Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

ACP Guideline for HBV Vaccination & Screening

Ann Intern Med; ePub 2017 Nov 21; Abara, et al

The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) has issued best practice statements for hepatitis B vaccination (HBV), screening, and linkage to care in order to reduce the burden of HBV infection. The organizations conducted a literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies between January 2005 and June 2017 and makes the following best practice recommendations:

  1. Clinicians should vaccinate against HBV in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure (sex partners of hepatitis B surface antigen [HBsAg]-positive persons, sexually active persons who are not in a mutually monogamous relationship, persons seeking evaluation or treatment for a sexually transmitted infection, and men who have sex with men); health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.
  2. Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease, blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels, incarcerated persons, pregnant women, and infants born to HBV-infected mothers.
  3. Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B–directed care.


Abara WE, Qaseem A, Schillie S, McMahon BJ, Harris AM. Hepatitis B Vaccination, Screening, and linkage to care: Best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. [Published online ahead of print November 21, 2017]. Ann Intern Med. doi:10.7326/M17-1106.


There are over 800,000 people in the US who are infected with hepatitis B, and two-thirds of them do not know that they are infected. About 70% of those who are infected are foreign-born. The rate of infection in the general population is approximately 0.3%, and among those born in foreign countries the rate is 3-5%. Most of the cases among foreign-born individuals occur in those from Africa, Asia, and the Pacific Islands with additional areas where infection is high including the Caribbean Islands, Central America, Eastern Europe, the Middle East, and parts of South America. Identification and treatment of hepatitis B is important because 15-40% of individuals with hepatitis B go on to develop cirrhosis, hepatocellular carcinoma, or liver failure. These guidelines give important guidance for vaccination, screening, and referral for treatment for this important disease. —Neil Skolnik, MD

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