Recommendation Statement

Screening for Hepatitis B Virus Infection

U.S. Preventive Services Task Force (USPSTF)

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for hepatitis B virus infection, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition.¹

Summary of Recommendations

The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit.
Rating: A Recommendation.

Rationale: The USPSTF found good evidence that universal prenatal screening for HBV infection using HBsAg substantially reduces prenatal transmission of HBV and the subsequent development of chronic HBV infection. The current practice of vaccinating all infants against HBV infection and postexposure prophylaxis with hepatitis B immune globulin administered at birth to infants of HBV-infected mothers substantially reduces the risk for acquiring HBV infection.
The USPSTF recommends against routinely screening the general asymptomatic population for chronic hepatitis B virus infection.
Rating: D Recommendation.

Rationale: The USPSTF found no evidence that screening the general population for HBV infection improves long-term health outcomes such as cirrhosis, hepatocellular carcinoma, or mortality. The prevalence of HBV infection is low; the majority of infected individuals do not develop chronic infection, cirrhosis, or HBV-related liver disease. Potential harms of screening include labeling, although there is limited evidence to determine the magnitude of this harm. As a result, the USPSTF concluded that the potential harms of screening for HBV infection in the general population are likely to exceed any potential benefits.

Background
Clinical Considerations
References
Members of the Task Force
Contact the Task Force
Available Products
Copyright and Electronic Dissemination

Task Force Ratings
Strength of Recommendations and Quality of Evidence

Background

The U.S. Preventive Services Task Force (USPSTF) last addressed screening for hepatitis B virus (HBV) infection in the 1996 Guide to Clinical Preventive Services and made the following recommendations:

Screening with hepatitis B surface antigen (HBsAg) was recommended to detect active (acute or chronic) HBV in all pregnant women at their first prenatal visit (A Recommendation). Routine screening of the general population for HBV infection was not recommended (D Recommendation). Certain persons at high risk for HBV could be screened to assess their eligibility for vaccination (C Recommendation).¹

Since then, the USPSTF criteria to rate the strength of the evidence have changed. Therefore, the recommendation statement that follows has been updated and revised based on the current USPSTF methodology and rating of the strength of the evidence.²

Clinical Considerations

Routine hepatitis vaccination has had significant impact in reducing the number of new HBV infections per year, with the greatest decline among children and adolescents. Programs that vaccinate health care workers also reduce the transmission of HBV infection.
Most people who become infected as adults or older children recover fully from HBV infection and develop protective immunity to the virus.
The main risk factors for HBV infection in the United States include diagnosis with a sexually transmitted disease, intravenous drug use, sexual contact with multiple partners, male homosexual activity, and household contacts of chronically infected persons. However, screening strategies to identify individuals at high risk have poor predictive value, since 30-40 percent of infected individuals do not have any easily identifiable risk factors.
Important predictors of progressive HBV infection include longer duration of infection and the presence of comorbid conditions such as alcohol abuse, HIV, or other chronic liver disease. Individuals with HBV infection identified through screening may benefit from interventions designed to reduce liver injury from other causes, such as counseling to avoid alcohol abuse and immunization against hepatitis A. However, there is limited evidence on the effectiveness of these interventions.

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References

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion, 1996.

2. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, Atkins D, for the Methods Word Group, third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(3S):21-35.

3. Screening for Hepatitis B Virus Infection: A Brief Evidence Update for the U.S. Preventive Services Task Force Rockville, MD, Agency for Healthcare Research and Quality, 2004. Available at www.preventiveservices.ahrq.gov.

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Members of the Task Force

Members of the U.S. Preventive Services Task Force* are are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, MD); Ned Calonge, M.D., M.P.H. (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, CO); Paul Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, M.D., M.B.A. (Deputy Director, Pan American Health Organization, Washington, DC); Russell Harris, M.D., M.P.H. (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, M.D., M.P.H. (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Loveland-Cherry, Ph.D., R.N. (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, M.D., M.P.H. (Professor, Department of Pediatrics, University of Texas at Houston, Houston, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, M.D., M.S.P.H. (Professor of Medicine, Chief of Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., M.Sc. (Professor of Obstetrics and Gynecology and Professor of Public Health, Columbia University, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor, Department of Family Practice and Department of Preventive and Community Medicine and Director of Research, Department of Family Practice, Virginia Commonwealth University, Fairfax, VA).

* Member of the USPSTF at the time this recommendation was finalized. For a list of current Task Force members, go to www.ahrq.gov/clinic/uspstfab.htm.

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Contact the Task Force

Address correspondence to: Ned Calonge, M.D., M.P.H., Chair, U.S. Preventive Services Task Force; c/o Program Director, USPSTF; 540 Gaither Road; Rockville, MD 20850; E-mail: uspstf@ahrq.gov.

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Available Products

This recommendation statement and the brief update, Screening for Hepatitis B Infection: A Brief Evidence Update for the U.S. Preventive Services Task Force,³ are available on the USPSTF Web site at www.preventiveservices.ahrq.gov.

Individual copies of this statement are available online through the National Guideline Clearinghouse™ at: www.guideline.gov; or may be obtained in print from the AHRQ Publications Clearinghouse: Phone Toll-Free 1-800-358-9295; E-mail ahrqpubs@ahrq.gov.

The brief update and the recommendation statement are also available in print by subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates. Select for order form: PDF Version (230 KB), Text Version. The cost of a subscription is $60 and can be ordered through the AHRQ Publications Clearinghouse (call 1-800-358-9295 or E-mail ahrqpubs@ahrq.gov).

Recommendations made by the USPSTF are independent of the U.S. Government. They should not be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.

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Copyright and Electronic Dissemination

This document is in the public domain within the United States. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Requests for linking or to incorporate content in electronic resources should be sent to: info@ahrq.gov.

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Current as of February 2004

Internet Citation:

U.S. Preventive Services Task Force. Screening for Hepatitis B Infection: Recommendation Statement. February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/hepbscr/hepbrs.htm

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