Prevalence of Chronic Hepatitis B Virus Infection: On the Path to Eradication

Hepatitis B virus
Hepatitis B virus
An understanding of the true burden of hepatitis on the US population is necessary for the creation of effective screening and prevention programs.

An updated literature review was conducted by the Chronic Liver Disease Foundation and a panel of leading US hepatologists to develop a contemporary hepatitis B virus (HBV) prevalence range estimate in the United States. The results were discussed in May 2019 during a live HBV epidemiology workshop, and a summary of the workshop findings was published in The American Journal of Gastroenterology.

Chronic HBV represents a major global health problem and is associated with substantial morbidity and mortality due to such clinical complications as liver cirrhosis and hepatocellular carcinoma. The burden of this disease is also significant in the United States despite the availability of resources for vaccination, screening, and treatment. To inform elimination plans put forth by the World Health Organization and the US Department of Health and Human Services, updated assessments of the prevalence and epidemiology of HBV were needed.

Globally, the burden of HBV is mostly represented in the African, Western Pacific, and Southeast Asia regions. The panel proposed an overall estimated prevalence of chronic HBV infection of 1.59 million persons (range, 1.25–2.49 million) in the United States. The panel found that foreign-born persons, particularly those of non-Hispanic Asian ethnicity, consistently have a higher prevalence of HBV than US-born persons. The proportion of people who have immigrated to the United States from both Latin America and Asia has been found to have increased between 2002 and 2018, and “an increasing influx of immigrants from HBV endemic regions of the world may help account for the overrepresentation of foreign-born individuals among patients with chronic HBV in the US.”

High-risk groups include veterans, healthcare professionals, men who have sex with men, prisoners, homeless individuals, people who inject drugs, and patients with HIV or HCV coinfections. The panel also provided information on the prevalence in other populations including pregnant women, newborns, and individuals with diabetes.

The review summarized key epidemiologic studies addressing HBV prevalence and based on epidemiologic surveys and imputation studies, the investigators proposed their updated prevalence estimates. They highlighted a need for further research to characterize HBV epidemiology in the United States in order to “better inform public health strategies to improve screening/diagnosis, linkage to care, and both immunization and treatment of HBV infection.”


Lim JK, Nguyen MH, Kim WR, Gish R, Perumalswami P, Jacobson IM. Prevalence of chronic hepatitis B virus infection in the United States [published online June 1, 2020]. Am J Gastroenterol. doi:10.14309/ajg.0000000000000651