Deciphering the New CDC Hepatitis B Screening and Testing Guidelines

Last week, the CDC launched new recommendations for screening and testing for hepatitis B (HBV). This was the first update since 2008, and offered some big changes including the CDC’s recommendation that all adults in the United States be universally tested for HBV at least once in their lifetime, and to test for total antibody to HBcAg, which may determine HBV in the window period and pick-up recent infection.

The new guidance was published in the MMWR Recommendations and Reports / Vol. 72 / No. 1.

With these new recommendations, there may be questions from both the general public and clinicians about what they should be doing going forward. To help decipher these new guidelines, Contagion spoke with the lead author of the report, Erin E. Conners, PhD, of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention. In this Q & A, Conners offers clarification on universal testing, insights on the clinical implications for providers, and how the new HBV guidelines can reduce incidence rates.

Contagion: What was the onus to update hepatitis B screening/testing recommendations?

Conners: More than half of people with hepatitis B are unaware of their infection—underscoring the need for increased screening. Research shows that one-time universal screening of adults is cost-effective, and most importantly, results in improved health outcomes, which means preventing liver disease, liver cancer, and death. The new recommendations also complement the recently updated 2022 ACIP recommendation to vaccinate all adults aged 19–59 against HBV infection to protect from future infection.

In 2021, the US Department of Health and Human Services released its Viral Hepatitis National Strategic Plan for the United States (2021-2025), which aims to increase the proportion of people with HBV infection who are aware of their infection to 90% by 2030. This updated recommendation can bring us closer to this goal.

Contagion: CDC now recommends that all adults in the US be tested for hepatitis B at least once in their lifetime. Is this something where everyone who has not been tested recently should consider making an appointment to getting tested?

Conners: People should talk to their providers about the new guidance to determine if they should be screened for hepatitis B. The decision to test for hepatitis B will be based on whether patients are vaccinated for hepatitis B, if they’ve ever been tested, and if there are factors that increase the patient’s risk of hepatitis B virus infection and would indicate the need for continued periodic testing.

Hepatitis B screening can be done at any routine doctor’s appointment. We suggest that people ask their doctor the next time they have an appointment.

Contagion: What are the important takeaways clinicians should consider for when they are communicating to patients about testing?

Conners: Although a cure is not yet available, early diagnosis, monitoring, and treatment of chronic HBV infections reduces the risk for cirrhosis, liver cancer, and death. Providers should implement the new CDC hepatitis B screening and testing recommendations to ensure all adults are screened for HBV infection with the triple-panel at least once in their lifetime, and that people who are not vaccinated for hepatitis B—but are at increased risk of HBV infection—receive periodic testing.

Unfortunately, risk-based testing alone has not identified most people with chronic hepatitis B and is inefficient for providers to implement. Along with vaccination strategies, universal screening of adults and appropriate periodic testing of unvaccinated persons at increased risk for HBV infection will improve health outcomes, reduce the prevalence of HBV infection in the United States, and advance viral hepatitis elimination goals.

Contagion: Do you think these new recommendations will eventually bring down the incidence rates for HBV and get more people vaccinated?

Conners: In 2021, the US Department of Health and Human Services released its Viral Hepatitis National Strategic Plan for the United States (2021-2025), which aims to reduce acute hepatitis B infections by 90% by 2030, and increase the proportion of people with HBV infection who are aware of their infection to 90% by 2030. This updated screening recommendation, in combination with our recently updated recommendation to vaccinate all adults through age 59 for hepatitis B, can bring us closer to these goals.