Reduce reported rate of new hepatitis B virus infections among persons who inject drugs by 25% or more

Summary of Findings

The rate of new hepatitis B cases reported to CDC among persons aged 18–40 years decreased from 1.4 cases per 100,000 population in 2017 to 0.7 in 2020, below the target rate of 1.3 per 100,000 population. 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. Injection drug use is the most common risk reported for persons aged 18–40 years with new hepatitis B virus infections in the United States (1).

Reduction needed to meet 2025 goal:

The 2020 rate of reported new hepatitis B cases is 30% below the 2025 goal of 1.0 case per 100,000 population, however, the decline observed in 2020 may not continue in subsequent years once testing and health department case investigation resume regular operations.

This reduction can best be achieved by:

• Continuing the promotion of routine child and adolescent 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 people who inject drugs (PWID) and their service providers.
• 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, especially among people who inject drugs.
• Conducting research about prevention focused on reaching PWID to demonstrate how best to provide a comprehensive set of interventions for hepatitis B vaccination, testing, and treatment.
• Increasing access to syringe services programs and linkage to testing and medication-assisted treatment programs by implementing comprehensive community-level programs for PWID.

Technical Notes

Data Sources:
CDC, National Notifiable Diseases Surveillance System (NNDSS) and CDC/National Center for Health Statistics/US Census Bureau, Bridged-race Population Estimates

Numerator:
Number of acute HBV infections reported annually among persons aged 18–40 years

Denominator:
Total population of persons aged 18–40 years in reporting jurisdictions

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. Only laboratory-confirmed cases of acute viral hepatitis are presented in this report. 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. Case rates per 100,000 population are calculated based on the projected resident population of the United States as of July 1 during each data-collection year.

Goal Setting:
The 2025 goal of 1.00 per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s 2021-2025 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:
Viral hepatitis is largely underreported in NNDSS. 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, the actual number of acute hepatitis B cases is estimated to be 6.5 times the number reported to CDC. (1–2) Additionally, rates of reported cases may vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition.