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Ann Intern Med. 2011 Mar 1;154(5):319-28. doi: 10.7326/0003-4819-154-5-201103010-00006.

Hepatitis B virus in the United States: infection, exposure, and immunity rates in a nationally representative survey.

Author information

1
Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, USA. georgei@medicine.washington.edu

Abstract

BACKGROUND:

Up-to-date estimates of the prevalence of hepatitis B virus (HBV) infection, exposure, and immunity are necessary to assess the effectiveness of ongoing programs aimed at preventing HBV transmission.

OBJECTIVE:

To determine the prevalence and associations of chronic HBV infection, past exposure, and immunity in the United States from 1999 to 2008.

DESIGN:

Nationally representative, cross-sectional household survey.

SETTING:

U.S. civilian, noninstitutionalized population.

PARTICIPANTS:

39 787 participants in the National Health and Nutrition Examination Survey (1999 to 2008) aged 2 years or older.

MEASUREMENTS:

Chronic HBV infection was defined by presence of serum HBV surface antigen and past exposure by serum antibody to hepatitis B core antigen among persons aged 6 years or older. Infant immunity was defined by presence of serum antibody to hepatitis B surface antigen among children aged 2 years.

RESULTS:

Among persons aged 6 years or older, 0.27% (95% CI, 0.20% to 0.34%) had chronic HBV infection (corresponding to approximately 704 000 persons nationwide), and 4.6% (CI, 4.1% to 5.0%) had been exposed to HBV (approximately 11 993 000 persons). These estimates are lower (P < 0.001) than estimates of HBV infection (0.42%) and exposure (5.1%) in the United States reported from 1988 to 1994. Infection and past exposure were very uncommon among persons aged 6 to 19 years. Children aged 2 years have high rates of immunity (68.6% [CI, 64.1% to 73.2%]). Adults, including those at high risk for infection, have much lower rates of immunity.

LIMITATIONS:

Incarcerated and homeless persons were not sampled. Categorization of race or ethnicity did not identify high-risk groups, such as persons of Asian and Pacific Islander descent.

CONCLUSION:

A cohort of children and adolescents is growing up in the United States with high rates of immunity against HBV and very low rates of infection. Vaccination of high-risk adults should continue to be emphasized.

PRIMARY FUNDING SOURCE:

The Veterans Affairs Research Enhancement Award Program.

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[Indexed for MEDLINE]

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