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CDC: All Adults Should Be Tested For Hepatitis B At Least Once In Their Lifetime
© Provided by Verywell Health ViktorCap / Getty Images Fact checked by Nick Blackmer If you're 18 or older, the Centers for Disease Control and Prevention (CDC) now recommends getting tested for hepatitis B at least once in your lifetime.
Previously, the CDC only recommended testing for people at risk of hepatitis B infection, including but not limited to men who have sex with men, people with HIV or sexually transmitted infections, people who've injected drugs.
Hepatitis B is a viral infection characterized by inflammation of the liver and transmitted through bodily fluids. While most people can clear the infection on their own, chronic cases can be quite serious and may require medication or even liver transplant. There is no cure for chronic hepatitis, but it can be prevented with a vaccine.
"Liver disease is one for which there's a lot of stigma, and any screening recommendations that move away from risk-based screening really de-stigmatize the disease," Emmanuel Thomas, MD, PhD, chairman of the national board of directors for the American Liver Foundation, told Verywell.
An infection with hepatitis B virus can be acute, which means that the body's immune system fights it off within a few weeks. However, some people develop chronic hepatitis B infection, which is lifelong. Chronic hepatitis B puts a person at increased risk for liver cancer and cirrhosis, and of dying prematurely. That's why testing is so important—knowing your infection status can help you get the antiviral treatment needed to keep symptoms at bay.
Testing Consists of 3 PartsA three-panel blood test is needed to identify the multiple parameters of chronic hepatitis B infection. You can get tested at locations like your primary care provider's office, a community health clinic, or chain pharmacies with clinics, like CVS. You can also purchase at-home test kits, which require a blood sample that you sent to a lab for analysis.
"Screening used to just involve checking for hepatitis B surface antigen, which only looks for chronic infection," liver specialist Jama Darling, MD, an assistant professor at the University of North Carolina School of Medicine, told Verywell.
Additional testing allows healthcare providers to determine how infectious a person is, how the virus is replicating, and which type of treatment is necessary.
If a person tests negative for hepatitis, providers can recommend vaccination.
The three tests used to determine hepatitis B infection status look for three different markers:
In addition to the change to universal testing, the CDC is continuing its recommendations that pregnant women be tested for hepatitis B surface antigen (HBsAg) during each pregnancy, whether they have been vaccinated against hepatitis B or have been previously tested for the virus.
Susceptible people who have ongoing risk for hepatitis B should be tested periodically if they continue to be at risk.
Who Is Most At-Risk for a Hepatitis B Infection?Hepatitis B is transmitted through contact with infected blood or body fluids, including through pregnancy and childbirth. In fact, transmission of the virus during childbirth is considered the greatest risk for chronic infection.
For people with a history of increased risk for hepatitis B, the CDC still recommends risk-based testing, which may require more than just one test per lifetime. Other risk factors for being infected with hepatitis B virus include having been in jail, prison, or other detention; having a history of sexually transmitted infections or multiple sex partners; using intravenous drugs; or being infected with hepatitis C virus.
People born outside of the United States are more likely to have chronic hepatitis B infection, and account for nearly 70% of those with a known chronic infection.
Anyone who asks to be tested for hepatitis B should also be tested without having to disclose if they have a risk factor for infection, the CDC says.
Related:Hepatitis B vs. Hepatitis C: What Are the Differences?
The opioid crisis and intravenous drug use gives the new universal recommendation for testing increased importance, Darling said. Patients don't necessarily tell their healthcare providers if they use or have used injected drugs, she noted.
According to the report announcing the change in recommendations, which appeared in Morbidity and Mortality Weekly Report, up to 2.4 million persons are living with hepatitis B virus infection in the United States. Two out of three of these people may be unaware of their infection.
The good news is the prevalence of hepatitis B is declining in the U.S. Thanks to the availability of a three-shot vaccine for the virus that is recommended for all newborns, Thomas said. Last year, the CDC recommended that everyone over age 18 and under age 59 be vaccinated against hepatitis B. These recommendations are in line with the World Health Organization guidelines.
"It is startlingly rare to see a 20-year-old who hasn't been vaccinated," Darling said, crediting the advent of newborn vaccinations for hepatitis B. "But it's … uncommon to see a 40-year-old vaccinated for B."
The CDC recommends that you be tested for hepatitis B at least once in your life if you are over age 18. The agency also recommends that anyone over age 18 be vaccinated against the virus.
CDC Recommends All Adults Should Be Screened For Hepatitis B At Least Once
© Provided by Health Getty Images / takasuu 
© Provided by Health Getty Images / takasuu The Centers for Disease Control and Prevention (CDC) recently updated its HBV testing recommendation.
According to the CDC, an estimated 580,000 to 2.4 million people are infected with HBV in the United States. An estimated two-thirds of these individuals might not know they are infected.
"There are typically no symptoms, and therefore patients may feel perfectly normal and not seek testing," Tatyana Kushner, MD, told Health. Kushner is an associate professor of medicine at the Icahn School of Medicine at Mount Sinai and the medical advisor to the Hepatitis Outreach Network.
