Which Test to Use
Serologic testing for HBsAg is the recommended method to identify persons with chronic HBV infection. Testing for HBV infection in high-risk groups should be performed with a FDA-licensed or FDA-approved serologic assay for HBsAg (sensitivity and specificity of > 98%) according to the manufacturer’s recommendations. Initially, reactive specimens should be confirmed with a licensed confirmatory test.
A positive HBsAg result indicates active infection, either acute or chronic. Other serological markers of HBV infection, such as presence of hepatitis B core IgM antibody, and the clinical context are used to differentiate between acute, chronic, or resolving infection. For identification of individuals who are at risk for chronic infection, the screening strategy should be with HBsAg only. For identifying susceptible persons who should be offered HBV vaccination, or patients that are at risk of reactivation or transmission of HBV, screening should include
testing for HBsAg, hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs).
The interpretation of HBV screening serology is shown in Table 3. Persons with chronic HBV infection are treated, if needed, per practice guidelines based on the initial test results and interpretation of the stage of the disease and counseled regarding transmission of infection. 9,10 Vaccination is recommended for uninfected persons.
Hepatitis B Education
There is relatively poor awareness of HBV among highrisk individuals and health care professionals (HCPs). A study examining the prevalence of chronic hepatitis B in an Asian and Pacific Islander population reported that about 15% of participants had not been previously tested for hepatitis B. 11 Another study that surveyed 3,163 Asian American adults in the San Francisco Bay Area found that of those screened and identified with chronic HBV infection (8.9%), two-thirds were unaware that they were infected. 12
Primary care providers in San Francisco correctly identified that Chinese immigrants have a higher prevalence of chronic hepatitis B than that of non-Hispanic white or U.S.-born Chinese people, but the providers incorrectly identified persons with HIV infection, men who have sex with men, and persons who inject drugs as having higher prevalence than that of Chinese immigrants in a survey. 13 Lack of awareness probably contributes to poor outcomes from the infection among at-risk persons as well as continued transmission to susceptible individuals. Furthermore, lack of knowledge is a barrier to testing, prevention, and care. Increased awareness to identify the at-risk population and early treatment is an important step to prevent morbidity and mortality from chronic hepatitis B.
Public Awareness
Many at-risk populations are unaware of HBV, its possible routes of transmission, or that a safe and effective vaccine exists for HBV prevention. Moreover, many foreign-born persons with chronic HBV infection feel stigmatized by others or have cultural barriers against Western medicine and prefer alternative therapies. As a result, the Institute of Medicine (IOM) has suggested that innovative approaches need to be developed to promote a better understanding of transmission, prevent and treat HBV, increase HBV vaccination rates among children and at-risk adults, educate women about vertical transmission risk, reduce stigmatization, and provide culturally sensitive and understandable educational material. 14