Which of the following is the most effective strategy to prevent hepatitis b infection?

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Summary

The last 50 years of hepatitis B research has resulted in the development of effective screening assays for surveillance, vaccines for prevention and antiviral drugs that significantly improve patient clinical outcomes. Not surprisingly then, the global epidemiology of hepatitis B virus [HBV] is set to change dramatically over the next decade. For example, the success and the high coverage of universal HBV vaccination and the ageing cohorts of patients with chronic hepatitis B [CHB] will result in reductions of incidence and prevalence of chronic hepatitis, cirrhosis and probably hepatocellular carcinoma. This will be further accelerated by the impressive progress in the treatment outcomes for patients with CHB. In spite of this success, challenges remain, such as planning for the impact of migration from countries with high prevalence rates to those countries with low rates of HBV infection. The recent establishment of the World Health Organisation Global Hepatitis Program with the provision of a framework for global action has become the cornerstone for all countries to now frame their own particular national responses to control hepatitis B. An effective policy framework can prevent new infections, ensure people can access clinical care, and in doing so reduce the burden of infection at an individual, country and regional level. These developments present a real opportunity to reduce the significant, social and economic burden of global hepatitis B, ultimately the critical next steps to render the world hepatitis B free.

Keywords

Epidemiology

Prevention

Hepatitis B vaccine

Acute hepatitis B

Chronic hepatitis B

Treatment

Chronic liver disease

Hepatocellular carcinoma

Public policy

WHO

© 2015 European Association for the Study of the Liver. Published by Elsevier B.V.

• All medically stable infants weighing ≥2,000 grams are recommended to receive the hepatitis B vaccine within the first 24 hours following birth.
• All adults aged 19 through 59 years and adults ≥60 years with risk factors for hepatitis B or without identified risk factors but seeking protection are recommended to receive the hepatitis B vaccine.
• Progress toward hepatitis B elimination has stalled. Since 2012, the rate of reported acute hepatitis B cases has ranged from 0.9 to 1.1 per 100,000 population.
• New hepatitis B infections are highest among people aged 30-59 years because many people at risk in this group have not been vaccinated as recommended.

Topics on this page: What Is Hepatitis B? | How Many People Have Hepatitis B? | Who Is Most Affected? | HIV and HBV Coinfection | How Is Hepatitis B Transmitted? | HBV Prevention | Testing | Treatment | Help Raise Awareness About Hepatitis B | Learn More About Hepatitis B

What Is Hepatitis B?

Hepatitis B is a liver infection caused by the hepatitis B virus [HBV]. HBV infection causes inflammation of the liver. When the liver is inflamed or damaged, its function can be affected.

• The best way to prevent HBV infection is by getting vaccinated. Safe and effective vaccines are available and covered as a preventive service by most health plans.
• Hepatitis B is transmitted when blood, semen, or another body fluid from a person infected with HBV enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth.
• For some people, HBV infection is an acute, or short-term, illness; for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2-6% of adults.
• Chronic hepatitis B can lead to cirrhosis, liver cancer, liver failure, and premature death.
• Hepatitis B is diagnosed with a simple blood test that can detect HBV infection years before symptoms develop and the virus has caused liver damage.
• There is no cure for hepatitis B, but there are several FDA-approved medications that treat HBV infection. People with chronic hepatitis B should be monitored regularly for signs of liver disease and evaluated for possible treatment.

How Many People Have Hepatitis B?

In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2019, 3,192 cases of acute hepatitis B were reported; however, because of low case detection and reporting, the Centers for Disease Control and Prevention [CDC] estimates that there were 20,700 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.

Globally, HBV is the most common blood-borne infection with an estimated 296 million people infected according to the World Health Organization .

Who Is Most Affected?

In the United States, rates of new HBV infections are highest among adults aged 30-59 years, reflecting low hepatitis B vaccination coverage among adults at risk. The most common risk factor among people with new HBV infections is injecting drugs, related to the opioid crisis.

The highest rates of chronic hepatitis B infection in the United States occur among foreign-born individuals, especially people born in Asia, the Pacific Islands, and Africa. Approximately 70% of cases in the United States are among people who were born outside of the United States. CDC developed this map of the geographic distribution of hepatitis B around the world - PDF. Other groups who have higher rates of chronic HBV infection include people who inject drugs and men who have sex with men.

HIV and HBV Coinfection

About 2% of people with HIV in the United States are coinfected with HBV; both infections have similar routes of transmission. People with HIV are at greater risk for complications and death from HBV infection. All people with HIV are recommended to be tested for HBV, and if susceptible, are further recommended to receive the hepatitis B vaccination or, if chronically infected, evaluated for treatment to prevent liver disease and liver cancer. For more information about HIV and HBV coinfection, visit HIV.gov’s pages about hepatitis B and HIV coinfection.

How Is Hepatitis B Transmitted?

Hepatitis B is spread in several distinct ways: sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother-to-child at birth.

In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.

Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.

Globally, mother-to-child transmission and inadequate infection control in health care settings represent significant modes of viral hepatitis transmission. That is why immigrants from many countries are recommended to be tested for HBV as well as hepatitis C virus [HCV].

Hepatitis B Prevention

Hepatitis B is a vaccine-preventable disease. The hepatitis B vaccine is safe and effective. To receive protection against hepatitis B, universal hepatitis B vaccination within 24 hours of birth for all medically stable infants weighing ≥2,000 grams, followed by completion of the series is recommended. The vaccine schedule and number of doses varies by vaccine type. In children, three doses are required to complete the vaccine series. In adults, two, three, or four doses are required. The two-dose vaccine is given over 30 days, which increases protection among adults more rapidly with fewer medical visits. There is also a combination vaccine that protects people from both hepatitis A and hepatitis B. The combined vaccine is usually given as 3 shots over a 6-month period. These tools may support increased vaccination in settings such as jails, prisons, substance use disorder prevention and treatment facilities, sexually transmitted disease treatment facilities, and HIV testing and treatment facilities.

Hepatitis B vaccine is recommended for the following people:

• All infants
• Unvaccinated children aged