Hepatitis B Virus – 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 and remained relatively stable in 2021 and 2022. During 2022, there were 13,800 estimated new infections, well below the 2022 target of 18,700. Changes in health care-seeking behavior and testing during the COVID-19 pandemic could potentially explain these observed declines; however, when compared to 2015–2019, the persistence of these lower numbers throughout 2020–2022 suggest some reduction in HBV transmission, which might be unrelated to the COVID-19 pandemic.

Further reduction can best be achieved by:

• Promoting the routine childhood, adolescent, and adult immunization schedules and raising awareness of the updated adult hepatitis B immunization recommendations from the Advisory Committee on Immunization Practices.
• Continuing to support medical education and developing partnerships to reach key audiences.
• Building capacity within jurisdictions to make it easier for them to collect and use a core set of surveillance data to locate higher-risk populations and gaps in vaccination coverage.
• Exploring prevention focused on reaching communities to demonstrate how best to provide a comprehensive set of interventions for hepatitis B vaccination, testing, and treatment and to increase awareness of hepatitis B.

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.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. Reported cases of acute viral hepatitis B are required to meet specific clinical and laboratory criteria. Estimated infections are based on laboratory-confirmed cases of acute viral hepatitis; these estimates are presented in the 2022 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 hepatitis B that meet the CSTE/CDC surveillance case definition. To account for under ascertainment and underreporting, the number of reported cases is multiplied by 6.5. 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 US Department of Health and Human Services' Viral Hepatitis National Strategic Plan. 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.2 This constant multiplier might not account for variations over time in underreporting and under ascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.