Despite Guideline Update, Universal HBV Screening Uptake Remains Suboptimal

Hepatitis B virus (HBV) infection often presents without symptoms. According to the US Centers for Disease Control and Prevention, an estimated 580,000 to 2.4 million persons are living with HBV infection in the United States, two thirds of whom might be unaware of their infection.1

To address historical challenges to HBV screening and support the World Health Organization’s viral hepatitis elimination goals, 2023 CDC guidelines introduced universal HBV screening for all adults, recommending a triple panel test at least once during a lifetime for adults ≥18 years of age.1

“That change in 2023 was to have a standard of universal screening and to catch more of these asymptomatic chronic hepatitis B cases with a triple panel, including a surface antigen, a surface antibody, and a total core antibody,” Najy Issa, MD, Internal Medicine PGY-2 at Mary Washington Hospital, explained to HCPLive. “The goal behind this is to catch the disease earlier, reduce transmission, have a better detection rate of the actual chronic illness, and prevent the further downstream effects of having hepatitis B, including liver complications and cancer.”

At Digestive Disease Week (DDW) 2025, Issa presented his research on the early impact of universal HBV screening in community primary care clinics. His analysis examined 31,777 patients ≥ 18 years of age in 6 primary care centers in Fredericksburg, VA, from July 2023 to December 2024 and found the frequency of triple-panel screening in these 6 centers was 1.5%, equating to 444 patients.2

“It really was, unfortunately, underwhelming, how many people were appropriately screened,” Issa said.

The prevalence of HBV in the screened cohort was 0.23%, with a single new case of HBV detected through the appropriate triple-panel screening. Of note, the patient had immigrated from Ghana, a country with an estimated HBV prevalence of 12.3%, and would have been screened under the prior risk-based guidelines.2

Acknowledging the limited data currently available on the impact of universal HBV screening, Issa cites the importance of examining potential discrepancies in screening and detection rates at different healthcare centers in different settings. In the community population, he says it will be essential to find ways to get high-risk patients to get screened.

“In our internal medicine clinic in the Fredericksburg area, we implemented a QI project, which added a forced stop in our Epic Health Record system when you complete your clinic note,” Issa explained to HCPLive. “That forces you basically to say whether or not you screened the patient for hepatitis B and a reason why you did one or the other. After a month, that has shown we've already increased our screening rate to 21%.”

Editors’ note: Issa has no relevant disclosures.

References

1. US Centers for Disease Control and Prevention. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023. March 10, 2023. Accessed May 8, 2025. https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm

2. Issa N, Makhijani U, Mangano A, et al. IMPACT OF UPDATED UNIVERSAL HEPATITIS B SCREENING GUIDELINES ON FREQUENCY AND PREVALENCE. Poster presented at Digestive Disease Week in San Diego, CA, from May 3 - May 6, 2025.