The U.S. Centers for Disease Control and Prevention (CDC) has published new testing recommendations for health care providers that are designed to increase routine testing in the United States for chronic hepatitis B.
These recommendations, published in a report in the Sept. 18 issue of Morbidity and Mortality Weekly Report Recommendations and Reports, build on and reinforce past recommendations to test all pregnant women, infants born to infected mothers, household contacts and sex partners of people who are infected, and people with HIV.
Along with continued testing of those groups, the CDC recommends routine testing for additional populations, including the following:
–people born in Asia, Africa and other geographic regions with a 2 percent or higher prevalence of chronic hepatitis B virus (HBV) infections; previous CDC recommendations called for testing of people born in areas with an 8 percent prevalence or higher. Expanded testing is essential because the rate of liver cancer deaths and chronic HBV in the United States remains high among foreign-born U.S. populations from these areas. For example, nearly one in 12 Asian Americans and Pacific Islanders living in the United States is infected with HBV, and one-third or more are unaware of their status.
–men who have sex with men and injection drug users; routine testing is needed for these populations because they have a higher prevalence of chronic HBV infection than does the overall U.S. population. It is estimated that up to 3 percent of men who have sex with men and up to 6 percent of injection drug users are infected chronically with HBV, compared with three-tenths of one percent of the general population.
–people with abnormal liver function test results (not explained by other conditions) and people who require immunosuppressive therapy (for example, chemotherapy for malignant diseases).
The Sept. 18 report also recommends that health care workers refer people with HBV infections to specialists for ongoing monitoring and medical care. Such guidelines are needed to help providers, because most of the effective medications for chronic HBV treatment have become available in the last five years. The recommendations also advise health care providers to provide culturally sensitive ongoing patient education, begin lifelong monitoring for progression of liver disease, and ensure protection of household members and other close contacts of infected people.
"Chronic hepatitis B affects the lives of more than one million Americans, many of whom do not even know they are infected," said John W. Ward, MD, director of the CDC’s Division of Viral Hepatitis. "These new recommendations are critical to identifying people who are living with the disease without the benefits of medical attention. Testing is the first step to identify infected persons so that they can receive lifesaving care and treatment, which can break the cycle of transmission, slow disease progression and prevent deaths from liver cancer."
