Adults should be tested for hepatitis B virus (HBV) at least once in their lifetime, according to updated guidelines from the Centers for Disease Control and Prevention (CDC).
This is the first update to HBV screening guidelines since 2008, the agency said.
“Risk-based testing alone has not identified most persons living with chronic HBV infection and is considered inefficient for providers to implement,” the authors write in the new guidance, published in the CDC’s Morbidity and Mortality Weekly Report. “Universal screening of adults for HBV infection is cost-effective compared with risk-based screening and averts liver disease and death. Although a curative treatment is not yet available, early diagnosis and treatment of chronic HBV infections reduces the risk for cirrhosis, liver cancer, and death.”
An estimated 580,000 to 2.4 million individuals are living with HBV infection in the United States, and two thirds may be unaware they are infected, the agency said.
The virus spreads through contact with blood, semen, and other body fluids of an infected person.
The guidance now recommends using the triple panel (HBsAg, anti-HBs, total anti-HBc) for initial screening.
“It can help identify persons who have an active HBV infection and could be linked to care; have [a] resolved infection and might be susceptible to reactivation (eg, immunosuppressed persons); are susceptible and need vaccination; or are vaccinated,” the authors write.
Pregnant people should be screened ideally in the first trimester of each pregnancy, regardless of vaccination status or testing history. Pregnant people who have already received timely triple panel screening for hepatitis B and who have no new HBV exposures only need HBsAg screening, the guidelines state.
The document added three groups at a higher risk for HBV infection: those incarcerated or formerly incarcerated, people with current or past hepatitis C virus infection, and people with current or past sexually transmitted infections and multiple sex partners. Those at higher risk for HBV should be screened periodically, based on shared decision-making between the provider and patient as well as individual risk and immune status.
Additional research into the optimal frequency of periodic testing is necessary, the authors say.
“Along with vaccination strategies, universal screening of adults and appropriate testing of persons at increased risk for HBV infection will improve health outcomes, reduce the prevalence of HBV infection in the United States, and advance viral hepatitis elimination goals,” the authors write.
MMWR Recomm Rep. Published March 10, 2023. Full text
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