Trends in Prevalence and Characteristics of Resolved and Current Hepatitis B Among US-Born Persons: National Health and Nutrition Examination Survey, 2001–2018

Abstract

Abstract Background After decades of decline, US acute hepatitis B incidence flattened since 2011. In persons aged ≥40 years and in jurisdictions affected by the opioid crisis, there is an increase in new cases. Data suggest new infections are occurring among US-born persons. Methods We used National Health and Nutrition Examination Survey data during 2001–2018 to examine changes in total antibody to hepatitis B virus core antigen (anti-HBc) prevalence in US-born persons. During 2013–2018, the distribution of characteristics was examined. Results During 2001–2006, 2007–2012, and 2013–2018, anti-HBc prevalence was 3.5%, 2.5%, and 2.6% among US-born persons, respectively. This corresponded to 5.7 (range, 4.8–6.6) million US-born persons with resolved or current HBV infection during 2013–2018, including 344 600 persons aged 6–29 years. The largest increase and highest prevalence was among persons who reported injection drug use (IDU), which increased from 35.3% during 2001–2006 to 58.4% during 2013–2018 (P = .07). Conclusions Anti-HBc prevalence among US-born persons remained flat during the most recent period, coinciding with a doubling of prevalence among persons reporting IDU. These data are consistent with acute hepatitis B surveillance trends, showing increasing incidence in subpopulations where prevention could be strengthened. Anti-HBc prevalence among US-born persons decreased from 2001–2006 to 2007–2012 and remained flat during 2013–2018, coinciding with a near doubling of prevalence among US-born persons reporting a history of injection drug use.