Who is at risk for chronic hepatitis B?

~2.2 million people in the US have chronic hepatitis B (CHB).1,2 Up to 95% of people in the US who have CHB emigrated from countries with intermediate and high endemicity3 of hepatitis B virus (HBV)—including certain Asian and African countries.

In the US, Asians have the highest prevalence of HBV infection4,a

Asian Americans and Pacific Islanders make up 5% of the US population, yet:

Donut graph showing 50%>50%
more than 50% of people in the US with CHB are Asian Americans and Pacific Islanders5
1 in 12Asian
Americans
Approximately 1 in 12 Asian Americans have CHB5
CHB=chronic hepatitis B.
aAs compared with other ethnic groups and the total population in the US.4

African-born people in the US have a higher prevalence of CHB2,b

Almost 200,000 men and women with CHB in America emigrated from Africa.6,c

~1 in 10African-
born
Up to 1 in 10 African-born people in the US have CHB2
bAs compared with other foreign-born people in the US.
c2008 estimate.6
At-risk patients should be screened for HBV infection to identify chronically infected people who may benefit from treatment and appropriate follow-up care.3How to Screen At-risk Patients

Groups at risk for HBV infection

The AASLD, ACP and CDC, and USPSTF identify the following groups at risk for HBV infection:

  • People born in regions where the prevalence of HBV infection is ≥2%3,7-9
  • US-born people not vaccinated as infants and whose parents were born in regions having an HBV prevalence of ≥8%3,8,9
  • Household and sexual contacts of persons with HBV infection3,7-9
  • All pregnant women8-10
  • Men who have sex with men3,7-9
  • People who inject drugs3,7-9
  • Individuals infected with HCV or HIV3,7-9
  • People with certain medical conditions3,7-9
    • Needing immunosuppressive therapy
    • Undergoing hemodialysis
  • People with elevated ALT or AST of unknown etiology8,9
  • Donors of blood/organ/tissue8,9
  • Healthcare providers8,9
  • People exposed to bodily fluids8,9
  • People who are incarcerated8
AASLD=American Association for the Study of Liver Diseases; ACP=American College of Physicians; ALT=alanine aminotransferase; AST=aspartate aminotransferase; CDC=Centers for Disease Control and Prevention; HCV=hepatitis C virus; HIV=human immunodeficiency virus; USPSTF=U.S. Preventive Services Task Force

Information for healthcare professionals

References:
  • Gish R, Cohen C, Block J, et al. Data supporting updating estimates of the prevalence of chronic hepatitis B and C in the United States. Hepatology. 2015;62:1339-1341.
  • Kowdley K, Wang C, Welch S, et al. Prevalence of chronic hepatitis B among foreign-born persons living in the United States by country of origin. Hepatology. 2012;56:422-433.
  • LeFevre ML, on behalf of the United States Preventive Services Task Force. Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(1):58-66.
  • Kim H, Rotundo L, Yang J, et al. Racial/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States. J Viral Hepat. 2017;24:1052-1066.
  • Centers for Disease Control and Prevention. Asian Americans and Pacific Islanders and chronic hepatitis B. CDC website. https://www.cdc.gov/hepatitis/populations/api.htm. Last reviewed August 27, 2019. Accessed October 15, 2019.
  • Kim WR. Epidemiology of hepatitis B in the United States. Hepatology. 2009;49:S28-S34.
  • Rajbhandari R, Chung RT. Screening for hepatitis B virus infection: a public health imperative. Ann Intern Med. 2014;161(1):76-77.
  • Abara W, Qaseem A, Schillie S, et al. Hepatitis B vaccination, screening, and linkage to care: best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167(11):794-804.
  • Terrault N, Lok A, McMahon B, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599.
  • U.S. Preventive Services Task Force. Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150(12):869-873.