CDC and NIH Call for More Hepatitis B Testing

Guidelines published on September 18 in CDC’s Morbidity and Mortality Weekly Report newly recommend testing for all individuals born in Asia and Africa, men who have sex with men, patients on immunosuppressive drugs, injection-drug users, and people with unexplained abnormal results on liver function tests. The guidelines also reinforce past CDC recommendations to test all pregnant women, infants born to infected mothers, household contacts and sex partners of infected individuals. Also reiterated in the updated guidelines are past recommendations for testing people with HIV and those who may have been exposed to infected blood, such as health care workers with needlestick injuries.

Likewise, a NIH consensus statement released October 22 by a panel of health care professionals calls for routine screening of all immigrants newly arrived to the United States from areas of the world with greater than 2% prevalence of hepatitis B. Identification of infected individuals would not preclude them from immigrating but would help them gain access to care and treatment and would provide important information on prevalence of the disease.

In the United States, chronic hepatitis B is the underlying cause of an estimated 2,000 to 4,000 deaths each year from cirrhosis and liver cancer. The call for wider testing is intended to spur more early diagnosis of chronic hepatitis B virus infection (HBV). Many of the estimated 800,000 to 1.4 million Americans with HBV have no symptoms and are unaware of their disease, according to the CDC.

“Chronic hepatitis B affects the lives of more than one million Americans, many of whom do not even know they are infected. These new recommendations are critical to identifying people who are living with the disease without the benefits of medical attention,” said John W. Ward, M.D., director of CDC′s Division of Viral Hepatitis. “Testing is the first step to identify infected persons so that they can receive lifesaving care and treatment, which can break the cycle of transmission, slow disease progression, and prevent deaths from liver cancer.”

Both CDC and NIH call for testing not only all people born in Asia and Africa but also other geographic regions where at least 2% of the population is known to have chronic HBV. While previous recommendations suggested testing people born in areas with 8% prevalence or higher, the high rate of chronic HBV among the U.S. population born in these areas makes testing people from areas with lower HBV incidence essential. It is important, too, for children born in the U.S. to mothers who are from these areas to be screened for HBV infection even if they received the vaccine because they may have contracted the disease from their mother prior to vaccination. Nearly 1 in 12 Asian Americans and Pacific Islanders living in the United States is HBV-infected, and one-third or more are unaware of their condition, CDC says.

The new CDC recommendations focus on men who have sex with men (MSM) and injection drug users (IDUs) for routine testing because these groups have a higher prevalence of chronic HBV infection than the overall U.S. population. Up to 3% of MSM and up to 6% of IDUs are estimated to be chronically infected with HBV, compared to 0.3% of the general population.

Also new in the updated guidelines and consensus statement are recommendations for health professionals’ effective management of chronically infected hepatitis B patients. All of these patients need lifelong monitoring, while those who also have HIV will require more complicated treatments, according to CDC and NIH.

The guidelines also call upon health departments to establish registries of chronic HBV patients, much like those that have been created to track HIV. CDC says information collected in the registries will help health departments determine which chronic HBV cases are new, aid communication between patients and physicians, and track follow-up.

Sources

Weisbaum, C. et al. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Morbiditiy and Mortality Weekly Report. September 18, 2008. Volume 57 (RR08). Pages 1-28. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm. Accessed November 2008.

Centers for Disease Control and Prevention Press Release. CDC Expands Testing Recommendations For Chronic Hepatitis B Virus Infection. September 18, 2008. Available online at http://www.cdc.gov/media/pressrel/2008/r080918.htm?s_cid=mediarel_r080918_x. Accessed November 2008.

(Oct. 22, 2008) National Institutes of Health. NIH Press Release, Panel Advocates Improved Understanding of Hepatitis B and Screening of High-Risk Populations. Available online at http://www.nih.gov/news/health/oct2008/od-22.htm. Accessed November 2008.

(Oct 22, 2008) National Institutes of Health Consensus Development Conference Statement, Management of Hepatitis B. PDF available online at http://consensus.nih.gov/2008/hebB%20draft%20statement%20102208_FINAL.pdf through http://consensus.nih.gov. Accessed November 2008.