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Hepatitis B Screening - U.S. Preventive Services Task Force New Draft Recommendation Statement
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currently, Hepatitis B screening: pregnant women - Grade A - The USPSTF strongly recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit. - June 2009 -
USPSTF Recommendations for STI
Screening.....http://www.uspreventiveservicestaskforce.org/uspstf08/methods/stinfections.htm
Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement
New DRAFT
Recommendations--......http://www.uspreventiveservicestaskforce.org/draftrec2.htm
This draft Recommendation Statement is available for comment from February 11 until March 10, 2014, at 5:00 PM ET.
The burden of HBV infection disproportionately affects foreign-born persons from high-prevalence countries and their unvaccinated offspring, persons who are HIV-positive, men who have sex with men, and injection drug users (Table 2)
The U.S. Preventive Services Task Force (USPSTF) recommends screening for hepatitis B virus (HBV) infection in persons at high risk for infection. This is a B recommendation. This recommendation applies to asymptomatic, nonpregnant adolescents and adults who have not been vaccinated and other individuals at high risk for HBV infection.
The USPSTF concludes with moderate certainty that screening for HBV infection in adults at high risk for infection has moderate net benefit.
In the United States, persons considered at high risk for HBV infection include
- persons from high-prevalence countries,
- persons who are HIV-positive,
- injection drug users,
- household contacts of persons with HBV infection, and
- men who have sex with men (2).
The natural history of chronic HBV infection varies but can include the potential long-term sequelae of cirrhosis, hepatic decompensation, and hepatocellular carcinoma. An estimated 15% to 25% of persons with chronic HBV infection die from cirrhosis or hepatocellular carcinoma (2, 3). Individuals who are chronically infected also serve as a reservoir for person-to-person transmission of HBV infection. Screening for HBV infection could identify chronically infected individuals who may benefit from treatment or other interventions, such as surveillance for hepatocellular carcinoma.
The goals of antiviral treatment are to achieve sustained suppression of HBV replication and remission of liver disease in order to prevent cirrhosis, hepatic failure, and hepatocellular carcinoma. Interferons or nucleoside/nucleotide analogues are used to treat HBV infection.
The USPSTF found no randomized, controlled trials that provide direct evidence of the health benefits (i.e., reduction in morbidity, mortality, and disease transmission) of screening for HBV infection in asymptomatic adolescents and adults.
The USPSTF found convincing evidence that antiviral treatment in patients with chronic HBV infection is effective at improving intermediate outcomes (i.e., virologic or histologic improvement or clearance of hepatitis B e antigen [HbeAg]) and adequate evidence that antiviral regimens improve health outcomes (such as reduced risk for hepatocellular carcinoma). The evidence showed an association between improvement in intermediate outcomes following antiviral therapy and improvement in clinical outcomes, but outcomes were heterogeneous and the studies had methodological limitations.
Recommendations of Others
The CDC and the American Association for the Study of Liver Diseases recommend screening for HBV infection in high-risk individuals, including all foreign-born persons from regions with an HBsAg prevalence of greater than 2%, regardless of vaccination history; U.S.-born persons not vaccinated as infants whose parents were born in regions with an HBsAg prevalence of 8% or greater; injection drug users; men who have sex with men; household contacts and sex partners of HBsAg-positive persons; hemodialysis patients; immunosuppressed persons; and persons who are HIV-positive (2, 9). The CDC also recommends screening for HBV infection in blood, organ, or tissue donors; persons with occupational or other exposures to infectious blood or body fluids; and persons who received HBV vaccination as adolescents or adults with high-risk behaviors (2). In addition, the American Association for the Study of Liver Diseases recommends that individuals with multiple sex partners or a history of sexually transmitted diseases, inmates of correctional facilities, and individuals with hepatitis C virus infection be screened (9). The Institute of Medicine endorses screening for HBV infection in high-risk groups similar to those recommended by the CDC (23). The American Academy of Family Physicians is currently reviewing its recommendation on screening for HBV infection
Current U.S. policy is for universal vaccination of all infants at birth, catchup vaccination of adolescents, and vaccination of high-risk adults, such as health care workers, injection drug users, and household contacts of patients with HBV infection (1). Vaccination results in greater than 90% protective antibody response after the third dose in adults and greater than 95% protective antibody response in adolescents (1). The CDC recommends that persons who are tested for HBV infection receive the first dose of the vaccine at the same medical visit as screening (2).
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