From the Guidelines
Hepatitis B screening is strongly recommended for all adults as part of a wellness exam, especially for those at high risk, including individuals born in countries with high hepatitis B prevalence, household contacts of hepatitis B patients, and those with multiple sexual partners 1.
Key Screening Tests
The screening should include a hepatitis B surface antigen (HBsAg) test and a hepatitis B core antibody (anti-HBc) test.
- Individuals who test positive for HBsAg should undergo further evaluation, including a hepatitis B e-antigen (HBeAg) test, hepatitis B virus DNA (HBV DNA) test, and liver function tests.
- Vaccination against hepatitis B is recommended for all unvaccinated adults, with a series of 2-3 doses of hepatitis B vaccine (Engerix-B or Recombivax HB) administered over 6 months 1.
Booster Doses
Booster doses are not typically recommended, but may be considered for certain high-risk individuals.
Importance of Screening
The importance of screening is highlighted by the fact that approximately 700,000 to 2.2 million persons in the United States have chronic HBV infection, and screening can help identify those who may benefit from treatment or other interventions, such as surveillance for hepatocellular carcinoma 1.
Risk Factors
Risk factors for HBV infection include being from countries with a high prevalence of HBV infection, HIV-positive persons, injection drug users, household contacts of persons with HBV infection, and men who have sex with men 1.
Clinical Considerations
Clinical decisions should be individualized to the specific patient or situation, taking into account the evidence of benefits and harms of screening, as well as other considerations such as cost and patient preferences 1.
From the FDA Drug Label
Screening of pregnant women for hepatitis B is recommended. Considering the serious consequences of infection, immunization should be considered for all persons at potential risk of exposure to the hepatitis B virus. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of all persons from birth to age 18. The role of Hepatitis B screening in wellness programs is to identify individuals at risk of infection and prevent transmission.
- Pregnant women should be screened for hepatitis B to prevent transmission to their infants.
- Immunization should be considered for all persons at potential risk of exposure to the hepatitis B virus.
- Vaccination is recommended for all persons from birth to age 18 2.
From the Research
Role of Hepatitis B Screening in Wellness Programs
- Hepatitis B screening is crucial in identifying individuals infected with the virus, particularly those at high risk, such as persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, and household and sexual contacts of HBV-infected persons 3, 4, 5.
- The US Preventive Services Task Force recommends screening for HBV infection in adolescents and adults at increased risk for infection, with moderate certainty that screening has a moderate net benefit 4.
- Clinical factors associated with hepatitis B screening include end-stage renal disease, alcoholic hepatitis, and cirrhosis or end-stage liver disease, while factors not associated with screening include age, insurance status, history of diabetes mellitus, and human immunodeficiency virus 6.
- Electronic health record tools can be an effective method of increasing hepatitis B screening and vaccination, and guidance on how to identify eligible patients and implement EHR strategies is necessary 7.
High-Risk Groups for Hepatitis B Infection
- Persons born in countries with 2% or higher HBV prevalence 3, 4, 5
- Men who have sex with men 3, 4, 5
- Persons who inject drugs 3, 4, 5
- HIV-positive persons 3, 4, 5
- Household and sexual contacts of HBV-infected persons 3, 4, 5
- Persons with end-stage renal disease, including hemodialysis patients 3, 6
- Persons with chronic liver disease, including cirrhosis or end-stage liver disease 3, 6
Recommendations for Hepatitis B Screening and Vaccination
- The American College of Physicians and the Centers for Disease Control and Prevention recommend vaccinating against hepatitis B virus in all unvaccinated adults at risk for infection, and screening for HBV in high-risk persons 3.
- The US Preventive Services Task Force recommends screening for HBV infection in adolescents and adults at increased risk for infection 4.
- The Centers for Disease Control and Prevention recommend that all adults be screened at least one time in their lives, and that all adults aged 19-59 years and those 60 years and older with risk factors for hepatitis B be vaccinated against the virus 7.