Hepatitis B: Comprehensive Facts, Statistics, and Guidelines
What is hepatitis B? What are the risk factors for hepatitis B infection? How is hepatitis B transmitted? Get answers to these and other key questions about hepatitis B.
Hepatitis B Vaccination Guidelines for Adults
The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B vaccination for the following groups of adults:
- All infants
- Unvaccinated children aged <19 years
- Adults aged 19 through 59 years
- Adults aged 60 years and older with risk factors for hepatitis B
The following groups may also receive hepatitis B vaccination:
- Adults aged 60 years and older without known risk factors for hepatitis B
- Persons at risk for infection by sexual exposure, such as sex partners of persons who test positive for hepatitis B surface antigen (HBsAg), sexually active persons who are not in a long-term, mutually monogamous relationship, and persons seeking evaluation or treatment for a sexually transmitted infection
- Persons at risk for infection by percutaneous or mucosal exposure to blood, such as persons with current or recent injection use, household contacts of persons who test positive for HBsAg, residents and staff of facilities for persons with developmental disabilities, health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids, and persons on maintenance dialysis
- Others, such as international travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection, persons with hepatitis C virus infection, persons with chronic liver disease, persons with HIV infection, and incarcerated persons
Implementing Hepatitis B Vaccination Guidelines
To ensure vaccination of persons at risk for HBV infection, health care providers should:
- Offer HepB vaccination to all adults aged 19–59 years who have not previously completed vaccination, as well as adults > 60 years with risk factors for hepatitis B or without identified risk factors but seeking protection.
- Implement standing orders to administer HepB vaccine as part of routine services to adults who have not completed the vaccine series.
- Offer HepB vaccination, when feasible, in outreach and other settings in which services are provided to persons at risk for HBV infection (e.g., syringe services programs, HIV testing sites, HIV prevention programs, homeless shelters).
Interpreting Hepatitis B Serologic Test Results
Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies. Different serologic “markers” or combinations of markers are used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection.
| Test and Result | Interpretation | Action |
|---|---|---|
| HBsAg—Positive Total anti-HBc — Positive IgM anti-HBc — Positive Anti-HBs — Negative | Acute infection | Link to hepatitis B care |
| HBsAg — Positive Total anti-HBc — Positive IgM anti-HBc — Negative1 Anti-HBs — Negative | Chronic Infection | Link to hepatitis B care |
| HBsAg — Negative Total anti-HBc — Positive Anti-HBs — Positive | Resolved Infection | Counsel about HBV infection reactivation risk |
| HBsAg — Negative Total anti-HBc — Negative Anti-HBs — Positive2 | Immune from receipt of prior vaccination (if documented complete series) | If no documentation of full vaccination, then complete vaccine series per ACIP recommendations. |
| HBsAg — Negative Total anti-HBc — Positive Anti-HBs — Negative | Only core antibody is positive. See possible interpretations and corresponding actions: | Resolved infection where anti-HBs levels have waned, Occult Infection, Passive transfer of anti-HBc to an infant born to an HBsAg-positive gestational parent, A false positive, thus patient is susceptible, A mutant HBsAg strain that is not detectable by laboratory assay |
| HBsAg — Negative Total anti-HBc — Negative Anti-HBs — Negative3 | Susceptible, never infected (if no documentation of HepB vaccine series completion) | Offer HepB vaccine per ACIP recommendations |
Notes:
- IgM anti-HBc also might be positive in persons with chronic infection during severe HBV infection flares or reactivation.
- Immune if anti-HBs concentration is >10 mIU/mL after vaccine series.
- Susceptible if no documentation of HepB vaccine series completion.
Hepatitis B Transmission Routes
Hepatitis B is primarily transmitted through the following routes:
- Unprotected sexual contact with an infected person
- Sharing of needles, syringes, or other equipment to inject drugs
- Exposure to infected blood or body fluids, such as through needle sticks or other sharps injuries in healthcare settings
- From an infected mother to her baby during childbirth
Hepatitis B is not spread through breastfeeding, food or water, or by casual contact such as hugging, kissing, or sharing eating utensils or drinks.
Hepatitis B Prevalence and Burden
Hepatitis B is a leading cause of liver disease worldwide. According to the World Health Organization (WHO):
- Approximately 296 million people were living with chronic hepatitis B infection in 2019.
- In 2019, hepatitis B resulted in an estimated 1.5 million new infections and 820,000 deaths, mostly from cirrhosis and liver cancer.
- The global prevalence of chronic hepatitis B infection is approximately 3.9%.
- The burden of hepatitis B is highest in the WHO Western Pacific and African regions, where prevalence can exceed 6% in some countries.
Hepatitis B Prevention and Control Strategies
Key strategies for preventing and controlling hepatitis B include:
- Universal hepatitis B vaccination, including for all infants and high-risk groups
- Timely diagnosis and linkage to care for those with chronic hepatitis B infection
- Appropriate management and treatment of chronic hepatitis B to reduce the risk of liver disease progression and transmission
- Harm reduction interventions, such as needle and syringe programs, to prevent transmission among people who inject drugs
- Screening of pregnant women and treatment to prevent mother-to-child transmission
- Infection control practices in healthcare settings to prevent transmission
Hepatitis B Research and Innovations
Ongoing research and innovations in hepatitis B include:
- Development of new antiviral drugs and therapy combinations to improve treatment outcomes
- Exploration of therapeutic vaccines and gene therapies to achieve a functional cure for chronic hepatitis B
- Improvements in diagnostic tools, including point-of-care tests, to expand access to testing
- Implementation research to optimize the delivery of hepatitis B services, particularly in resource-limited settings