CDC Recommendation for Universal Hepatitis B Screening
Recently, on March 10th, 2023, the Centers for Disease Control & Prevention (CDC) issued a new recommendation that states that all adults (over 18) should be screened for hepatitis B.
Hepatitis B (HBV) is transmitted when infected blood, semen, or body fluids from a person infected with HBV enters the body of someone not infected [1]. This can occur from mother to baby at birth, through sharing needles or syringes, or during sexual contact. HBV disproportionately affects Asians and Black people who are 9 times and 2.5 times more likely to die from hepatitis B–related complications than non-Hispanic White persons respectively [2]. It is estimated that 1.6 million to 2.4 million people are living with HBV infection in the United States, yet two-thirds of them may be unaware of their infection, highlighting the importance of screening [3].
To interpret screening tests to determine HBV infection status, three main serologic markers are used: hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc). Serologic markers change over typical courses of resolved acute infection and progression to chronic infection.
The new CDC recommendation provided updates and expanded the CDC’s previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. To further reduce chronic hepatitis B morbidity and mortality in the US, CDC introduced new risk-based testing recommendations to include populations, activities, exposures, or conditions associated with increased risk for HBV infection [2].
California paved the way for hepatitis B and C elimination with Assembly Bill 789. As of 2022, all primary care clinics are required by law to offer their adult patients in California a hepatitis B and hepatitis C screening test and provide follow-up hepatitis-directed care and treatment if they tested positive [4]. Since then, all primary care clinics affiliated with Stanford Health Care have added hepatitis B and C screening as a health maintenance alert in electronic health records.
While the bill and CDC’s new recommendations have been significant and unprecedented, efforts still need to be made to spread awareness and ensure that healthcare providers beyond Stanford, where the Asian Liver Center is located, are familiar with AB 789. As the law is still fairly new, more practicing doctors need to be informed to include reminders on each patient’s EHR records of screening across the state to reach all eligible patients to take advantage of the screenings.
References
[1] Office of Infectious Disease and HIV/AIDS Policy (OIDP). “Hepatitis B Basics.” HHS.gov, 30 Nov. 2022, https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html.
[2] So S, Terrault N, Conners EE. Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination. JAMA. Published online March 10, 2023. doi:10.1001/jama.2023.2806
[3] “Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Mar. 2023, https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm?s_cid=rr7201a1_w.
[4] “Bill Tracking in California - AB 789 (20212022 Legislative Session).” FastDemocracy, 16 Feb. 2021, https://fastdemocracy.com/bill-search/ca/20212022/bills/CAB00022172/.