Hepatitis B Virus ¨C Reduce Rate Among PWID

Incidence rate* of reported new hepatitis B cases among persons aged 18‒40 years^† and annual targets for the United States by year

Source: CDC, National Notifiable Diseases Surveillance System.1
^*Rate per 100,000 population.
^†Persons aged 18–40 years were used as a proxy for persons who inject drugs.

Summary of findings

Among persons aged 18–40 years, a proxy for persons who inject drugs (PWID), the rate of new hepatitis B cases reported to CDC ranged from 1.2–1.6 during 2013–2019 and decreased substantially to 0.7 cases per 100,000 population in 2020. Since 2021, the rate has remained stable at 0.6 cases per 100,000 population, well below the annual target rate of 1.0. Although the rate of reported new hepatitis B cases among persons aged 18–40 continues to remain low and exceed annual targets, the rate has remained stable for three years, indicating that additional efforts to continue reductions among this population are needed.

Further reduction can best be achieved by:

• Building and harnessing partnerships that amplify the use of effective prevention, testing, and treatment strategies in persons and settings with higher rates of hepatitis B virus (HBV) transmission.
• Building capacity within jurisdictions to collect and analyze surveillance data to identify where HBV infection is occurring, understand transmission networks, and enhance what is learned from outbreak investigations among PWID.
• Developing trainings, technical assistance, and clinical decision support tools for primary care and other health care providers to support and increase implementation of hepatitis B vaccination, screening, testing, and care.
• Developing educational materials that outline injection drug use as a risk factor for HBV infection.
• Increasing access to care and appropriate treatment for persons with chronic HBV infection.
• Increasing access to harm reduction services, such as substance use disorder treatment (for example, medication-assisted treatment) programs, for PWID.
• Promoting and implementing hepatitis B birth dose and childhood and adolescent immunization schedules.
• Promoting and implementing universal adult hepatitis B vaccination recommendations.
• Promoting and implementing universal hepatitis B screening for all adults at least once in their life and for every pregnant woman during each pregnancy.
• Supporting continuing medical education and developing partnerships with service providers to improve confidence and comfort when working with people with HBV infection.
• Using digital technology and telemedicine models to expand access to specialty health care providers.

Technical notes

Data sources: CDC, National Notifiable Diseases Surveillance System (NNDSS)

Numerator: Number of new (acute) HBV infections reported annually among persons aged 18–40 years

Denominator: Total population of persons aged 18–40 years in reporting jurisdictions

Indicator notes: NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.1 Surveillance for viral hepatitis through NNDSS is based on case definitions developed and approved by the Council of State and Territorial Epidemiologists (CSTE) and CDC. . Only laboratory-confirmed cases of acute viral hepatitis are presented in this report. Acute hepatitis B is reportable in all jurisdictions. Health care providers, hospitals, and/or laboratories report cases to the local or state health department, and states voluntarily submit reports or notify CDC of newly diagnosed cases of hepatitis B that meet the CSTE/CDC surveillance case definition. Case rates per 100,000 population are calculated based on the projected resident population of the United States as of July 1 during each data collection year.1

Goal setting: The 2025 goal of 1.0 per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and the . Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations: Viral hepatitis is largely underreported in NNDSS. Based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year, the actual number of acute hepatitis B cases is estimated to be 6.5 times the number reported to CDC.12 Additionally, rates of reported cases might vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.