Recommendations for Identification and Public Health Management of Persons With Chronic Hepatitis B Virus Infection

[Guest guest]

http://cme.medscape.com/viewarticle/732116

From Morbidity & Mortality Weekly Report

Recommendations for Identification and Public Health Management of Persons With

Chronic Hepatitis B Virus Infection CME

M. Weinbaum, MD; Ian , PhD; E. Mast, MD; A. Wang, MD;

Lyn Finelli; Annemarie Wasley, ScD; M. Neitzel; W. Ward, MD

Authors and Disclosures

CME Released: 11/12/2010; Valid for credit through 11/12/2011

Summary and Introduction

Summary

Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to

identify persons with chronic hepatitis B virus (HBV) infection. Testing has

been recommended previously for pregnant women, infants born to HBsAg-positive

mothers, household contacts and sex partners of HBV-infected persons, persons

born in countries with HBsAg prevalence of ¡Ý8%, persons who are the source of

blood or body fluid exposures that might warrant postexposure prophylaxis (e.g.,

needlestick injury to a health-care worker or sexual assault), and persons

infected with human immunodeficiency virus. This report updates and expands

previous CDC guidelines for HBsAg testing and includes new recommendations for

public health evaluation and management for chronically infected persons and

their contacts. Routine testing for HBsAg now is recommended for additional

populations with HBsAg prevalence of ¡Ý2%:persons born in geographic regions

with HBsAg prevalence of ¡Ý2%, men who have sex with men, and injection-drug

users. Implementation of these recommendations will require expertise and

resources to integrate HBsAg screening in prevention and care settings serving

populations recommended for HBsAg testing. This report is intended to serve as a

resource for public health officials, organizations, and health-care

professionals involved in the development, delivery, and evaluation of

prevention and clinical services.

Introduction

Chronic infection with hepatitis B virus (HBV) is a common cause of death

associated with liver failure, cirrhosis, and liver cancer. Worldwide,

approximately 350 million persons have chronic HBV infection, and an estimated

620,000 persons die annually from HBV-related liver disease.[1,2] Hepatitis B

vaccination is highly effective in preventing infection with HBV and consequent

acute and chronic liver disease. In the United States, the number of newly

acquired HBV infections has declined substantially as the result of the

implementation of a comprehensive national immunization program.[3-5] However,

the prevalence of chronic HBV infection remains high; in 2006, approximately

800,000-1.4 million U.S. residents were living with chronic HBV infection (Table

1), and hepatitis B is the underlying cause of an estimated 2,000-4,000 deaths

each year in the United States.[6]

(Enlarge Image) Table 1.

Estimated number and percentage of hepatitis B surface antigen (HBsAg)¨Cpositive

persons, by population segment¡ªUnited States, 2006

[ CLOSE WINDOW ]Table 1. Estimated number and percentage of hepatitis B surface

antigen (HBsAg)¨Cpositive persons, by population segment¡ªUnited States, 2006

Improving the identification and public health management of persons with

chronic HBV infection can help prevent serious sequelae of chronic liver disease

and complement immunization strategies to eliminate HBV transmission in the

United States. Persons with chronic HBV infection can remain asymptomatic for

years, unaware of their infections and of their risks for transmitting the virus

to others and for having serious liver disease later in life. Early

identification of persons with chronic HBV infection permits the identification

and vaccination of susceptible household contacts and sex partners, thereby

interrupting ongoing transmission.

All persons with chronic HBV infection need medical management to monitor the

onset and progression of liver disease and liver cancer. Safe and effective

antiviral agents now are available to treat chronic hepatitis B, providing a

greater imperative to identify persons who might benefit from medical

evaluation, management, and antiviral therapy and other treatment when

indicated. The majority of the medications now in use for hepatitis B treatment

were approved by the Food and Drug Administration (FDA) in 2002 or later; two

forms of alfa 2 interferon and five oral nucleoside/nucleotide analogues have

been approved, and other medications are in clinical trials.

Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to

identify persons with chronic HBV infection. Because of the availability of

effective vaccine and postexposure prophylaxis, CDC previously recommended HBsAg

testing for pregnant women, infants born to HBsAg-positive mothers, household

contacts and sex partners of HBV-infected persons, persons born in countries

with HBsAg prevalence of ¡Ý8%, and persons who are the source of blood or body

fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick

injury to a health-care worker or sexual assault), and persons infected with

human immunodeficiency virus (HIV).[4,5,7-11] This report updates and expands

these multiple previous CDC guidelines for HBsAg testing and includes new

recommendations for public health evaluation and management of chronically

infected persons and their contacts. Routine HBsAg testing now is recommended

for persons born in geographic regions in which HBsAg prevalence is ¡Ý2%, men

who have sex with men (MSM), and injection-drug users (IDUs).

