Hepatitis B: Part I. Updates on Screening and Prevention

Up to 2.4 million people in the United States and 254 million people worldwide have acute or chronic hepatitis B virus infection. The virus is transmitted by blood and body fluid, and approximately two-thirds of people with a chronic infection in the United States are unaware of their diagnosis. The Centers for Disease Control and Prevention recommends screening all adults at least once with triple panel testing (measurement of hepatitis B surface antigen, antibodies to hepatitis B surface antigen, and antibodies to hepatitis B core antigen) because antiviral therapy can reduce associated morbidity and mortality. Screening is also recommended during each pregnancy to reduce the risk of vertical transmission. Nonimmune patients with higher risk of exposure should be screened periodically and, if eligible, vaccinated. Only 30% of adults in the United States are vaccinated for hepatitis B. Recommendations for routine vaccination have expanded to include all children, beginning with a birth-dose vaccine; all adults 19 to 59 years of age; and adults 60 years and older at higher risk of exposure. High rates of adult and childhood vaccination, improved diagnoses of chronic hepatitis B, and broader access to care are essential to eliminate hepatitis B in the United States.