In the JournalsPerspective

ACP, CDC: Screen, vaccinate at-risk adults for HBV

Jack Ende

The ACP and CDC jointly released a clinical guideline recommending that adults at-risk for hepatitis B virus infection be screened for and vaccinated against the infection and that those found to be infected be linked to care.

“The majority of persons at risk for or infected with the hepatitis B virus do not get screened, vaccinated or linked to care,” Jack Ende, MD, president of ACP, said in a press release. “Hepatitis B vaccination and screening are cost-effective interventions to reduce the burden of chronic hepatitis B infection. Utilization, however, remains low.”

After a narrative literature review of HBV clinical guidelines, systematic reviews, randomized trials and intervention studies, members of the ACP’s High Value Care Task Force and the CDC developed three best practice statements for HBV vaccination, screening and linkage to care.

ACP and CDC advised that all unvaccinated adults, including pregnant women, exposed to the virus via sexual, percutaneous or mucosal contact be administered the HBV vaccine. In addition, physicians should also vaccinate health care and public safety workers who may be exposed to infected blood; adults with HIV, chronic liver disease or end-stage renal disease, including those undergoing hemodialysis; those traveling to HBV-endemic regions; and those seeking to be protected from HBV.

“Hepatitis B vaccination is the most effective measure to prevent HBV infection and its complications,” Winston Abara, MD, PhD, medical epidemiologist at the CDC, said in the release. “Because of HBV transmission risk and low hepatitis B vaccination coverage, increasing hepatitis B vaccination coverage among unvaccinated adults is essential.”

Individuals at high risk for HBV should be screened for the infection, according to ACP and CDC.

This includes individuals born in countries with 2% or higher HBV prevalence, men who have sex with men, those who inject drugs, individuals with HIV, those in household or sexual contact with HBV-infected individuals, those requiring immunosuppressive therapy, those with end-stage renal disease, blood and tissue donors, hepatitis C virus-infected individuals, those with elevated alanine aminotransferase levels (19 IU/L for women and 30 IU/L for men), those who have been incarcerated, pregnant women and infants born to mothers with HBV, according to ACP and CDC.

Furthermore, ACP and CDC recommended that all individuals diagnosed with HBV be referred to posttest counseling and HBV-directed care. ACP and CDC also advised that history evaluations and physical exams should be conducted to identify hepatocellular carcinoma and treatment eligibility in all patients with chronic HBV.

“The best practice advice statements in this article amplify and complement existing clinical guidelines by reiterating the importance of hepatitis B vaccination and screening in at risk persons and linking infected persons to care,” Abara and colleagues wrote. “Evidence-based strategies that effectively implement this advice are critical to accomplishing the goals of the national hepatitis B elimination plan.” – by Alaina Tedesco

Disclosure: Abara reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

Jack Ende

The ACP and CDC jointly released a clinical guideline recommending that adults at-risk for hepatitis B virus infection be screened for and vaccinated against the infection and that those found to be infected be linked to care.

“The majority of persons at risk for or infected with the hepatitis B virus do not get screened, vaccinated or linked to care,” Jack Ende, MD, president of ACP, said in a press release. “Hepatitis B vaccination and screening are cost-effective interventions to reduce the burden of chronic hepatitis B infection. Utilization, however, remains low.”

After a narrative literature review of HBV clinical guidelines, systematic reviews, randomized trials and intervention studies, members of the ACP’s High Value Care Task Force and the CDC developed three best practice statements for HBV vaccination, screening and linkage to care.

ACP and CDC advised that all unvaccinated adults, including pregnant women, exposed to the virus via sexual, percutaneous or mucosal contact be administered the HBV vaccine. In addition, physicians should also vaccinate health care and public safety workers who may be exposed to infected blood; adults with HIV, chronic liver disease or end-stage renal disease, including those undergoing hemodialysis; those traveling to HBV-endemic regions; and those seeking to be protected from HBV.

“Hepatitis B vaccination is the most effective measure to prevent HBV infection and its complications,” Winston Abara, MD, PhD, medical epidemiologist at the CDC, said in the release. “Because of HBV transmission risk and low hepatitis B vaccination coverage, increasing hepatitis B vaccination coverage among unvaccinated adults is essential.”

Individuals at high risk for HBV should be screened for the infection, according to ACP and CDC.

This includes individuals born in countries with 2% or higher HBV prevalence, men who have sex with men, those who inject drugs, individuals with HIV, those in household or sexual contact with HBV-infected individuals, those requiring immunosuppressive therapy, those with end-stage renal disease, blood and tissue donors, hepatitis C virus-infected individuals, those with elevated alanine aminotransferase levels (19 IU/L for women and 30 IU/L for men), those who have been incarcerated, pregnant women and infants born to mothers with HBV, according to ACP and CDC.

Furthermore, ACP and CDC recommended that all individuals diagnosed with HBV be referred to posttest counseling and HBV-directed care. ACP and CDC also advised that history evaluations and physical exams should be conducted to identify hepatocellular carcinoma and treatment eligibility in all patients with chronic HBV.

“The best practice advice statements in this article amplify and complement existing clinical guidelines by reiterating the importance of hepatitis B vaccination and screening in at risk persons and linking infected persons to care,” Abara and colleagues wrote. “Evidence-based strategies that effectively implement this advice are critical to accomplishing the goals of the national hepatitis B elimination plan.” – by Alaina Tedesco

Disclosure: Abara reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

    Perspective

    The majority of persons with chronic HBV infection in the United States are foreign-born from countries in Asia, Africa and Pacific Island where infection is endemic. Approximately one in 12 Asian Americans are living with hepatitis B, but two in three Asian Americans with hepatitis do not know they are infected.

    Hepatitis B screening in the high-risk population is the first step in liver cancer prevention. Hepatitis B vaccination is also vital to protect Asian Americans from liver cancer. However, the vaccination rates remained low among Asian Americans due to low knowledge and seriousness of hepatitis B infection. These best practice advice statements should be implemented to reduce disparities of chronic Hepatitis B infection in high risk Asian Americans.      

    • Hee-Soon Juon, RN, PhD
    • Professor, Department of Medical Oncology Division of Population Science Thomas Jefferson University

    Disclosures: Juon reports no relevant financial disclosures.