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

Summary of findings

The rate of new hepatitis B cases reported to CDC among persons aged 18–40 years, a proxy for persons who inject drugs (PWID), was between 1.2–1.6 during 2015–2019 but decreased substantially in 2020 and remained relatively stable in 2021 and 2022. During 2022, the rate was 0.6 cases per 100,000 population, well below the 2022 target rate of 1.1 cases per 100,000 population. Changes in health care-seeking behavior and testing during the COVID-19 pandemic could potentially explain these observed declines; however, the continued low rates throughout 2020–2022 suggest that other factors unrelated to the COVID-19 pandemic might have reduced hepatitis B virus (HBV) transmission.

Reduction needed to meet 2025 goal:

The 2022 rate of reported new hepatitis B cases among persons aged 18–40 years is 40% below the 2025 goal of 1.0 case per 100,000 population

Further reduction can best be achieved by:

• Promoting the 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 PWID and their service providers.
• Building capacity within jurisdictions to collect and use a core set of surveillance data to locate higher-risk populations and gaps in vaccination coverage, especially among PWID.
• Conducting research focused on 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 for PWID.

Technical notes

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

Numerator:
Number of new (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:
NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.¹ 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 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.¹

Goal setting:
The 2025 goal of 1.0 per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and the US Department of Health and Human Services’ 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 might vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.