According to the United States Preventive Services Task Force (USPSTF), approximately 700,000 to 2.2 million people in this country have chronic infection with hepatitis B virus (HBV). Many of these people are unaware that they are infected.
HBV is one of five "hepatitis viruses" identified so far that are known to mainly infect the liver. It is spread through contact with blood or other body fluids from an infected person, such as during sex or by sharing needles, razors or toothbrushes, and can also be passed from an infected mother to her baby during or after birth.
HBV infection can be acute or chronic, with the course of infection varying from a mild form that lasts only a few weeks to a more serious form lasting years that can lead to complications such as cirrhosis or liver cancer. According to the Centers for Disease Control and Prevention (CDC), approximately 2,000-4,000 people die every year in the U.S. from HBV-related liver disease.
The vast majority of those with chronic infections will have no symptoms. A test for hepatitis B surface antigen (HBsAg) may be used for screening asymptomatic people who fall into one of the high-risk categories for chronic HBV. Effective vaccines against HBV are available; however, those who have not been vaccinated or who are at high risk and were vaccinated before being screened for HBV infection may want to consider getting tested.
According to the USPSTF, in the U.S., people considered at high risk for HBV infection include those from countries with a high prevalence of HBV infection, those who are HIV-positive, injection drug users, household contacts of those with HBV infection, and men who have sex with men. Since the prevalence of HBV infection is low in the general U.S. population and most of those infected do not develop complications, HBV screening is not recommended for those who are not at increased risk.
In 2008, the CDC revised its guidelines to recommend that the following groups be screened for HBV:
- Healthcare and public safety workers
- People born in areas of the world that have a greater than 2% prevalence of HBV (for example, much of Asia and Africa)
- People born in the U.S. but who were not vaccinated and whose parents are from an area with greater than 8% prevalence of HBV
- Men who have sex with men
- People who have elevated liver enzymes (ALT and AST) with no known cause
- People with certain medical conditions that require that their immune system be suppressed, such as organ transplant recipients
- Pregnant women
- People who are in close contact with someone infected with HBV
- Those infected with HIV
In 2014, the USPSTF updated its statement to recommend screening for HBV among asymptomatic, non-pregnant adolescents and adults in certain high-risk groups, bringing their recommendations into line with those of the CDC. The USPSTF had previously published the recommendation for HBV screening during pregnancy.
Why get tested?
People with chronic HBV can unwittingly spread the infection to others and remain at risk for serious complications of the infection.
Sources Used in Current Review
USPSTF Urges HBV Screening for High-Risk People. By Michael Smith. MedPage Today. Published May 27, 2014. Available online through http://www.medpagetoday.com. Accessed June 2014.
USPSTF Recommends Hepatitis B Screening for High-Risk Groups. By Amy Orciari Herman. May 27, 2014. Journal Watch. Available online at http://www.jwatch.org/fw108870/2014/05/27/uspstf-recommends-hepatitis-b-screening-high-risk-groups?query=pfw through http://www.jwatch.org. Accessed June 2014.
Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force. Annals of Internal Medicine. Article published online 27 May 2014. Available online at http://annals.org/article.aspx?articleid=1874740 through http://annals.org. Accessed June 2014.
Centers for Disease Control and Prevention. Hepatitis B FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/b/bFAQ.htm#statistics through http://www.cdc.gov. Accessed June 2014.
Centers for Disease Control and Prevention. Hepatitis B Information for the Public. Available online at http://www.cdc.gov/hepatitis/B/index.htm through http://www.cdc.gov. Accessed June 2014.
Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. Recommendations and Reports. September 19, 2008 / 57(RR08);1-20. Morbidity and Mortality Weekly Report. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm through http://www.cdc.gov. Accessed June 2014.