The Centers for Disease Control and Prevention now advise people to get tested for hepatitis B at least once in their lifetime. Although the infection can be managed with antivirals and prevented with a highly effective childhood vaccine, many Americans today still live with chronic hepatitis B, which can increase the risk of liver damage and cancer. According to the CDC, two-thirds of these Americans may not even know they have the disease.
Hepatitis B is one of many unrelated viruses that are the main cause of hepatitis (inflammation of the liver) in humans. It spreads through blood and other bodily fluids, which can be transmitted through sex, sharing contaminated needles and syringes, or from mother to child in the womb. Most people initially infected with hepatitis B will not have symptoms, but those who experience it experience fatigue, lack of appetite, stomach pain, nausea, and jaundice. The infection is often short-lived, but sometimes the virus persists in the body. Untreated chronic hepatitis B can damage the liver over time, increasing the risk of developing cirrhosis and liver cancer.
The first hepatitis B vaccine was introduced to the world in the early 1980s, and childhood vaccination became common in the United States beginning in the early 1990s. The vaccine is highly effective in preventing hepatitis B and, after its introduction, the rate of new cases steadily fell in the United States. But more recently, the incidence of hepatitis B has remained stable, although low. And while children born in the United States are largely protected from it, many residents were born in countries where vaccination is less common, as well as older adults who may never have been vaccinated (the CDC recommended that people as old as 59 should get vaccinated).
The new council released Thursday is an update to the CDC guidelines previously published in 2008. These called for people at higher risk of infection to be screened for the virus, such as those born in countries where it is common, people who currently inject or used to s injecting recreational drugs and men who have sex with men. But the CDC now says anyone over the age of 18 should get tested for the virus at least once in their lifetime.
Today, about 20,000 new cases of hepatitis B are occurring in the United States, according to the CDC. About half a million to 2.4 million Americans live with chronic hepatitis B, and up to two-thirds may be unaware of their infection. About 1,600 deaths in the United States attributed to hepatitis B were documented in 2019, although this is likely an undercount.
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Although most people don’t have hepatitis B, the CDC says universal one-time testing should still be globally cost-effective and life-saving. According to a recent analysis cited by the agency, the change would be is expected to prevent about two liver transplants and 10 hepatitis B-related deaths per 100,000 Americans screened, as well as many cases of cirrhosis.
The guidelines also aim to reinforce an ambitious World Health Organization goal to effectively eliminate viral hepatitis everywhere by 2030. Globally, According to WHO, 296 million people were living with chronic hepatitis B in 2019, while 1.5 million people are newly infected each year. It is estimated that these infections kill more than 800,000 people a year, mainly from liver cancer and cirrhosis.
Chronic hepatitis B is incurable, but antiviral treatments can control it. Newborns who contract the virus can also receive treatment to help prevent chronic infection.