CDC Recommends Universal Hepatitis B Vaccinations for Adults

The US Centers for Disease Control and Prevention (CDC) has released new guidelines for hepatitis B virus (HBV) vaccination, calling for universal HBV vaccination for all adults aged 19-59 years in the US.

The CDC said in the Morbidity and Mortality Weekly Report (MMWR) that the decision is based on 4 decades of safety, immunogenicity, and efficacy data on the HBV vaccine, but with suboptimal coverage in the US.

ACIP Reccomendations

Last November, the Advisory Committee on Immunization Practices (ACIP) first made the recommendations for universal vaccinations within that age group, while removing the risk factor assessment previously in place to determine vaccine eligibility. The reccomendations are the result of more than 2 years of work evaluating the incidence of hepatitis B, morbidity related to hepatitis B, mortality related to hepatitis B, and vaccine-related serious adverse events.

HBV vaccination recommendations were previously based on individual risk factors, which could be inefficient and burdensome to both providers and patients, while adding to the stigma of the disease. Approximately 30% of US adults have been vaccinated against HBV, despite rates of acute hepatitis B virus steadily increasing the last decade, particularly among those aged 40 years and older.

“It has been frustrating to watch rates of infection rise when we know that there is a safe and effective vaccine that can prevent hepatitis B and liver cancer,” Michaela Jackson, MS, MPH, prevention policy manager at the Hepatitis B Foundation, said in a statement. “This recommendation will help remedy a very significant health inequity for marginalized groups and it will serve to make many adults in the U.S. safer.”

The recommendations for those aged 60 years and older are expected to continue to follow risk-based guidelines to determine vaccination.

Hepatitis B Statistics

Since the advent of HBV vaccines, incident hepatitis B has decreased from 26,654 reported cases and 172,700 estimated actual cases in 1985 to 2791 reported cases and 18,100 estimated actual cases in 2014.

In 2019 there was 3192 cases of acute HBV reported to the CDC, which equates to 20,700 estimated acute infections (95% CI, 11,800-50,800). There was also an estimated 880,000 (95% CI, 580,000-1.17 million) prevalent chronic HBV infections in the US, according to 2013-2018 National Health and Nutrition Examination Survey Data, with a modeled estimate of 1.89 million.

A lot of the estimates account for potential underrepresented individuals of the non-US born population.

Commonly reported risk behaviors and exposures include injection drug use (35%), multiple sex partners (23%), and surgery (10%). Other risk factors include sexual and bloodborne risk behaviors.

“This is a major step forward that the Hepatitis B Foundation had strongly advocated for over many years,” said Chari Cohen, DrPH, MPH, senior vice president of the Hepatitis B Foundation, in a statement. “These greatly expanded and simplified recommendations will improve access and make it easier to protect millions more Americans from hepatitis B. This will save countless lives and ultimately reduce health care costs.”