CDC Recommends All Adults Should Be Screened for Hepatitis B at Least Once

  • The CDC has updated its hepatitis B testing recommendations, encouraging individuals to be screened for HBV at least once in their lifetime.
  • It’s estimated that two-thirds of individuals with HBV might not know they have the virus.
  • Experts recommend prioritizing screening and vaccination to help individuals remain aware of their HBV risk.
Doctor reviewing test results with patient

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The Centers for Disease Control and Prevention (CDC) recently updated its hepatitis B virus—or HBV—testing recommendations.

According to the CDC, an estimated 580,000 to 2.4 million people are infected with HBV in the United States. An estimated two-thirds of these individuals might not know they are infected. 

“There are typically no symptoms, and therefore patients may feel perfectly normal and not seek testing,” Tatyana Kushner, MD, told Health. Kushner is an associate professor of medicine at the Icahn School of Medicine at Mount Sinai and the medical advisor to the Hepatitis Outreach Network.

Individuals might also not know about their infection status because they have limited access to healthcare or are intimidated by the stigma associated with hepatitis B and are avoiding testing, noted Dr. Kushner.

Hepatitis is a vaccine-preventable, potentially deadly liver infection caused by the hepatitis B virus. While for some people, hepatitis B is a short-term illness, for others, it can be a chronic disease.

To catch early cases and connect patients to treatment, the Centers for Disease Control and Prevention updated its HBV recommendations in March.

Updated Hepatitis B Screening Recommendation

The CDC now offers these HBV recommendations: 

  • All adults aged 18 years and older should be screened at least once in their lifetime with three lab tests.
  • Periodic risk-based testing should be expanded to people incarcerated, people with multiple sex partners, people with a history of sexually transmitted infections, and people with hepatitis C virus infection.
  • Anyone who requests HBV testing should receive it regardless of whether or not they are at risk.

The CDC continues to recommend that all pregnant people should be tested during each pregnancy, regardless of their vaccination status and if they’ve been tested before.

So, Why the Update?

The number of people unaware of their infection underscores the need for increased testing, said Erin Conners, PhD, of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. 

“Research shows that one-time universal screening of adults is cost-effective, and most importantly, results in improved outcomes,” Dr. Conners told Health

This means preventing liver disease, liver cancer, and death. 

The updated CDC recommendations support an objective outlined in the Viral Hepatitis Strategic Plan developed by the U.S. Department of Health and Human Services: to have 90 percent of people with an HBV infection be aware of their infection by 2030. Between 2013 and 2016, just 32 percent of people with an HBV infection were aware of it. 

David Hutton, PhD, an associate professor of health management and policy at the University of Michigan School of Public Health, told Health this is an optimistic but achievable goal. Increased awareness about the need to screen, along with improved processes in health systems—like automation for default one-time testing in electronic medical record systems—will help hit this target. 

“I think the CDC is being careful and thoughtful about HBV updates,” Dr. Hutton explained. “The current guidance for one-time screening for adults is a good recommendation.” 

Warning Signs of Hepatitis B

Most people don’t look or feel sick when infected with hepatitis B. However, symptoms can emerge. For example, some signs of short-term hepatitis B include fever, fatigue, dark urine, and nausea. According to the CDC, symptoms can start between eight weeks and five months after exposure. But on average, they begin three months after exposure.

People with chronic hepatitis B can remain symptom-free for decades. While eventual symptoms can mirror those linked to acute infections, these can also indicate advanced liver disease. Chronic hepatitis B is linked to liver damage, liver failure, liver cancer, and death. Approximately 1,752 deaths were related to HBV in 2020—though the CDC states this is likely an underestimate.

Getting Tested for HBV

Ideally, care providers will bring up HBV screening with patients, but patients should also ask about it, Dr. Hutton encouraged.

The decision to test for HBV will be based on whether patients are vaccinated for HBV, if they’ve ever been tested, and if there are factors that increase the patient’s risk for HBV infection and would indicate the need for periodic testing, explained Dr. Connors.

“Hepatitis B screening can be done at any routine doctor’s appointment,” said Dr. Connors. “We suggest that people ask their doctor the next time they have an appointment.”

Who Should Test for HBV?

Previously, the CDC only recommended the screening of higher-risk individuals. The new recommendation is that all adults should test at least once. The younger a person is when they are infected with HBV, the more likely they are to develop chronic hepatitis B.

Meanwhile, people with ongoing or new risk factors for HBV should be screened more than once, recommended Dr. Kushner.

An especially important population to test is pregnant women, Dr. Kushner said. It is critical to test during prenatal care during each pregnancy so that providers and patients can take the necessary steps to prevent transmission. In practice, this means providing the hepatitis B vaccine and the hepatitis B immune globulin injection to the infant within 12 hours of birth. 

“Given the risk of vertical transmission of hepatitis B to the baby, it is absolutely critical to screen during pregnancy,” Dr. Kushner explained.

How to Prevent HBV

HBV spreads when an uninfected person comes into contact with an infected person’s blood, semen, and other bodily fluids. It is most commonly transmitted from a mother to child during birth and delivery. It can also be spread through sex with a partner with hepatitis B, sharing contaminated needles, and sharing contaminated razors, among other ways. It is not transmitted through kissing, sneezing, or breastfeeding.

Hepatitis B vaccination is very effective at preventing HBV infection and subsequent liver disease, but 70 percent of adults in the United States are unvaccinated.

This disparity may partly be explained by the timing of the vaccine’s availability, noted Dr. Hutton. The hepatitis B vaccine became available in 1982, and in 1997 the Advisory Committee on Immunization Practices (ACIP) expanded its hepatitis B vaccination recommendations to include all children under 18. People who were children before this change missed the window for early vaccination.

To close this vaccination gap, in 2022, the ACIP recommended HBV vaccination for all between 19 and 59.

Treatment for Hepatitis B

While seven medications are approved to treat chronic hepatitis B, there is no medicine for acute hepatitis B. Instead, people with mild symptoms are recommended fluids, healthy meals, and rest.

However, no medication totally eradicates the virus. While new drugs are in development, there is no cure for now. This reality reinforces why experts view screening as a meaningful step toward connecting people to help sooner. 

Dr. Conners concluded, “Although a cure is not yet available, early diagnosis, monitoring, and treatment of chronic HBV infections reduce the risk for cirrhosis, liver cancer, and death.”

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