Hepatitis B Virus ¨C Reduce Infections

Estimated* new hepatitis B virus infections and annual targets for the United States by year

Source: CDC, National Notifiable Diseases Surveillance System1.

* The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases by a factor that adjusted for underascertainment and underreporting.12

Summary of findings

The number of estimated new hepatitis B virus (HBV) infections was relatively stable at around 20,000 infections annually during 2015–2019 but decreased substantially in 2020. Further declines since 2020 have not been observed, and estimated new infections have remained relatively stable at around 14,000 infections annually. While the 14,400 estimated infections in 2023 remained well below the annual target of 18,000, the stable rate of new infections highlights the need for continued efforts to maintain these reductions.

Further reduction can best be achieved by:

• Building and harnessing partnerships that amplify the use of effective prevention, testing, and treatment strategies for persons and settings with higher rates of 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.
• Conducting cost-benefit analyses to inform how payer policies could potentially increase access to hepatitis B services.
• 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 public health campaigns that raise awareness about hepatitis B and encourage all persons to be screened and vaccinated.
• Increasing access to care and appropriate treatment for persons with chronic HBV infection.
• 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.
• Supporting research and development for new and more effective antiviral therapies with the goal of a functional cure for hepatitis B.
• 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 estimated new (acute) HBV infections

Denominator: Not applicable

Indicator notes: NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.2 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. . Estimated infections are based on laboratory-confirmed cases of acute viral hepatitis; these estimates are presented in the 2023 Annual Surveillance Report1 along with their 95% confidence intervals to show the range of estimated infections accounting for error. 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 acute hepatitis B that meet the CSTE/CDC surveillance case definition. To account for underascertainment and underreporting, the number of reported cases is multiplied by 6.5 to estimate the number of new HBV infections for a given year. The methods for developing the multiplication factor have been previously described and used by CDC to estimate the number of annual infections.12

Goal setting: The 2025 goal of 18,000 estimated infections 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: The number of estimated infections is 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.1 This constant multiplier might not account for variations over time in underreporting and underascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.