Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988‐2012

Abstract

The number of persons with chronic hepatitis B virus (HBV) infection in the United States is affected by diminishing numbers of young persons who are susceptible because of universal infant vaccination since 1991, offset by numbers of HBV‐infected persons migrating to the United States from endemic countries. The prevalence of HBV infection was determined by serological testing and analysis among noninstitutionalized persons age 6 years and older for: antibody to hepatitis B core antigen (anti‐HBc), indicative of previous HBV infection; hepatitis B surface antigen (HBsAg), indicative of chronic (current) infection; and antibody to hepatitis B surface antigen (anti‐HBs), indicative of immunity from vaccination. These prevalence estimates were analyzed in three periods of the National Health and Nutrition Examination Survey (NHANES): 1988‐1994 (21,260 persons); 1999‐2008 (29,828); and 2007‐2012 (22,358). In 2011‐2012, for the first time, non‐Hispanic Asians were oversampled in NHANES. For the most recent period (2007‐2012), 3.9% had anti‐HBc, indicating approximately 10.8 (95% confidence interval [CI]: 9.4‐12.2) million noninstitutionalized U.S. residents having ever been infected with HBV. The overall prevalence of chronic HBV infection has remained constant since 1999: 0.3% (95% CI: 0.2‐0.4), and since 1999, prevalence of chronic HBV infection among non‐Hispanic blacks has been 2‐ to 3‐fold greater than the general population. An estimated 3.1% (1.8%‐5.2%) of non‐Hispanic Asians were chronically infected with HBV during 2011‐2012, which reflects a 10‐fold greater prevalence than the general population. Adjusted prevalence of vaccine‐induced immunity increased 16% since 1999, and the number of persons (mainly young) with serological evidence of vaccine protection from HBV infection rose from 57.8 (95% CI: 55.4‐60.1) million to 68.5 (95% CI: 65.4‐71.2) million. Conclusion: Despite increasing immune protection in young persons vaccinated in infancy, an analysis of chronic hepatitis B prevalence in racial and ethnic populations indicates that during 2011‐2012, there were 847,000 HBV infections (which included ∼400,000 non‐Hispanic Asians) in the noninstitutionalized U.S. population. (Hepatology 2016;63:388–397)