Information IBCA needs to show a person has or had chronic hepatitis B

Overview

A summary of the information IBCA needs to accept that a person claiming compensation had or currently has chronic hepatitis B.

What the regulations say

The Infected Blood Compensation Scheme Regulations state that you are only eligible for compensation if your hepatitis B infection is chronic.

A hepatitis B infection is considered chronic if it lasts more than 6 months. If you were infected with hepatitis B and the infection cleared within 6 months, you are not eligible for compensation.

Most people clear hepatitis B within 6 months. This is often called an acute infection.

Information IBCA needs to show chronic hepatitis B

Supporting information from medical records

We will accept you have chronic hepatitis B if there is one or more pieces of supporting information in your medical records, such as:

2 positive HBsAg (surface antigen) tests taken more than 6 months apart
2 positive PCR (polymerase chain reaction) tests taken more than 6 months apart that show detectable hepatitis B virus DNA
1 positive core antibody anti-HBc (total hepatitis B core antibody) test followed by a positive PCR or HBsAg test more than 6 months later
a written statement from a medical professional that clearly says you have or had a chronic hepatitis B infection
treatment with antivirals for hepatitis B

Your claim manager will try and use your medical records to confirm your diagnosis of chronic hepatitis B. If that is not possible, they may speak to you about getting a current diagnosis.

If information is missing

From the claims completed so far, we know some people do not have information in their medical records that shows they have or had hepatitis B for 6 months.

Your information may be missing because:

your medical records were lost or destroyed
tests did not exist when you were infected and diagnosed
you were tested once but did not get follow-up testing to make sure your hepatitis B infection had cleared

If information in your medical records is missing, your claim manager will speak to you about contacting your GP or clinician. They can help you get a current diagnosis, which may include taking a new test.

Unless you have symptoms of chronic hepatitis B and have never been diagnosed, you do not need to get a new test before you start your claim.

Getting a current chronic hepatitis B diagnosis

Confirming eligibility

Before you get a current diagnosis, your claim manager will confirm you received NHS treatment with infected blood or tissue before 1985, or with blood products before 1989.

It is not probable that someone was infected through NHS treatment after those dates. However, if there is information that shows you were, you can still get compensation.

If you meet those eligibility requirements and get a new positive test result, it will show you have or had chronic hepatitis B.

Statement from a medical professional

If there is limited or missing information in your medical records, the claim manager will first ask your clinician or GP to provide a current diagnosis through a written statement.

This must be a statement of fact and not speculation. We cannot accept a statement that does not provide a clear diagnosis and uses words like "probably" or "possibly".

If a diagnosis is not clear, the claim manager will share all supporting information with one of IBCA's clinical advisors. The clinical advisor will use all available information to provide their specialist medical opinion on whether the hepatitis B infection is or was chronic.

We take this approach to make sure that any medical opinion and decision we make is consistent across all claims.

Current diagnosis through new test results

If your specialist or GP cannot confirm you have or had chronic hepatitis B, your claim manager may suggest you get a new test. You will need to speak to your GP to get a new test.

Most chronic hepatitis B infections stay chronic. That means if you have or had chronic hepatitis B, it is likely you will still test positive. It is possible to have chronic hepatitis B without having any symptoms.

Your claim manager will use your new test results to work out whether you are eligible for compensation for chronic hepatitis B.

It is important you speak to your GP if you have symptoms of chronic hepatitis B. You should also speak to your GP if you believe you have chronic hepatitis B, but do not have symptoms.

Your GP can help you get a current diagnosis and any treatment and medical support you need.

When to get new test results

You do not need to get a new test before you start your claim and speak to your claim manager.

Where it is available, we will always use existing information in your medical records that shows you have chronic hepatitis B. Your claim manager will tell you if they think you should consider speaking to your GP about getting a new test.

At the moment, we only accept test results from NHS facilities. This includes private hospitals, clinics and GPs that use NHS Pathology Services for their diagnostic testing.

Risk of reactivated hepatitis B

It is possible for a hepatitis B virus to reactivate after it has cleared or become inactive. Reactivation is rare and usually happens when a person has a weakened immune system.

If your claim manager thinks you are at risk of reactivated hepatitis B, they will suggest you get a new test. If the test is positive, getting a diagnosis will help you get the support, treatment and regular monitoring you need.

What new test results mean

Before they speak to you about new tests, your claim manager will need to confirm that you received NHS treatment with infected blood or tissue before 1985, or with blood products before 1989.

If you only have one positive historical test result

HBsAg and PCR tests

If you currently have one positive historical HBsAg or PCR test result and get a new positive HBsAg and PCR test result, we can accept you have or had chronic hepatitis B. If only one of the new tests is positive, we can still confirm you have or had chronic hepatitis B.

If both new tests are negative, it is likely that you cleared acute hepatitis B and the infection never became chronic. Unless there is information that shows otherwise, you are not eligible for compensation for hepatitis B.

Antibody test

If you have a historical positive core antibody (anti-HBc) test and get a positive new HBsAg or PCR test, we can accept you have or had chronic hepatitis B.

If you only have a historical positive surface antigen antibody (anti-HBs) test, we do not recommend you take a new HBsAg or PCR test. This is because anti-HBs indicate past infection and immunity, or immunity from vaccination.

We do not expect a person to develop chronic hepatitis B after testing positive for anti-HBs.

If you have no historical test results

If you have no historical test results and get new positive test results from your GP, we can accept you have or had chronic hepatitis B.

If you have no historical test results and get a new negative PCR and HBsAg test result, we cannot accept you have or ever had chronic hepatitis B. You are not eligible for compensation for hepatitis B.

Tests and antibodies explained

HBsAg – a sign of current infection

HBsAg (hepatitis B surface antigen) has been used to screen for hepatitis B infection since the 1970s. It is the first marker to appear in a new acute infection. A person who had acute hepatitis B, where they have spontaneously recovered, will usually get a negative HBsAg test result.

Anti-HBs or HBsAb (surface antibodies) – possible immunity

Anti-HBs or HBsAb (hepatitis B surface antibody) show on a blood test after HBsAg has disappeared. This is when a person has recovered from an acute infection and no longer has the virus. Anti-HBs are a marker of past infection and immunity from vaccination. Based on clinical research and advice, we would not expect someone to develop chronic hepatitis B after testing positive for anti-HBs.

Anti-HBc (core antibodies) – past or current infection

Anti-HBc (total hepatitis B core antibodies) indicate a past or current infection. It is possible for someone to test positive for anti-HBc and develop chronic hepatitis B through reactivation.

Why we take this approach

New testing approach

If a medical professional cannot provide a written diagnosis, new testing is the most robust way to confirm whether you have or had chronic hepatitis B. Getting tested through your GP will make sure you get any treatment and regular monitoring that you need.

Our approach is based on expert clinical opinion and research evidence. We worked with specialist hepatologists (liver specialists) and haematologists (blood specialists), and their research evidence from organisations including the World Health Organization and UKHCDO.

By taking new tests, you can show you are eligible for compensation if you do not have supporting information that confirms your infection is or was chronic. It also makes it possible for people who do not know they have chronic hepatitis B to take a test and find out.