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Clin Infect Dis. 2019 Aug 26. pii: ciz841. doi: 10.1093/cid/ciz841. [Epub ahead of print]

Trends in Hepatitis B Infection and Immunity among Women of Childbearing Age in the United States.

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Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.
Quest Diagnostics, Secaucus, New Jersey, U.S.
Division of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, U.S.
Departments of Behavioral Medicine & Psychiatry, Neuroscience and Medicine, Division of Infectious Diseases, West Virginia University, Morgantown, West Virginia, U.S.
Division of Gastroenterology/Hepatology, University of Southern California, Los Angeles, CA, U.S.



The current opioid injection drug use epidemic has been associated with an increase in hepatitis C (HCV) infections among women of childbearing age in the US, but changes in hepatitis B (HBV) infection have not been studied.


A retrospective analysis of HBV status among women of childbearing age nationally and by state was conducted utilizing the Quest Diagnostics database. Rates of HBV in women born before and after implementation of universal HBV vaccination recommendations were determined.


We identified 8,871,965 women tested for HBV from 2011-2017. Nationally, the annual rate of acute HBV infections was stable, but increased in Kentucky, Alabama and Indiana (p<0.03). The national prevalence of new chronic HBV diagnoses decreased significantly from 0.83% to 0.19% from 2011 to 2017 (p<0.0001), but increased in Mississippi, Kentucky and West Virginia (p≤0.05). A declining prevalence of HBV seroprotection was evident over time, especially within the birth-dose cohort (48.5% to 38.5%, p<0.0001).


National rates of newly diagnosed acute and chronic HBV infection declined or were stable overall, but increased significantly in specific Appalachian states. HBV vaccine is effective in decreasing infection, but seroprotection wanes over time. These trends in new infections may be related to increased injection drug use and highlights potential gaps in HBV vaccine protection.


hepatitis B exposure; hepatitis B vaccination; hepatitis B virus; reproductive age; testing


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