Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023

Abstract

Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available. This report updates and expands CDC's previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection (MMWR Recomm Rep 2008;57[No. RR-8]) regarding screening for HBV infection in the United States. New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years. The report also expands risk-based testing recommendations to include the following populations, activities, exposures, or conditions associated with increased risk for HBV infection: persons incarcerated or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. In addition, to provide increased access to testing, anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

Prevalence and awareness of Hepatitis B virus infection in the United States: January 2017 - March 2020

“… 5 However, studies in communities and health care systems demonstrate testing rates of only 22%–76% among non–US-born persons. 6 , 7 One-time universal screening for all adults in the US is now recommended, 8 and some state and local health departments are planning towards the elimination of hepatitis B. 9 Respectful ongoing outreach to non–US-born persons is also needed to improve testing and increase awareness.…”

Viral Hepatitis in Pregnancy

“…Pregnant patients should be screened for hepatitis B virus infection at the first prenatal visit of each pregnancy (12,(26)(27)(28). The HBsAg test should always be performed regardless of prior vaccination.…”

Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination

“…The updated screening guidelines also newly recommend periodic testing for an expanded list of risk factors among persons currently or formerly incarcerated, persons with a history of hepatitis C virus infection, persons with a history of sexually transmitted infections or multiple sex partners, and anyone who requests hepatitis B testing. Every person should know their HBV status …”

“…Every person should know their HBV status. 1 Universal hepatitis B screening of adults complements the 2022 ACIP recommendation for universal hepatitis B vaccination of adults aged 19 to 59 years (in addition to adults >59 years with risk factors for HBV infection or who request vaccination) to protect the large unvaccinated adult population from hepatitis B. Although the new ACIP recommendation does not require adults to receive prevaccination hepatitis B testing, when feasible, the triple panel can save vaccination costs by identifying adults who do not need additional vaccine doses (ie, people who test positive for HBsAg or antibody to hepatitis B core antigen).…”

“…New Centers for Disease Control and Prevention (CDC) recommendations for onetime universal screening of adults aged 18 years and older for hepatitis B virus (HBV) infection are a major step toward reducing chronic hepatitis B (CHB)–related morbidity and mortality in the US, in which an estimated 1.6 million to 2.4 million people are living with CHB . Although the burden of CHB is greatest among people born outside the US, any US resident, regardless of country of birth, socioeconomic status, or race, can be infected with HBV.…”