Hepatology Communications · 5 authors, 1 centre
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Based on NHANES data from January 2017 to March 2020, an estimated 660,000 persons aged 6 years and older in the US had hepatitis B virus (HBV) infection, representing 0.2% of the population. Only 49.8% of those infected were aware of their infection, falling far short of the 90% awareness target set for 2030. Non-Hispanic Asian persons accounted for nearly half of all infections, and nearly three-quarters of infected individuals were born outside the US.
**Background:** During 2013–2016, only 32% of US persons aged 6 years and older with HBV infection were aware of their infection. The US Department of Health and Human Services set a goal to increase this proportion to 90% by 2030. Prior estimates from 2013–2018 indicated 880,000 persons (0.3%) had HBV infection, with 69.1% being non-US-born and highest prevalence among non-Hispanic (NH) Asian persons. This analysis aimed to measure progress toward hepatitis B elimination goals using more recent data.
**Methods:** The study used the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 prepandemic file, a nationally representative sample survey. Consenting participants aged 6 years and older had serum tested for antibodies to HBcAg (anti-HBc); if positive, serum was also tested for HBsAg. Persons positive for both anti-HBc and HBsAg were classified as having HBV infection. Participants were interviewed about race, Hispanic origin, place of birth, health insurance, and whether they had ever been told they had hepatitis B. Estimates and 95% confidence intervals (CIs) accounting for survey design were calculated. Proportions aware of infection were weighted, and 95% Clopper-Pearson exact CIs were adjusted using the Korn and Graubard adjustment.
**Key Results:** From January 2017 to March 2020, 10,917 NHANES participants had blood tested for anti-HBc. Of 641 who tested positive for anti-HBc, 640 had HBsAg results; 45 tested positive for HBsAg, and 44 responded to the awareness question. Among persons aged 6 years and older, 4.0% (95% CI: 3.1%–4.9%) had past or present hepatitis B, and 0.2% (95% CI: 0.1%–0.3%) had HBV infection, corresponding to an estimated 660,000 persons (95% CI: 410,000–1,000,000). Among those with HBV infection, 49.8% (95% CI: 25.1%–74.6%) were aware of their infection. Among NH-Asian persons, 1.9% (95% CI: 1.2%–2.9%) had HBV infection (estimated 320,000 persons; 95% CI: 200,000–490,000), with 62.3% (95% CI: 19.2%–94.0%) aware. Among non-US-born persons, 1.0% (95% CI: 0.6%–1.4%) had HBV infection (estimated 480,000 persons; 95% CI: 300,000–730,000), with 56.4% (95% CI: 28.8%–81.3%) aware. NH-Asian persons accounted for 48.4% (95% CI: 30.6%–66.5%) and non-US-born persons accounted for 73.6% (95% CI: 50.6%–90.0%) of all persons with HBV infection. No persons under age 20 years were identified with HBV infection.
**Clinical Implications:** Despite progress from the 32% awareness estimate in 2013–2016, only 50% of persons with HBV infection were aware of their infection in 2017–March 2020, far below the 90% target for 2030. Antiviral therapy is associated with reductions in hepatocellular carcinoma, cirrhosis, and mortality, but testing rates among non-US-born persons range from only 22%–76%. One-time universal screening for all adults in the US is now recommended. The low prevalence among persons under 20 years reflects successful perinatal, infant, and childhood immunization programs. Major limitations include ~50% response rates, exclusion of unsheltered homeless and incarcerated persons, small sample sizes yielding wide CIs, and suspension of NHANES data collection in March 2020 due to the pandemic. These data demonstrate continued challenges in meeting elimination goals, and researchers should investigate other data sources to supplement NHANES estimates.