UK Shooting Up report finds hepatitis C among people who inject drugs remains high and one-half currently undiagnosed

An annual report on the prevalence and trends of infections among people who inject drugs in the UK has been published.

The ‘Shooting Up’ report for 2017, published by Public Health England, highlights trends and information on outbreaks of infection across the UK for that year.

People who inject drugs are vulnerable to a wide range of viral and bacterial infections, which can result in high levels of illness and death. Sharing needles and syringes is a highly effective transmission mechanism for HIV, hepatitis B virus and hepatitis C virus.

Public health surveillance of infectious diseases and associated high-risk behaviours among people who inject drugs can provide important information which can be used to understand the extent of these infections.

Key points of the 2017 report are:

Hepatitis C prevalence remains high and one-half of those infected are undiagnosed

Hepatitis C remains the most common blood borne infection among people who inject drugs, and there are significant levels of transmission among this group in the UK. One-quarter of this population is currently infected with hepatitis C and approximately one-half of those infected are unaware of their HCV infection. The increasing availability of the new directly acting antiviral (DAA) drugs provides an opportunity to reduce morbidity and mortality from hepatitis C, and to decrease the risk of onward transmission.

The proportion of people who inject drugs who report uptake of voluntary confidential testing for hepatitis C has increased across the UK in the last decade. Whilst Scotland has seen a sustained increase, England, Wales and Northern Ireland have seen a more gradual increase in testing which has possibly plateaued over the last 7 years. The sustained increase in Scotland is synchronous with the Hepatitis C Action Plan 2006-2011 and the Scottish Government Sexual Health and Blood Borne Virus Framework 2011-15 as well as the 2015-2020 update which both aimed to increase diagnoses and treatment of hepatitis C among those who inject drugs.

Overall UK HIV levels remain low, but risks continue

In the UK, around 1 in 100 people who inject drugs are living with HIV. Most have been diagnosed and will be accessing HIV care. However, HIV is often diagnosed at a late stage among people who inject drugs.

There is still an ongoing HIV outbreak in Glasgow.

Hepatitis B remains rare, but vaccine uptake needs to be sustained, particularly in younger age groups

In the UK, around 1 in every 500 people who inject drugs is living with hepatitis B infection. About three- quarters of people who inject drugs report being vaccinated against hepatitis B, but this level is no longer increasing, and is particularly low among younger age groups and in those who recently began injecting.

Bacterial infections continue to be a problem

One half of people who inject drugs report having a recent symptom of a bacterial infection. Among people who inject drugs, bacterial infections continue to occur and some have increased in incidence in recent years.

In Scotland, there were 138 MSSA and 1 MRSA bacteraemia cases associated with injecting drug use reported in 2017: this is 9.2% and 1.3% of all MSSA and MRSA bacteraemia cases reported, respectively.

During 2017, there were 2 cases of wound botulism in the UK; 1 confirmed and 1 probable. Both were identified in Scotland.

Injecting risk behaviours have declined but remain a problem

The level of needle and syringe sharing among people who inject drugs has fallen across the UK, but needle and syringe sharing remains a problem, with 1 in 6 reporting sharing of needles and syringes in the past month.

In Scotland, sharing of needles and syringes in the fell from 20% during 2007-08 to 16% in 2016-17 among individuals attending drug treatment services.

In 2015-16, the proportion of people who had injected drugs in the past 6 months in Scotland who reported adequate needle/syringe provision was 73%.

Among those surveyed during 2015-16 at needle and syringe programmes across Scotland, 20% reported that they had experienced an abscess, sore or open wound during the past year.

Changing patterns of psychoactive drug injection remain a concern

The prevalence of risky behaviours associated with injecting drug use, such as groin injecting and the use of stimulants, have significantly increased over the past decade.

In Scotland, among people who had injected drugs during the past 6 months, heroin was the most commonly injected drug, reported by over 90% of those surveyed at services providing injecting equipment between 2008 and 2016. Injection of crack was reported by 3% of those who injected in the last 6 months in 2015-16

Provision of effective interventions needs to be maintained and optimised

The provision of effective harm reduction interventions to reduce risk and prevent and treat infections needs to be maintained. These interventions include needle and syringe programmes (NSP), opioid substitution treatment (OST) and other treatments for drug misuse and dependence. Vaccinations and diagnostic tests for infections need to be routinely and regularly offered to people who inject or have previously injected drugs.

Click here to view the full report