Understanding the Updated Universal Hepatitis B Screening and Treatment Guidelines
Debika Bhattacharya, MD MSc, and Su H. Wang, MD, MPH, FACP, provide important insights on the latest in hepatitis B (HBV) clinical care.
Last year, the US federal government updated the screening and treatment guidelines for hepatitis C. And in a continuation of trying to reduce these blood-borne diseases, US federal and global guidelines are looking to address hepatitis B. The overarching public health goals are to make significant changes to HBV testing and clinical care including increasing vaccinations, extending universal screening to everyone at least once during a lifetime for all adults 18 years of age and older, reducing the number of new infections, and getting those patients who have contracted the disease into the continuum of care.
“The CDC is now recommending universal screening for hepatitis B,” said Debika Bhattacharya, MD MSc, clinical professor, David Geffen School of Medicine, University of California, Los Angeles (UCLA). “Remember that happened for hepatitis C…but now we've updated that to now include hepatitis B testing, and that includes a triple panel test, so that's a surface antigen, core antibody and surface antibody test. The other really important point to say is that in addition to universal screening, we're also now recommending universal vaccination, by and large, of hepatitis B, and those are new and I think really important for providers to be aware of.”
Su H. Wang, MD, MPH, FACP, medical director, Viral Hepatitis Programs & the Center for Asian Health at the Cooperman Barnabas Medical Center, RWJBarnabas Health points out that although the World Health Organization has an ambitious goal to try and eliminate hepatitis B as a public health threat by 2030, there is still a lot of ground to make up.
“In terms of reducing hep B as a public health threat, and we've got huge gaps, like only 13% of people with hep B have been diagnosed, and less than 3% are on treatment. So it's really important to do universal screening and universal vaccination to really help close those gaps,” Wang said.
They agree the idea of changing the criteria from risk-stratified questions to decipher which patients should be tested for HBV to universal screening simplifies the matter and can work towards getting more individuals into the continuum of care.
“We're at such a small amount of people who've been treated, that there is a push and need for us to really simplify the guidelines,” Wang said. “And I think we're seeing that the guidelines were quite complex and very lab based in terms of trying to phase people based on E antigen, viral load, abnormal alanine aminotransferase (ALT), and a lot of people just never got to the point where they had actually gotten all the tests and were being followed and being staged, and a lot of people were being lost to follow up.”