Individuals might also not know about their infection status because they have limited access to healthcare or are intimidated by the stigma associated with hepatitis B and are avoiding testing, noted Dr. Kushner.
Hepatitis is a vaccine-preventable, potentially deadly liver infection caused by the hepatitis B virus (HBV). While for some people, hepatitis B is a short-term illness, for others, it can be a chronic disease.
To catch early cases and connect patients to treatment, the Centers for Disease Control and Prevention updated its HBV recommendations in March.
Updated Hepatitis B Screening RecommendationThe CDC now offers these HBV recommendations:
The CDC continues to recommend that all pregnant people should be tested during each pregnancy, regardless of their vaccination status and if they've been tested before.
So, Why the Update?The number of people unaware of their infection underscores the need for increased testing, said Erin Conners, PhD, of the CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention.
"Research shows that one-time universal screening of adults is cost-effective, and most importantly, results in improved outcomes," Dr. Conners told Health.
This means preventing liver disease, liver cancer, and death.
The updated CDC recommendations support an objective outlined in the Viral Hepatitis Strategic Plan developed by the U.S. Department of Health and Human Services: to have 90 percent of people with an HBV infection be aware of their infection by 2030. Between 2013 and 2016, just 32 percent of people with an HBV infection were aware of it.
David Hutton, PhD, an associate professor of health management and policy at the University of Michigan School of Public Health, told Health this is an optimistic but achievable goal. Increased awareness about the need to screen, along with improved processes in health systems—like automation for default one-time testing in electronic medical record systems—will help hit this target.
"I think the CDC is being careful and thoughtful about HBV updates," Dr. Hutton explained. "The current guidance for one-time screening for adults is a good recommendation."
Related:Facts About Hepatitis
Warning Signs of Hepatitis BMost people don't look or feel sick when infected with hepatitis B. However, symptoms can emerge. For example, some signs of short-term hepatitis B include fever, fatigue, dark urine, and nausea. According to the CDC, symptoms can start between eight weeks and five months after exposure. But on average, they begin three months after exposure.
People with chronic hepatitis B can remain symptom-free for decades. While eventual symptoms can mirror those linked to acute infections, these can also indicate advanced liver disease. Chronic hepatitis B is linked to liver damage, liver failure, liver cancer, and death. Approximately 1,752 deaths were related to HBV in 2020—though the CDC states this is likely an underestimate.
Getting Tested for HBVIdeally, care providers will bring up HBV screening with patients, but patients should also ask about it, Dr. Hutton encouraged.
The decision to test for HBV will be based on whether patients are vaccinated for HBV, if they've ever been tested, and if there are factors that increase the patient's risk for HBV infection and would indicate the need for periodic testing, explained Dr. Connors.
"Hepatitis B screening can be done at any routine doctor's appointment," said Dr. Connors. "We suggest that people ask their doctor the next time they have an appointment."
Who Should Test for HBV?Previously, the CDC only recommended the screening of higher-risk individuals. The new recommendation is that all adults should test at least once. The younger a person is when they are infected with HBV, the more likely they are to develop chronic hepatitis B.
Meanwhile, people with ongoing or new risk factors for HBV should be screened more than once, recommended Dr. Kushner.
An especially important population to test is pregnant women, Dr. Kushner said. It is critical to test during prenatal care during each pregnancy so that providers and patients can take the necessary steps to prevent transmission. In practice, this means providing the hepatitis B vaccine and the hepatitis B immune globulin injection to the infant within 12 hours of birth.
"Given the risk of vertical transmission of hepatitis B to the baby, it is absolutely critical to screen during pregnancy," Dr. Kushner explained.
How to Prevent HBVHBV spreads when an uninfected person comes into contact with an infected person's blood, semen, and other bodily fluids. It is most commonly transmitted from a mother to child during birth and delivery. It can also be spread through sex with a partner with hepatitis B, sharing contaminated needles, and sharing contaminated razors, among other ways. It is not transmitted through kissing, sneezing, or breastfeeding.
Hepatitis B vaccination is very effective at preventing HBV infection and subsequent liver disease, but 70 percent of adults in the United States are unvaccinated.
This disparity may partly be explained by the timing of the vaccine's availability, noted Dr. Hutton. The hepatitis B vaccine became available in 1982, and in 1997 the Advisory Committee on Immunization Practices (ACIP) expanded its hepatitis B vaccination recommendations to include all children under 18. People who were children before this change missed the window for early vaccination.
To close this vaccination gap, in 2022, the ACIP recommended HBV vaccination for all between 19 and 59.
Treatment for Hepatitis BWhile seven medications are approved to treat chronic hepatitis B, there is no medicine for acute hepatitis B. Instead, people with mild symptoms are recommended fluids, healthy meals, and rest.
However, no medication totally eradicates the virus. While new drugs are in development, there is no cure for now. This reality reinforces why experts view screening as a meaningful step toward connecting people to help sooner.
Dr. Conners concluded, "Although a cure is not yet available, early diagnosis, monitoring, and treatment of chronic HBV infections reduce the risk for cirrhosis, liver cancer, and death."
Related:The Medical Tests Every Woman Needs in Their 30s, 40s, 50s, and 60s
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