Marking a shift from a risk-based approach, the Centers for Disease Control and Prevention (CDC) now recommends that all adults ≥18 years should be screened for hepatitis B at least one time. The updated guidelines from CDC were published March 10, 2023, in the Morbidity and Mortality Weekly Report (MMWR).¹ However, children and adolescents younger than 18 years have been exempted from universal screening. Those at risk and the unvaccinated should be tested in this age group.

The triple panel comprising of hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen is recommended for initial screening to detect active / resolved infection including vaccination status

It further recommends screening all pregnant women during the first trimester (preferably) of each pregnancy "regardless of vaccination status or history of testing”. For pregnant women who have recently been screened and are not at risk of new exposures to hepatitis B, HBsAg screening suffices.

All persons at increased risk for hepatitis B infection should be tested for the virus. The at-risk group includes infants born to hepatitis B (surface antigen) positive mothers, injection drug users, persons with HIV infection, needle sharing, dialysis patients, unvaccinated persons, men who have sex with men. The CDC has added three new at-risk groups, which include persons in jails, those with history of current or previous hepatitis C infection and people with STIs and multiple sex partners.

In a new recommendation, the CDC further says that anybody who wishes to undergo HBV testing should be tested for the infection “regardless of disclosure of risk”.

All those who are continually exposed to the risk of infection should undergo periodic testing for hepatitis B, irrespective of their age.

Reference

1. Conners EE, et al. Screening and testing for hepatitis B virus infection: CDC recommendations - United States, 2023. MMWR Recomm Rep. 2023 Mar 10;72(1):1-25. doi: 10.15585/mmwr.rr7201a1.