Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights Trends in Hepatitis B Infection and Immunity Among Women of Childbearing Age in the United States, authored by Kushner T, Chen Z, Tressler S, Kaufman H, Feinberg J, Terrault NA, and published in Clinical Infectious Diseases in August 2020.
What questions(s) does this study address?
Using the database of a large commercial laboratory, the investigators reviewed the test results of 8,871,965 women, aged 15-44 years, who were tested for Hepatitis B virus, or HBV, during the years 2011 through 2017. They wanted to determine if there had been an increase in Hepatitis B infections among women of childbearing age, as has been reported for Hepatitis C virus. Increases in Hepatitis C prevalence among reproductive-age women in the U.S. have been attributed to increases in injection drug use related to America’s opioid epidemic. A secondary goal of the study was to assess immunity related to Hepatitis B vaccination, defined as HBV surface antibody positivity and HBV core antibody negativity.
What are the major findings of this report/article?
- Nationally, the annual rate of acute, or new, Hepatitis B infections was stable during the study period, but the states of Kentucky, Alabama and Indiana showed significantly increasing trends in acute infections over the 7-year period.
- Overall, the national prevalence of new, chronic Hepatitis B diagnoses decreased by 77% between 2011 (0.83%) and 2017 (0.19%), but increased significantly in Mississippi, Kentucky and West Virginia.
- Overall, the rate of Hepatitis B vaccine-associated immunity was 46.8% and higher rates of vaccine protection were found in those born in or after 1992 (who were likely to have been vaccinated at birth as recommended by the Advisory Committee on Immunization Practices (ACIP) in 1991) and those born in 1980 to 1991 (who likely benefited from the 1997 ACIP recommendations to vaccinate all previously unvaccinated children under the age of 19).
What are the implications for the prevention and control of viral hepatitis?
- While overall trends in Hepatitis B infection among reproductive-aged women have decreased over time, these findings suggest that there have been increases in Hepatitis B infections in specific states in Appalachia; this finding may be related to increased injection drug use.
- The Hepatitis B vaccine is effective in decreasing infections but the efficacy of the vaccine wanes over time.
- These researchers opined that in addition to screening for Hepatitis B during pregnancy, “interval screenings for HBV among at-risk women are warranted.”
- Because these data were derived from women who accessed health care and received testing services, they do not necessarily reflect Hepatitis B risk among women who may not access healthcare and, as such, may be distinct from the patient populations studied by the NHANES (National Health and Nutrition Examination Survey) or the National Health Interview Survey (NHIS).