Universal hepatitis B vaccination recommended in adults 19 to 59 years
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) now recommends universal hepatitis B vaccination in all adults ages 19 to 59 years.
Previously, a risk factor assessment was recommended to determine vaccine eligibility in this age group. While hepatitis B vaccines have demonstrated safety, immunogenicity, and efficacy over the past four decades, vaccination rates in the US have been suboptimal. The removal of the risk factor assessment in this age group is hoped to increase vaccination coverage and decrease cases of hepatitis B infection.
A risk factor assessment is still recommended for adults 60 years of age and older. However, adults in this age group without known risk factors may still be offered hepatitis B vaccination.
Nearly two million people are estimated to be living with chronic hepatitis B infection in the US. A total of 3192 cases of acute hepatitis B infection were reported in 2019, corresponding to an estimated 20,700 acute infections. The most commonly reported risk behaviors and exposures were injection drug use, multiple sex partners, and surgery, followed by other sexual and bloodborne risk behaviors.
The new recommendations are reflected in the Centers for Disease Control and Prevention’s updated 2022 immunization schedule.
Hepatitis B infection is the most common liver infection globally, caused by the hepatitis B virus (HBV).
People from endemic areas (Asia, Africa), or injection drug users and those with high-risk sexual behaviors, are at an increased risk for infection.
Most people are asymptomatic, although some will present with complications such as cirrhosis, hepatocellular carcinoma, or liver failure.
Serologic markers are essential in making the diagnosis and evaluating disease activity, including differentiating between people with acute and chronic infection and chronic asymptomatic carriers.
Goal of treatment is to improve survival and quality of life by preventing disease progression. Current treatments do not completely eradicate the virus. The mainstay of management is antiviral therapy, although some patients also require referral to a liver transplant center.
The most common liver infection globally, caused by the hepatitis B virus (HBV). HBV is a DNA virus transmitted by percutaneous and permucosal routes. HBV infection is also a sexually transmitted infection. HBV infection may result in a self-limited disease requiring no treatment, particularly in adult-acquired infection, but it may also result in a chronically infected state with cirrhosis, hepatocellular carcinoma, or liver failure, particularly if it is acquired perinatally or in early childhood.
History and exam
Key diagnostic factors
- high risk of exposure
Other diagnostic factors
- maculopapular or urticarial rash
- right upper quadrant pain
- palmar erythema
- spider angiomata
- perinatal exposure in an infant born to an HBV-infected mother
- high-risk sexual behaviors
- injection drug use
- male sex
- born in highly endemic region
- family history of HBV, hepatocellular carcinoma, and/or chronic liver disease
- infected with HIV
- infected with hepatitis C virus
- blood or blood product transfusion
- healthcare workers
- household contact with HBV infection
- history of incarceration
- solid organ transplantation
1st investigations to order
- hepatic panel
- basic metabolic panel
- coagulation profile
- serum hepatitis B surface antigen
- serum antibody to hepatitis B surface antigen
- serum antibody to hepatitis B core antigen
- serum hepatitis B e antigen
- serum antibody to hepatitis B e antigen
- serum HBV DNA
Investigations to consider
- abdominal ultrasound
- liver biopsy
- transient elastography
- serum liver fibrosis biomarkers
- CT/MRI abdomen
- testing for co-infections
- drug resistance testing
- HBV genotype
acute HBV infection
chronic HBV infection: adult nonpregnant without co-infection or cirrhosis
chronic HBV infection: adult nonpregnant with cirrhosis
chronic HBV infection: adult nonpregnant with HIV co-infection
chronic HBV infection: adult nonpregnant with hepatitis C co-infection
chronic HBV infection: adult nonpregnant with hepatitis D co-infection
chronic HBV infection: adult pregnant or breast-feeding
chronic HBV infection: children
- Acute hepatitis A virus infection
- Acute hepatitis C virus infection
- Chronic hepatitis C virus infection
- Recommended immunization schedule for adults aged 19 years or older - United States, 2022
- Recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2022
Hepatitis B: should I have the vaccine?More Patient leaflets
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