Recommendation Statement
Date: February 2004
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
The information found here is current for the general asymptomatic population other than pregnant women. This recommendation has been updated in part for pregnant women. Go to http://www.ahrq.gov/clinic/uspstf/uspshepbpg.htm to view the new recommendation for pregnant women, published in June 2009. |
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.
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Contents
Background
Clinical Considerations
References
Members of the Task Force
Contact the Task Force
Available Products
Copyright and Electronic Dissemination
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 http://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 http://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: info@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 http://www.preventiveservices.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
540 Gaither Road Rockville, MD 20850