Hepatitis D Is More Prevalent in US Than Previously Thought

Improving Vaccination Perception
Improving Vaccination Perception
Researchers found that the US population has a higher prevalence of hepatitis D virus, which could be lowered with vaccinations.

The seroprevalence of hepatitis D virus (HDV) in the United States is higher than previously thought and is highest in nonhispanic Asians and people born outside the United States, according to study results published in Clinical Infectious Diseases.

The study included data from the National Health and Nutrition Examination Survey (NHANES). NHANES uses a stratified multistage probability cluster sampling scheme designed to represent the population of the United States. The survey consists of a household interview, a follow-up medical examination, and obtaining a blood sample. The researchers estimated the prevalence of ongoing HBV infection and the seroprevalence of HDV infection in the United States from 2011 to 2016.

In total, the researchers used data from 21,832 respondents from 2011 to 2016 who had complete data on demographic characteristics, hepatitis B virus (HBV) core antibody status, hepatitis B surface antigen (HBsAg) status, and antibodies to HDV (antiHDV) status. In participants aged ≥6 years (n=21,832), the researchers found a 0.28% (95% CI, 0.22%-0.35%) prevalence of HBsAg, which represents approximately 862,000 (95% CI, 668,000-1,056,000) people with ongoing HBV infection. The prevalence of antiHDV was 0.11% (95% CI, 0.08%-0.17%), corresponding to approximately 357,000 (95% CI, 210,000-503,000) people with past or ongoing HDV infection.

When the researchers looked at children aged 6-17 years (n=5689), there was only 1 participant with HBsAg: A foreign-born Asian boy was antiHDV negative.

In adults aged ≥18 years (n=16,143), the prevalence of HBsAg was 0.36%, and the prevalence of antiHDV was 0.15%. The results indicated that Asian and foreign-born adults had the highest prevalence of both HBsAg and antiHDV.

Related Articles

“HBsAg-carriers without prior HDV exposure should be counseled on their risk for HDV superinfection,” the researchers wrote. “Increasing equitable coverage of prophylactic HBV vaccination remains critical for the elimination of HBV and HDV.”


Patel EU, Thio CL, Boon D, Thomas DL, Tobian AAR. Prevalence of hepatitis B and hepatitis D virus infections in the United States, 2011-2016 [published online January 3, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz001/5272449