New CDC Guidelines Target Hepatitis B

Screening, vaccinating and providing health-care services and resources to individuals infected with the hepatitis B virus (HBV) are US public health priorities.

To make that message clear, the American College of Physicians (ACP) and US Centers for Disease Control and Prevention (CDC) have released new best practice guidelines to address the liver-attacking virus.

About 847,000 people in the US are living with chronic HBV, with 14,000 deaths in the country attributable to the virus each year, researchers from the ACP and CDC reported in a recent study.

“Prior recommendations have not accomplished the critical goals of screening high risk populations, vaccinating those who are at risk, and referring for care those who are already infected,’’ Jack Ende, MD, MACP, President, ACP, told MD Magazine. ``The current guidelines are straightforward and should be of great value for clinicians, health-care workers and patients.’’

The authors examined literature on clinical guidelines, systematic reviews, randomized trials and intervention studies involving HBV vaccination, screening and linkage to care published between January 2005 and June 2017.

They concluded that vaccination is the most effective way to prevent HBV infection and its complications.

All adults, including pregnant women, who are at risk for infection because of sexual, percutaneous or mucosal exposure should be vaccinated, the guidelines recommend. In addition, health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease, or human immunodeficiency virus (HIV) infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection should also get the vaccine.

“Vaccination confers 90% protection in adults younger than 40 who receive the complete vaccination series. Immunity lasts at least 30 years,” Ende said. “This is extraordinary. Now we need to do all we can to implement these guidelines.”

Screening for HBV in high-risk persons is crucial to stem the virus, the guidelines advise. Pregnant women and infants born to HBV-infected mothers are among those who require screening.

“Many of the risk factors for hepatitis B also portend non-adherence,’’ Ende said, citing injection drug users, prison inmates and people at risk of sexual exposure. “But with public health efforts, these important populations can be reached, and proper screening, vaccination and care provided.”

Other high-risk groups where screening is recommended include people born in countries with 2% or higher HBV prevalence; those living with HIV or hepatitis C (HCV); persons requiring immunosuppressive therapy; those with end-stage renal disease; blood and tissue donors; and people with elevated alanine aminotransferase levels, the researchers wrote.

Screening is important because two-thirds of people chronically infected with HBV are unaware of their status, a situation that contributes to ongoing transmission, the authors noted.

The third step in the new guidelines advises clinicians to provide post-test counseling and HBV-directed care -- or to refer all patients identified with HBV to professionals who can help them.

Between 15% and 40% of persons with chronic HBV infection develop cirrhosis, hepatocellular carcinoma, or liver failure, and 25% die prematurely of these complications, the authors wrote.

“We need all the oars in the water,’’ said ACP’s Ende, whose organization is the largest medical specialty group in the US with members in more than 145 countries.

Efforts to implement the guidelines begin with primary care practices, correctional facilities and public health sites that administer care, he said.

"But given that patients with liver disease and renal disease, as well as pregnant women, are candidates for screening and vaccinations, specialists need to be involved as well,’’ Ende said.

The study, "Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention," was published online in Annals of Internal Medicine last month.

This article was originally published by MD Magazine.