Based on recent CDC action, HepB vaccination now is recommended for all adults aged 19 to 59 years as well as those aged 60 years and older with risk factors for the infection.
The CDC added that adults aged 60 years and older without known risk factors may also receive HepB vaccines. It added that everyone younger than age 19 years was already recommended to be vaccinated against HepB.
Those changes were enthusiastically welcomed by the National Viral Hepatitis Roundtable (NVHR), a coalition working to eliminate viral hepatitis. "NVHR applauds Director Walensky and CDC for recommending universal hepatitis B virus (HBV) vaccination for all adults ages 19-59 in the United States," stated Director of Policy, Daniel Raymond. "The adoption of this recommendation moves us closer to our goal of eliminating viral hepatitis by stemming the tide in hepatitis B infections across the country, particularly for communities who have long been subjected to health inequities."
Mr. Raymond added, "The formal adoption of this recommendation, one that was made unanimously by the CDC Advisory Committee on Immunization Practices (ACIP), marks a new milestone in the fight against hepatitis B. Despite major reductions in HBV infections achieved through evolving hepatitis B vaccine policy over the past four decades, progress has stalled in the past 10 years. The shift from risk-based guidelines to a universal recommendation will help to overcome that stalled progress by preventing thousands of adult infections per year."
The NVHR pointed out that vaccines have contributed to a 96% decline in the incidence of acute HepB in children and adolescents with nearly universal uptake.
In an article in the Morbidity & Mortality Weekly Report (MMWR), the CDC advised that about half of acute HepB cases reported in 2019 occurred among adults aged 30 to 49 years, adding that the number of cases of acute HepB has increased among adults aged 40 years and older; that is especially the case for those aged 40 to 49 years, for whom the rate of reported cases increased from 1.9 per 100,000 population in 2011 to 2.7 per 100,000 population in 2019.
At the same time, public health officials noted that the rate among adults aged 50 to 59 years increased 45.5% (from 1.1 to 1.6 per 100,000 population) and made up 22.2% of all reported cases.
Acute HBV infections among adults leads to chronic HepB disease in about 2% to 6% of cases, according to the CDC.
Yet, the authors wrote, HepB vaccination coverage among adults aged older than 19 years remains low, with self-reported HepB vaccination coverage (three or more doses) in that age group at 30.0% in 2018.
In fact, during 2013 to 2018, only 21.4% (95% CI = 20.2%-22.6%) of adults aged 25 years and older had vaccine-induced immunity to HepB, according to the article.
"HepB vaccination coverage among adults with risk factors has been suboptimal," the CDC authors emphasized. "In 2018, self-reported coverage (>3 doses) was 33.0% among adults with chronic liver disease, 38.9% among travelers to countries where HBV infections have been endemic since 1995, 33.0% among adults with diabetes aged 19Ð59 years, and 67.2% among health care personnel."
Among the reasons for the low uptake, according to a national survey of 433 family medicine physicians and 420 internal medicine physicians, is patients' nondisclosure of risk factors (cited by 68%) and inadequate time to routinely assess patients for risk factors (cited by 44%).
Risk factors for HepB include travel to certain countries, work exposure to blood, high-risk sexual behavior, injectable drug use, specific living situations, and certain medical conditions.
"A universal recommendation for HepB vaccination could increase the number of persons who receive vaccination before the onset of chronic liver disease and other comorbidities (e.g., obesity or diabetes) that might make vaccination less effective," the article pointed out. "For example, patients with chronic liver disease are known to have decreased immune response to HepB vaccination."
The report also discusses racial and ethnic disparities that exist with HBV infection. In 2005, acute HepB incidence among non-Hispanic Black Americans was about twice that among several other racial and ethnic populations, according to the MMWR article. In 2019, it added, the rate of HBV infection among non-Hispanic Black adults was triple that of Asian or Pacific Islander adults and about twice that of Hispanic adults.
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