
13.5%
44
16.1%
81
10.4%
138
16.2%
214
14.0%
431
12.7%
1873
16.1%
215
23.5%
315
14.9%
919
23.2%
413
17.2%
29
31.5%
4945
16.5%
83
4.1%
32
11.7%
62
7.9%
49
5.7%
96
6.3%
192
5.7%
558
4.8%
98
10.7%
136
6.4%
451
11.4%
146
6.1%
16
17.4%
1919
6.4%
Total1
2016
273
780
853
1533
3388
11636
913
2109
3960
2399
92
29952
1. Includes those under the age of 20 and those for whom age was not known
‘NHS board’ refers to the persons NHS board of residence, or where this is not known, the NHS board of
source of referral
All Islands refers to NHS Orkney, NHS Shetland and NHS Western Isles
The last hepatitis c Surveillance Report was in Issue 13/43
The next hepatitis c Surveillance Report will be in Issue 14/42
HPS WEEKLY REPORT Volume 48 No.2014/18
8 May 2014
249