CDC: All Adults Should Be Tested for Hepatitis B at Least Once in Their Lifetime

Fact checked by Nick Blackmer

• The Centers for Disease Control and Prevention has updated its guidance for hepatitis B testing. It now recommends that everyone over age 18 be tested for hepatitis B at least once in their lifetime.
  

• This is the first change in testing recommendations since 2008 and makes testing universal for adults, rather than based on whether a person has any risk factors for hepatitis B infection.

• The CDC also recommends that adults aged 18 to 59 get vaccinated against hepatitis B if they haven’t already. Vaccination against hepatitis B is already recommended for infants.

If you’re 18 or older, the Centers for Disease Control and Prevention (CDC) now recommends getting tested for hepatitis B at least once in your lifetime.

Previously, the CDC only recommended testing for people at risk of hepatitis B infection, including but not limited to men who have sex with men, people with HIV or sexually transmitted infections, people who’ve injected drugs.

Hepatitis B is a viral infection characterized by inflammation of the liver and transmitted through bodily fluids. While most people can clear the infection on their own, chronic cases can be quite serious and may require medication or even liver transplant. There is no cure for chronic hepatitis, but it can be prevented with a vaccine.

“Liver disease is one for which there’s a lot of stigma, and any screening recommendations that move away from risk-based screening really de-stigmatize the disease,” Emmanuel Thomas, MD, PhD, chairman of the national board of directors for the American Liver Foundation, told Verywell.

An infection with hepatitis B virus can be acute, which means that the body’s immune system fights it off within a few weeks. However, some people develop chronic hepatitis B infection, which is lifelong. Chronic hepatitis B puts a person at increased risk for liver cancer and cirrhosis, and of dying prematurely. That’s why testing is so important—knowing your infection status can help you get the antiviral treatment needed to keep symptoms at bay.

Testing Consists of 3 Parts

A three-panel blood test is needed to identify the multiple parameters of chronic hepatitis B infection. You can get tested at locations like your primary care provider’s office, a community health clinic, or chain pharmacies with clinics, like CVS. You can also purchase at-home test kits, which require a blood sample that you sent to a lab for analysis.

"Screening used to just involve checking for hepatitis B surface antigen, which only looks for chronic infection," liver specialist Jama Darling, MD, an assistant professor at the University of North Carolina School of Medicine, told Verywell.

Additional testing allows healthcare providers to determine how infectious a person is, how the virus is replicating, and which type of treatment is necessary.

If a person tests negative for hepatitis, providers can recommend vaccination.

The three tests used to determine hepatitis B infection status look for three different markers:

• Hepatitis B surface antigen (HBsAg) indicates that the person with hepatitis B is infectious

• Antibody to hepatitis B surface antigen (anti-HBs) indicates that the person has recovered from a hepatitis B infection and can show immunity after vaccination

• Antibody to hepatitis B core antigen (anti-HBc) indicates the presence of hepatitis B and persists for life after the initial infection

In addition to the change to universal testing, the CDC is continuing its recommendations that pregnant women be tested for hepatitis B surface antigen (HBsAg) during each pregnancy, whether they have been vaccinated against hepatitis B or have been previously tested for the virus.

Susceptible people who have ongoing risk for hepatitis B should be tested periodically if they continue to be at risk.

Who Is Most At-Risk for a Hepatitis B Infection?

Hepatitis B is transmitted through contact with infected blood or body fluids, including through pregnancy and childbirth. In fact, transmission of the virus during childbirth is considered the greatest risk for chronic infection.

For people with a history of increased risk for hepatitis B, the CDC still recommends risk-based testing, which may require more than just one test per lifetime. Other risk factors for being infected with hepatitis B virus include having been in jail, prison, or other detention; having a history of sexually transmitted infections or multiple sex partners; using intravenous drugs; or being infected with hepatitis C virus.

People born outside of the United States are more likely to have chronic hepatitis B infection, and account for nearly 70% of those with a known chronic infection.

Anyone who asks to be tested for hepatitis B should also be tested without having to disclose if they have a risk factor for infection, the CDC says.

Related:Hepatitis B vs. Hepatitis C: What Are the Differences?

The opioid crisis and intravenous drug use gives the new universal recommendation for testing increased importance, Darling said. Patients don’t necessarily tell their healthcare providers if they use or have used injected drugs, she noted.

According to the report announcing the change in recommendations, which appeared in Morbidity and Mortality Weekly Report, up to 2.4 million persons are living with hepatitis B virus infection in the United States. Two out of three of these people may be unaware of their infection.

The good news is the prevalence of hepatitis B is declining in the U.S. thanks to the availability of a three-shot vaccine for the virus that is recommended for all newborns, Thomas said. Last year, the CDC recommended that everyone over age 18 and under age 59 be vaccinated against hepatitis B. These recommendations are in line with the World Health Organization guidelines.

“It is startlingly rare to see a 20-year-old who hasn’t been vaccinated,” Darling said, crediting the advent of newborn vaccinations for hepatitis B. “But it’s … uncommon to see a 40-year-old vaccinated for B.”

The CDC recommends that you be tested for hepatitis B at least once in your life if you are over age 18. The agency also recommends that anyone over age 18 be vaccinated against the virus.