Reduce estimated new hepatitis B virus infections by 20% or more

Summary of Findings

The estimated number of new hepatitis B virus (HBV) infections was relatively stable at around 20,000 cases annually from 2015 through 2019. In 2020, there were 14,000 estimated new infections, well below the 2020 target of 20,100 estimated infections. The abrupt decline may be attributable to major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic; therefore, 2020 data should be interpreted with caution.

Reduction needed to meet 2025 goal:

The estimated number of new HBV infections in 2020 is 22% below the 2025 goal of 18,000 estimated infections. The decline observed in 2020 may not continue in subsequent years once testing and health department case investigations resume regular operations.

The goal can best be achieved by:

• Continuing promotion of routine childhood, adolescent and adult immunization schedules and raising awareness of the updated adult hepatitis B immunization recommendations from the Advisory Committee on Immunization Practices.
• Supporting continuing medical education and developing partnerships to reach key audiences.
• Building capacity within jurisdictions to make it easier for them to collect and use a core set of surveillance data to locate higher risk populations and gaps in vaccination coverage.
• Exploring prevention focused on reaching communities to demonstrate how best to provide a comprehensive set of interventions for hepatitis B vaccination, testing, and treatment and to increase awareness of hepatitis B.

Technical Notes

Data Sources:
CDC, National Notifiable Diseases Surveillance System (NNDSS)

Numerator:
Number of estimated new (acute) HBV infections

Denominator:
Not applicable

Indicator Notes:
(1) NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable-disease-related health information. Surveillance for viral hepatitis through NNDSS is based on case definitions developed and approved by the Council of State and Territorial Epidemiologists (CSTE) and CDC. Reported cases of acute viral hepatitis B are required to meet specific clinical and laboratory criteria. Estimated infections are based on laboratory-confirmed cases of acute viral hepatitis; these estimates are presented in the 2020 Annual Surveillance Report (1) along with their 95% Confidence Intervals to show the range of estimated infections accounting for error. Acute hepatitis B is reportable in all jurisdictions. Health care providers, hospitals, and/or laboratories report cases to the local or state health department, and states voluntarily submit reports or notify CDC of newly diagnosed cases of hepatitis B that meet the CSTE/CDC surveillance case definition. To account for underascertainment and underreporting, the number of reported cases is multiplied by 6.5. The methods for developing the multiplication factor are documented in Klevens, et al (2) with corrected multipliers developed by CDC (1).

Goal Setting:
The 2025 goal of 18,000 estimated cases is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations:
The number of estimated infections is based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year (2). This constant multiplier may not account for variations over time in underreporting and underascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition.