Prevalence of HBV Infection, Vaccine‐Induced Immunity, and Susceptibility Among At‐Risk Populations: US Households, 2013‐2018

Background and Aims In the USA, HBV is one of the leading causes of chronic liver disease and cirrhosis and is a major cause of liver cancer. We aimed to estimate the prevalence of past and present HBV infection, susceptibility to HBV infection, and vaccine‐induced immunity to hepatitis B among the US population during 2013‐2018. Approach and Results Prevalence estimates and 95% CIs were analyzed using 2013‐2018 data from the National Health and Nutrition Examination Survey. Serologic testing among noninstitutionalized persons aged ≥ 6 years was used for classifying persons as total hepatitis B core antibody (anti‐HBc), indicative of current or previous (ever having had) HBV infection; HBsAg, indicative of current HBV infection; and antibody to ABsAg (anti‐HBs), indicative of immunity attributable to hepatitis B vaccination. Persons who tested negative for anti‐HBc, HBsAg, and anti‐HBs were considered susceptible to HBV infection. Non–US‐born residents accounted for 69.1% of the population with chronic HBV infection and were 9.1 times more likely to be living with chronic hepatitis B, compared with US‐born persons. Among adults aged ≥ 25 years who resided in US households, an estimated 155.8 million persons (or 73.4%) were susceptible to HBV infection, and an estimated 45.4 million had vaccine‐induced immunity to hepatitis B. Men who have sex with men (MSM) were 3.6 times more likely to have ever been infected with HBV; however, MSM were just as likely to have vaccine‐induced immunity to hepatitis B as non‐MSM. Conclusion Despite increasing immune protection among young persons vaccinated after birth, the estimated prevalence of persons living with chronic hepatitis B in the USA has remained unchanged at 0.3% since 1999.