Less Than One-Third of At-Risk Adults Have Protective Hepatitis B Antibodies

Data published in Clinical Infectious Diseases revealed that by 2014, less than one-third of individuals aged 18 to 49 years who were at risk for hepatitis B virus (HBV) exhibited hepatitis B surface antibody levels indicative of protection (anti-HBs >10 mIU/mL).

Data from the 2003 to 2014 National Health and Nutrition Examination Surveys were used to identify a sample of adults who were tested for HBV and reported at least one of the following risks: history of STD, sex with men (for male respondents), infection with HIV, and injection drug use. Investigators identified a study cohort of 2127 individuals.

During this period, the prevalence of positive anti-HBs serology was 23.4%, although investigators noted an increase between 2003 to 2006 and 2007 to 2010, which demonstrated a prevalence of 16.3% and 27.3%, respectively. However, the prevalence remained relatively unchanged between 2007 to 2010 and 2011 to 2014 (27.3% and 28.1%, respectively). Factors that were predictive of positive anti-HBs serology included age 18 to 29 years (adjusted odds ratio [aOR], 4.62; 95% CI, 3.08-6.92), female sex (aOR, 1.53; 95% CI, 1.12-2.10), attainment of higher education (aOR, 1.91; 95% CI, 1.38-2.65), and having health insurance (aOR, 1.76; 95% CI, 1.23-2.52).

Investigators noted several unavoidable limitations to this work, including the possible underestimation of hepatitis B vaccination status because serologic data were used to document status and anti-HBs vaccination titers can wane over time. The study also excluded institutionalized populations and persons experiencing homelessness. Two different laboratory assays were also used to confirm HBV infection over the course of the study, potentially affecting the estimates. In addition, the survey included questions regarding drug use and sexual behavior that may encourage a socially desirable response bias, and it also employed a cross-sectional study design, meaning test-retest reliability and causal inferences are not possible.

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Despite these limitations, the investigators were confident in the trends reported in what was, to their knowledge, “the first study to assess trends in protection from hepatitis B among adults at high risk using serological data.”

Although an effective vaccine to prevent HBV infection exists, and there was an increase in the prevalence of protective levels of anti-HBs among respondents since 2003, less than one-third of US adults at high risk have anti-HBs indicative of protection. Therefore, the investigators stress that national, state, and local intervention strategies are required to improve vaccination coverage among this population and achieve the goal of national HBV elimination.


King H, Xing J, Dean HD, Holtzman D. Trends in prevalence of protective levels of hepatitis B surface antibody among adults aged 18-49 years with risk factors for hepatitis B virus infection-United States, 2003-2014 [published online June 20, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz537