ACP's High Value Care Task Force and the CDC recently issued joint best practice advice on hepatitis B virus (HBV) vaccination, screening, and linkage to care.
The recommendations are based on a narrative literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies published from January 2005 to June 2017. Outcomes evaluated were vaccination coverage, HBV transmission, knowledge of HBV infection status, HBV-directed care, complications of chronic HBV infection, and health care costs. All of the best practice statements were reviewed by the CDC and the task force and were approved by consensus.
The best practice advice, which was published by Annals of Internal Medicine on Nov. 21, recommended that clinicians vaccinate all previously unvaccinated adults who are at risk for HBV infection, including the following groups:
- adults at risk because of sexual exposure;
- adults at risk because of percutaneous or mucosal exposure to blood;
- adults with chronic liver disease, such as hepatitis C virus infection, cirrhosis, or autoimmune hepatitis;
- adults with end-stage renal disease;
- adults with HIV infection;
- pregnant women who are at risk for HBV during pregnancy;
- those who have traveled internationally to regions with high or intermediate levels of endemic HBV infection; and
- any adult who wants protection from HBV.
Regarding screening, the statement recommended that clinicians screen for HBV in patients at high risk, such as those born in countries where the HBV prevalence is 2% or higher, men who have sex with men, patients who require immunosuppressive therapy, or patients with end-stage renal disease. The statement also recommended that clinicians provide post-test counseling and HBV-directed care to all patients who are identified as having HBV or refer patients for such counseling and care.
The statement authors noted that chronic HBV infection in the U.S. has a high burden and high costs and that vaccination is vital to preventing infection and reducing transmission, while screening those at high risk is the first step to identifying HBV infection and providing appropriate care. “Evidence-based strategies that effectively implement this advice are critical to accomplishing the goals of the national hepatitis B elimination plan,” the authors wrote.