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December 12, 2017
Journal Watch, General Medicine
GUIDELINE WATCH, FREE FULL-TEXT ARTICLE
Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Abara WE et al. Ann Intern Med 2017 Dec 5.
New guidelines attempt to consolidate various existing recommendations.
Sponsoring Organization: American College of Physicians (ACP) and CDC
Target Audience: All clinicians
Background
Nearly 1 million people in the U.S. have chronic hepatitis B virus (HBV) infection; about two thirds of them are unaware that they're infected. Universal HBV vaccination in infants has contributed to a nearly 90% decrease in acute HBV infections among adults, but challenges remain in unvaccinated at-risk adults. Also, only 10% to 15% of infected adults who are eligible for antiviral therapy receive it. The ACP and the CDC have collaborated to develop updated recommendations on HBV screening, vaccination, and linkage to care.
Key recommendations
Offer screening (HBV surface antigen [HBsAg], HBV core antigen antibody, antibody to HBsAg) to the following high-risk groups:
Foreign-born people from countries with high HBV prevalence (i.e., 2% or higher; e.g., all countries in Africa and Asia, most countries in Eastern Europe and the Middle East)
Men who have sex with men (MSM), injection drug users, and incarcerated populations
Patients who are positive for HIV or hepatitis C, contacts of people with HBV infections, and infants born to HBV-positive mothers
Patients who need immunosuppressive therapy
Patients with end-stage renal disease (ERSD)
People with elevated alanine aminotransferase levels
Pregnant women
Offer HBV vaccination to unvaccinated adults in the following groups:
People at risk for infection based on sexual exposure
People at risk based on exposure to blood or blood-contaminated fluids
Patients with any chronic liver disease (including elevated transaminase levels greater than twice the upper limit of normal), HIV, or ERSD
Pregnant women at risk for HBV infection during pregnancy
International travelers to countries with intermediate or high levels of endemic HBV infection
Link HBV-positive patients to care:
HBsAg-positive patients should be referred to experienced providers for counseling, antiviral treatment, and follow-up care.
COMMENT
Lowering the burden of HBV disease begins with screening and vaccinating at-risk people and arranging follow-up care for those with chronic HBV disease. Systems-level improvements in healthcare institutions are needed to address these needs most effectively.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Daniel D. Dressler, MD, MSc, SFHM, FACP at time of publication
Royalties
McGraw-Hill
Editorial boards
Journal of Hospital Medicine (Frontline); Principles and Practice of Hospital Medicine (McGraw-Hill)
CITATION(S):
Abara WE et al. 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. Ann Intern Med 2017 Dec 5; 167:794. (http://dx.doi.org/10.7326/M17-1106)
https://www.jwatch.org/na45537/2017/12/12/updated-recommendations-hepatitis-b-screening-and?query=etoc_jwgenmed&jwd=000100032085&jspc=GP (https://www.jwatch.org/na45537/2017/12/12/updated-recommendations-hepatitis-b-screening-and?query=etoc_jwgenmed&jwd=000100032085&jspc=GP)