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Hepatitis B, Screening, 2014

* Indicates an old grade definition

Recommendations: Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults

  • Hepatitis B: Screening -- Nonpregnant Adolescents and Adults At High Risk
    Grade: B
    Specific Recommendations:

    The USPSTF recommends screening for hepatitis B virus (HBV) infection in persons at high risk for infection. 

    Frequency of Service:

    Periodic screening may be useful in patients with ongoing risk for HBV transmission (for example, active injection drug users, men who have sex with men, and patients receiving hemodialysis) who do not receive vaccination. Clinical judgment should determine screening frequency, because the USPSTF found inadequate evidence to determine specific screening intervals.

    Risk Factor Information:

    A major risk factor for HBV infection is country of origin. The risk for HBV infection varies substantially by country of origin in foreign-born persons in the United States. Persons born in countries with a prevalence of HBV infection of 2% or greater account for 47% to 95% of those with chronic HBV infection in the United States (Table 1). Another important risk factor for HBV infection is lack of vaccination in infancy in U.S.-born persons with parents from a country or region with high prevalence (≥8%), such as sub-Saharan Africa, central and southeast Asia, and China (Figure). Because HBV infection prevalence may gradually change over time, it is important to note that some countries and regions with prevalence rates between 5-7% are considered to be highly endemic areas. 

    The CDC also recommends screening in persons receiving hemodialysis or cytotoxic or immunosuppressive therapy (for example, chemotherapy for malignant diseases and immunosuppression related to organ transplantation and for rheumatologic and gastroenterologic disorders).

    Some persons with combinations of risk factors who are not members of one of these risk factor groups may also be at increased risk for HBV infection. However, reliable information about combinations of risk factors is not available. Clinicians should exercise their judgment in deciding whether these persons are at sufficiently high risk to warrant screening. For example, screening is probably appropriate in settings that treat a large proportion of persons at increased risk, such as clinics for sexually transmitted infections; HIV testing and treatment centers; health care settings that provide services for injection drug users or men who have sex with men; correctional facilities; and institutions that serve populations from countries with a high prevalence of infection, including community health centers.

    The prevalence of HBV infection is low in the general U.S. population, and most infected persons do not develop complications. Therefore, screening is not recommended in those who are not at increased risk. The USPSTF notes that high rates of HBV infection have been found in cities and other areas with high numbers of immigrants or migrant persons from Asia or the Pacific Islands or their adult children. Providers should consider the population they serve when making screening decisions.

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