In the Journals

HBV burden increases in Appalachian states despite decreasing trend in US

Photo of Harvey Kaufman
Harvey W. Kaufman

The rate of newly diagnosed acute and chronic hepatitis B virus infections in women of childbearing age has significantly increased in some Appalachian states, despite overall national rates that have declined or remained stable.

Researchers suggested that injection drug use and waning HBV vaccine effectiveness may be contributing to this trend.

“Women of childbearing age represent a priority group for HBV viral elimination efforts due to the risk of mother-to-child transmission of HBV,” Harvey W. Kaufman, MD, MBA, FCAP, senior medical director of medical informatics at Quest Diagnostics, told Infectious Disease News. “Higher rates of acute and chronic HBV among women of childbearing age may increase the rates of HBV infection among infants.”

According to the study, researchers have linked the increase in hepatitis C virus infections among women in the United States aged 15 to 44 years with the current opioid injection drug use epidemic. However, Kaufman and colleagues noted, changes in HBV infections have not been investigated.

They conducted a retrospective analysis of HBV status among women of childbearing age on the national and state level to determine rates of HBV in women born before and after the implementation of universal HBV vaccination.

Between 2011 and 2017, 8,871,965 women were tested for HBV. According to the study, 25.3% were born before 1980 (the no-universal-vaccine cohort), 55.1% were born between 1980 and 1991 (adolescent-dose cohort) and 19.6% were born after 1992 (the birth-dose cohort).

The researchers observed a stable national rate of acute HBV infections but an increase in Kentucky, Alabama and Indiana (P < .03). Additionally, the national prevalence of new chronic HBV diagnoses decreased significantly from 0.83% in 2011 to 0.19% in 2017 (P < .0001). Yet, in Mississippi, Kentucky and West Virginia, Kaufman and colleagues reported an increase of new chronic HBV diagnoses.

“These are states that have been especially adversely affected by the opioid epidemic, according to the CDC,” Kaufman said. “[IV] drug use of opioids such as heroin and fentanyl is associated with heightened rates of infection from [HCV] and HIV. Our study suggests a similar pattern is at work for [HBV] infection.”

In total, vaccine seroprotection was 46.8%, and the researchers reported a declining prevalence of HBV seroprotection over time. The greatest decline was observed in the birth-dose cohort. Specifically, protection waned 21.6%, from 48.5% in 2011 to 38.5% in 2017 (P < .0001).

“Taken together, these data suggest that in Appalachia, where an increase in HCV cases attributable to [IV] drug use has already been seen, there is also an increase in HBV infection. The other key message is that protection provided by vaccination for [HBV] may wane over time,” Kaufman said. “Our study also suggests that additional research is needed to determine whether booster vaccination may be needed, especially among individuals with risk factors such as [IV] drug use or higher risk sex practices. Because our study systematically evaluated all states, the findings may help inform state-level planning of HBV vaccination strategies.” – by Marley Ghizzone

Disclosures: Kaufman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Photo of Harvey Kaufman
Harvey W. Kaufman

The rate of newly diagnosed acute and chronic hepatitis B virus infections in women of childbearing age has significantly increased in some Appalachian states, despite overall national rates that have declined or remained stable.

Researchers suggested that injection drug use and waning HBV vaccine effectiveness may be contributing to this trend.

“Women of childbearing age represent a priority group for HBV viral elimination efforts due to the risk of mother-to-child transmission of HBV,” Harvey W. Kaufman, MD, MBA, FCAP, senior medical director of medical informatics at Quest Diagnostics, told Infectious Disease News. “Higher rates of acute and chronic HBV among women of childbearing age may increase the rates of HBV infection among infants.”

According to the study, researchers have linked the increase in hepatitis C virus infections among women in the United States aged 15 to 44 years with the current opioid injection drug use epidemic. However, Kaufman and colleagues noted, changes in HBV infections have not been investigated.

They conducted a retrospective analysis of HBV status among women of childbearing age on the national and state level to determine rates of HBV in women born before and after the implementation of universal HBV vaccination.

Between 2011 and 2017, 8,871,965 women were tested for HBV. According to the study, 25.3% were born before 1980 (the no-universal-vaccine cohort), 55.1% were born between 1980 and 1991 (adolescent-dose cohort) and 19.6% were born after 1992 (the birth-dose cohort).

The researchers observed a stable national rate of acute HBV infections but an increase in Kentucky, Alabama and Indiana (P < .03). Additionally, the national prevalence of new chronic HBV diagnoses decreased significantly from 0.83% in 2011 to 0.19% in 2017 (P < .0001). Yet, in Mississippi, Kentucky and West Virginia, Kaufman and colleagues reported an increase of new chronic HBV diagnoses.

“These are states that have been especially adversely affected by the opioid epidemic, according to the CDC,” Kaufman said. “[IV] drug use of opioids such as heroin and fentanyl is associated with heightened rates of infection from [HCV] and HIV. Our study suggests a similar pattern is at work for [HBV] infection.”

In total, vaccine seroprotection was 46.8%, and the researchers reported a declining prevalence of HBV seroprotection over time. The greatest decline was observed in the birth-dose cohort. Specifically, protection waned 21.6%, from 48.5% in 2011 to 38.5% in 2017 (P < .0001).

“Taken together, these data suggest that in Appalachia, where an increase in HCV cases attributable to [IV] drug use has already been seen, there is also an increase in HBV infection. The other key message is that protection provided by vaccination for [HBV] may wane over time,” Kaufman said. “Our study also suggests that additional research is needed to determine whether booster vaccination may be needed, especially among individuals with risk factors such as [IV] drug use or higher risk sex practices. Because our study systematically evaluated all states, the findings may help inform state-level planning of HBV vaccination strategies.” – by Marley Ghizzone

Disclosures: Kaufman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.