This article was originally published in ContagionLive.

The US Centers for Disease Control and Prevention (CDC) has announced recommendations for screening and testing for hepatitis B virus (HBV), calling for all adults in the US to be universally tested for HBV at least once in their lifetime and to test for total antibody to HBcAg, which may determine HBV in the window period and pick-up recent infection.¹

The new guidance, which is the first update since 2008, is aimed at providing more awareness around HBV and getting more people involved in the continuum of care. CDC is also expanding continual risk-based testing to include more groups, activities, exposures, and conditions, while noting the limitations to risk-based testing.

“Risk-based testing alone has not identified most persons living with chronic HBV infection and is inefficient for providers to implement,” the authors wrote.

Listed below are the new screening/testing HBV recommendations put forth:

Universal HBV screening

• HBV screening at least once during a lifetime for adults aged ≥18 years (new recommendation)
• During screening, test for hepatitis B surface antigen (HBsAg), antibody to HBsAg, and total antibody to HBcAg (total anti-HBc) (new recommendation)

Screening pregnant persons

• HBV screening for all pregnant persons during each pregnancy, preferably in the first trimester, regardless of vaccination status or history of testing

• Pregnant persons with a history of appropriately timed triple panel screening and without subsequent risk for exposure to HBV (i.e., no new HBV exposures since triple panel screening) only need HBsAg screening

Risk-based testing

• Testing for all persons with a history of increased risk for HBV infection, regardless of age, if they might have been susceptible during the period of increased risk
• Periodic testing for susceptible persons, regardless of age, with ongoing risk for exposures, while risk for exposures persists

A Need for Greater Public Awareness

HBV awareness remains a significant health care challenge, despite existing therapies to treat it as well as prophylactic HBV vaccines to prevent it. It’s estimated that more than half of patients with HBV are unaware of their infection, mainly because virus presents asymptomatically in the majority of positive cases. Some people do eventually develop chronic hepatitis (elevation of AST/ALT), cirrhosis, or liver cancer.

Although there is no cure for HBV, treatment with any of the number of multiple antivirals available can make the virus a manageable, chronic condition.

On the vaccine side, there are prophylactic HBV vaccines, but uptake is limited. It has been reported that 70% of adults in the US were unvaccinated as of 2018.

Future Considerations

In addition to the comprehensive screening and testing updates, the authors would like to see continued collaboration with laboratories to bundle the three HBV tests so they can be ordered together. And they also acknowledge the need to understand hepatitis D (HDV) more effectively to guide future recommendations for HDV screening among persons with HBV infection.

References:

Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023. MMWR Recomm Rep 2023;72(No. RR-1):1–25. DOI: http://dx.doi.org/10.15585/mmwr.rr7201a1.