Section 1 of 8

[Guest guest]

http://cme.medscape.com/viewarticle/732116

From Morbidity & Mortality Weekly Report

Recommendations for Identification and Public Health Management of Persons With

Chronic Hepatitis B Virus Infection CME

M. Weinbaum, MD; Ian , PhD; E. Mast, MD; A. Wang, MD;

Lyn Finelli; Annemarie Wasley, ScD; M. Neitzel; W. Ward, MD

Authors and Disclosures

CME Released: 11/12/2010; Valid for credit through 11/12/2011

Summary and Introduction

Summary

Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to

identify persons with chronic hepatitis B virus (HBV) infection. Testing has

been recommended previously for pregnant women, infants born to HBsAg-positive

mothers, household contacts and sex partners of HBV-infected persons, persons

born in countries with HBsAg prevalence of ¡Ý8%, persons who are the source of

blood or body fluid exposures that might warrant postexposure prophylaxis (e.g.,

needlestick injury to a health-care worker or sexual assault), and persons

infected with human immunodeficiency virus. This report updates and expands

previous CDC guidelines for HBsAg testing and includes new recommendations for

public health evaluation and management for chronically infected persons and

their contacts. Routine testing for HBsAg now is recommended for additional

populations with HBsAg prevalence of ¡Ý2%:persons born in geographic regions

with HBsAg prevalence of ¡Ý2%, men who have sex with men, and injection-drug

users. Implementation of these recommendations will require expertise and

resources to integrate HBsAg screening in prevention and care settings serving

populations recommended for HBsAg testing. This report is intended to serve as a

resource for public health officials, organizations, and health-care

professionals involved in the development, delivery, and evaluation of

prevention and clinical services.

Introduction

Chronic infection with hepatitis B virus (HBV) is a common cause of death

associated with liver failure, cirrhosis, and liver cancer. Worldwide,

approximately 350 million persons have chronic HBV infection, and an estimated

620,000 persons die annually from HBV-related liver disease.[1,2] Hepatitis B

vaccination is highly effective in preventing infection with HBV and consequent

acute and chronic liver disease. In the United States, the number of newly

acquired HBV infections has declined substantially as the result of the

implementation of a comprehensive national immunization program.[3-5] However,

the prevalence of chronic HBV infection remains high; in 2006, approximately

800,000-1.4 million U.S. residents were living with chronic HBV infection (Table

1), and hepatitis B is the underlying cause of an estimated 2,000-4,000 deaths

each year in the United States.[6]

(Enlarge Image) Table 1.

Estimated number and percentage of hepatitis B surface antigen (HBsAg)¨Cpositive

persons, by population segment¡ªUnited States, 2006

[ CLOSE WINDOW ]Table 1. Estimated number and percentage of hepatitis B surface

antigen (HBsAg)¨Cpositive persons, by population segment¡ªUnited States, 2006

Improving the identification and public health management of persons with

chronic HBV infection can help prevent serious sequelae of chronic liver disease

and complement immunization strategies to eliminate HBV transmission in the

United States. Persons with chronic HBV infection can remain asymptomatic for

years, unaware of their infections and of their risks for transmitting the virus

to others and for having serious liver disease later in life. Early

identification of persons with chronic HBV infection permits the identification

and vaccination of susceptible household contacts and sex partners, thereby

interrupting ongoing transmission.

All persons with chronic HBV infection need medical management to monitor the

onset and progression of liver disease and liver cancer. Safe and effective

antiviral agents now are available to treat chronic hepatitis B, providing a

greater imperative to identify persons who might benefit from medical

evaluation, management, and antiviral therapy and other treatment when

indicated. The majority of the medications now in use for hepatitis B treatment

were approved by the Food and Drug Administration (FDA) in 2002 or later; two

forms of alfa 2 interferon and five oral nucleoside/nucleotide analogues have

been approved, and other medications are in clinical trials.

Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to

identify persons with chronic HBV infection. Because of the availability of

effective vaccine and postexposure prophylaxis, CDC previously recommended HBsAg

testing for pregnant women, infants born to HBsAg-positive mothers, household

contacts and sex partners of HBV-infected persons, persons born in countries

with HBsAg prevalence of ¡Ý8%, and persons who are the source of blood or body

fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick

injury to a health-care worker or sexual assault), and persons infected with

human immunodeficiency virus (HIV).[4,5,7-11] This report updates and expands

these multiple previous CDC guidelines for HBsAg testing and includes new

recommendations for public health evaluation and management of chronically

infected persons and their contacts. Routine HBsAg testing now is recommended

for persons born in geographic regions in which HBsAg prevalence is ¡Ý2%, men

who have sex with men (MSM), and injection-drug users (IDUs).

Section 1 of 8