Public health recommendations that all adults be screened for hepatitis B (HB) at least once in their lifetime not only are expected to reduce morbidity and mortality from liver disease but also to create more opportunities to promote vaccination.

“Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available,” according to a new summary from the CDC.

Essentially, public health officials argue that a one-time HBV screening of adults would be “complementary” to the 2022 Advisory Committee on Immunization Practices (ACIP) recommendation to vaccinate all adults aged 19 to 59 years for HBV infection because screening establishes any history of infection, and vaccination protects from future infection and need for additional testing.

In addition to a recommendation for HB screening using three laboratory tests at least once during a lifetime for adults, a new report also expands risk-based testing recommendations to include the following because of the increased risk for HBV infection:

• Those incarcerated or formerly incarcerated in a jail, prison, or other detention setting
• Those with a history of sexually transmitted infections or multiple sex partners
• Those with a history of hepatitis C virus infection.

The report pointed out that universal screening of adults is cost-effective compared with risk-based screening and averts liver disease and death. “Although a curative treatment is not yet available, early diagnosis and treatment of chronic HBV infections reduces the risk for cirrhosis, liver cancer, and death,” according to the guidelines. “Risk-based testing alone has not identified most persons living with chronic HBV infection and is considered inefficient for providers to implement.”

The guidance further advised that using the triple panel (HBsAg [surface antigen of the HBV], anti-HBs [HB surface antibody], and total anti-HBc) is recommended for initial screening “because it can help identify persons who have an active HBV infection and could be linked to care, have resolved infection and might be susceptible to reactivation (e.g., immunosuppressed persons), are susceptible and need vaccination, or are vaccinated.” It added that after someone receives triple panel screening, any future periodic testing can use tests as appropriate (e.g., only HBsAg and anti-HBc if the patient is unvaccinated).

The report also emphasizes the importance of promoting vaccination, which is recommended for all adults aged 19 to 59 years and those aged 60 years and older who have risk factors for HB or without identified risk factors but who are seeking protection.

“After the collection of blood for serologic testing, persons who have not completed a vaccine series should be offered vaccination per ACIP recommendations at the same visit or at an associated provider visit,” according to the CDC. “Blood collection before vaccination is recommended because transient HBsAg positivity has been reported for up to 18 days after vaccination.”

The guidance pointed out that providers do not need to wait for the serologic testing results to administer the first or next dose of vaccine. It added that, while screening “can identify those who are unvaccinated and susceptible to HBV infection, screening should not be a barrier to HB vaccination, especially in populations that have decreased engagement with or access to health care.”

“Universal screening complements a robust HepB vaccination program,” the CDC noted. “Documentation of HepB vaccine administration in the medical record provides verification of vaccination. Per ACIP recommendations, providers should only accept dated records as evidence of HepB vaccination. For persons who are unvaccinated or partially vaccinated (e.g., did not complete a full series), HepB vaccine should be administered immediately after collection of the blood for serologic testing. Persons with evidence of active HBV infection (i.e., HBsAg positive) or a past HBV infection (i.e., total anti-HBc positive) do not need additional vaccine doses.”

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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