CDC calls for all U.S. adults to be screened for hepatitis B

All adults should undergo triple-panel screening at least once in their lives, and screening should be repeated during the first trimester of every pregnancy, the CDC said.

The CDC updated its recommendations last week to call for hepatitis B virus (HBV) screening of all U.S. adults.

The recommendations, which became CDC policy when published by MMWR on March 10, update those published in 2008 and represent a significant expansion in the population recommended for screening and testing.

The CDC now calls for screening of all adults aged 18 years or older at least once during their lifetimes. That screening should entail testing for hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc), the CDC said, noting that the triple panel can help identify patients who have an active HBV infection and could be linked to care or have resolved infection and might be susceptible to reactivation.

After collection of blood for serologic testing, patients who are not already vaccinated against HBV should be offered vaccination, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) in 2022. The new recommendations note that it is not necessary to wait for the serologic testing results to administer the first or subsequent dose of vaccine.

The CDC is now also recommending screening during every pregnancy, preferably in the first trimester, regardless of a patient's vaccination status or history of testing. Testing is also still recommended for everyone with a history of risk for hepatitis infection, regardless of age, and those with ongoing risk should be retested periodically while their risk persists. The recommendations list risk factors for HBV, including a few that were newly added with this update: current or past incarceration, current or past hepatitis C infection, and current or past sexually transmitted infections or multiple sex partners. The recommendations note that anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

“The recommendations were supported by peer reviewers who are experts in the field as well as the majority of public comments,” the recommendations said. “These recommendations consider a simpler and less stigmatizing implementation strategy than previous risk-based HBV screening recommendations. The recommendations also provide guidance that is complementary to the 2022 ACIP recommendations to vaccinate all adults aged 19–59 years against HBV infection by providing a means to establish immunity or any history of infection or the need for vaccination to protect from future infection.”