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New Guidelines for Hepatitis B Screening

U.S. Preventive Services Task Force this week released updated guidelines for hepatitis B virus (HBV) screening for adults. The draft recommendations call for screening of high-risk individuals including people with HIV, gay men, people who inject drugs, and people from parts of the world where hepatitis B is common.

HBV is transmitted primarily through contact with blood. Most people infected as adults naturally clear the infection, but up to 10% develop chronic infection lasting more than 6 months. Those infected as infants are much more likely to become chronic carriers, and mother-to-child transmission is common in some regions where hepatitis B is endemic. In recent years, however, hepatitis B incidence has fallen worldwide thanks to widespread vaccination.

An estimated 700,000 to 1.4 million people in the U.S. are thought to have chronic hepatitis B, according to the draft statement's background information. But many remain unaware that they are infected, and therefore do not receive treatment or follow-up care. Over years or decades, chronic hepatitis B can lead to serious liver disease including cirrhosis and liver cancer.

The USPSTF makes recommendations about the effectiveness of preventive services for people without related signs or symptoms. It bases its recommendations on evidence of both benefits and harms and an assessment of the balance between them. Cost is not considered in the analysis.

In 2004 USPSTF recommended against HBV screening for asymptomatic people in the general population, since this does not improve long-term health outcomes such as cirrhosis, hepatocellular carcinoma, or mortality. HBV prevalence is low in the U.S. general population, and the majority of infected individuals do not develop chronic infection, cirrhosis, or HBV-related liver disease. The current recommendations continue to advise against screening of the general population or of any specific age group (such as the recommendation that all Baby Boomers born between 1945 and 1965 get screened for hepatitis C).

The Centers for Disease Control and Prevention (CDC) and the American Association for the Study of Liver Diseases (AASLD) recommend HBV screening for high-risk individuals including all foreign-born people from regions with a hepatitis B prevalence of greater than 2%, people born in the U.S. who were not vaccinated and whose parents were born in high-prevalence regions, injection drug users, men who have sex with men, household contacts and sex partners of people with hepatitis B, kidney dialysis patients, and immune-compromised people including those with HIV. CDC also recommends HBV screening for blood or tissue donors and people with occupational or other exposures to infectious blood or body fluids, while AASLD also advises screening for people with multiple sex partners or a history of sexually transmitted diseases, inmates of correctional facilities, and individuals with hepatitis C.

The full draft of the hepatitis B screening statement is available online, along with a fact sheet summarizing the recommendations. The draft is open for comment until March 10.

Below is an edited excerpt from a U.S. Preventive Services Task Force press release describing the new draft recommendations.

U.S. Preventive Services Task Force Seeks Comment on its Draft Recommendation Statement on Hepatitis B Screening for High-Risk Adults

Washington, D.C. -- February 11, 2014 -- The U.S. Preventive Services Task Force (Task Force) today posted its draft recommendation statement and draft evidence report on screening for hepatitis B virus infection, recommending screening people who are at high risk for hepatitis B infection. The Task Force is providing an opportunity for public comment on this draft recommendation statement and evidence report until March 11. All public comments will be considered as the Task Force develops its final recommendation and statement.

Today, most people born in the United States have been vaccinated for hepatitis B, which is the best way to prevent the infection. However, there still are almost 1 million people in the U.S. chronically infected with hepatitis B virus (HBV) infection. Among individuals with chronic HBV infection, 15 to 25 percent die from liver disease (cirrhosis) or liver cancer.

After reviewing the evidence, the Task Force’s is recommending screening people who have the following risk factors for hepatitis B:

• People who were born in countries and regions with a high prevalence of HBV infection, such as Africa, Southeast Asia, Middle East, Eastern Europe, and the northern countries in South America.
• U. S.-born persons not vaccinated as infants whose parents were born in regions with a high prevalence of HBV infection.
• People who are HIV positive, injection drug users, and men who have sex with men.
• Patients who are have a weakened immune system or undergo treatment for kidney failure 
(hemodialysis).

The most important way to prevent hepatitis B is to get vaccinated. "The United States has universal vaccination of all infants at birth, catch-up vaccination of adolescents, and vaccination of high-risk groups. Fortunately, most people in the U.S. are no longer at risk of getting hepatitis B," says Task Force member Mark Ebell, MD, MS. "Because some countries have high rates of HBV infection, it is important for immigrants from those countries and their doctors to be aware of their risk status and screen them if appropriate."


"The good news is that evidence shows we can catch the disease early in many people who are already infected by screening for hepatitis B virus infection in persons at high risk for infection," says Douglas K. Owens, MD, MS. "And, treatment can help prevent liver cancer in people who have chronic hepatitis B infection."

The Task Force’s draft recommendation statement and evidence report have been posted for public comment on the Task Force Web site at: www.uspreventiveservicestaskforce.org. Comments can be submitted February 11 to March 10, 2014 at www.uspreventiveservicestaskforce.org/tfcomment.htm.

The Task Force is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

2/14/14

Reference

U.S. Preventive Services Task Force. Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement. February 2014.

Other Sources

U.S. Preventive Services Task Force. U.S. Preventive Services Task Force Seeks Comment on its Draft Recommendation Statement on Hepatitis B Screening for High-Risk Adults. Press release. February 11, 2014.

U.S. Preventive Services Task Force. Screening for Hepatitis B Virus Infection in Non-Pregnant Adolescents and Adults. Fact Sheet. February 2014.

National Viral Hepatitis Roundtable. USPSTF Releases Draft Hepatitis B Screening Recommendations. Press release. February 10, 2014.