SUMMARY:

Hepatitis B is a common viral infection that affects the liver and, if left untreated, can lead to cirrhosis, hepatocellular carcinoma, and fulminant liver failure. When detected early patients with Hepatitis B virus (HBV) can be monitored closely for the development of liver damage and receive appropriate therapies to prevent complications. The CDC issued new guidance in March of 2023 for the screening and testing of HBV which focuses on universal screening for all adults and periodic screening for those at higher risk. 

Universal Screening

• All adults aged 18 and older should be screened at least once with a triple panel HBV test regardless of vaccination history
  • Triple panel testing includes: Hepatitis B surface antigen (HBsAg) | Hepatitis B surface antibody (anti-HBs) | Total antibody to Hepatitis B core antigen (anti-HBc)
  • If there is suspicion for acute HBV infection IgM antibody to hepatitis B core antigen (IgM anti-HBc) may be ordered as well
• All patients who request HBV screening should be tested with a triple panel test regardless of the presence of risk factors

Pregnancy

• All pregnant patients should be tested for HBsAg, and testing should be repeated with each pregnancy regardless of vaccination status or testing history 
  • If the patient has never had a triple panel test, then that should be obtained instead of an HBsAg 
  • HBsAg testing can then be used in subsequent pregnancies if prior triple panel test was negative, and no new exposures have occurred  

Periodic Testing

• Patients should be periodically reassessed for activities, exposures, or new conditions that increase their risk of HBV and offered repeat HBV testing if they are unvaccinated (or if exposure occurred prior to a recent vaccination)
• Periodic risk-based testing continues to be recommended and has been expanded to include people who
  • Are incarcerated or formerly incarcerated
  • Have a history of a STI
  • Are sexually active with multiple partners
  • Are infected with HCV or history of HCV
  • People who inject drugs or have a history of injection drug use | history of sharing needs with HBV infected contacts
  • People with HIV infection
  • Men who have sex with men
  • Household contact or former household contacts of people with known HBV infection
  • People on maintenance dialysis, including in-center o home hemodialysis and peritoneal dialysis
  • People with elevated liver enzymes
  • Infants born to HBsAg-positive people
  • People born in regions with HBV infection prevalence of ≥ 2%
  • US born people not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of > 8%

Note: For a full list of risk factors please visit the CDC screening website below

USPSTF Recommendations

• At present, the USPTF only recommends screening for adults at increased risk for Hepatitis B with Hepatitis B surface Ag testing

Learn More – Primary Sources

CDC Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection (HBV)

Related PcMed Topics:

USPSTF Recommends Universal Screening for Hepatitis C