CDC Recommends Universal Hepatitis B Vaccinations for Adults Over 19 Years of Age

New CDC guidelines based on four decades of safety, immunogenicity, and efficacy data on the HBV vaccine, but with suboptimal coverage in the United States.

The CDC has released new guidelines regarding hepatitis B virus (HBV) vaccinations, which expands the recommendation for universal HBV vaccinations for all adults over 19 years in the United States.1

The recommendations specify that adults 19 through 59 years of age and adults 60 years of age and older with risk factors for HBV should receive the vaccine. The recommendations also state adults 60 years of age and older without known risk factors for HBV “may receive” the vaccine.

The “may receive” the HBV vaccine recommendation for adults 60 years of age and older without known risk factors for HBV is intended to encourage providers to offer the vaccine to this group versus waiting for patients to request it. Further, these recommendations are intended for those who have not completed an HBV vaccine series or who have a history of infection.

In the Morbidity and Mortality Weekly Report (MMWR), the CDC noted that this decision is based on 4 decades of safety, immunogenicity, and efficacy data on the HBV vaccine, but with suboptimal coverage in the United States.

In February, updated adult immunization guidelines from the Advisory Committee on Immunization Practices (ACIP) included universal HBV vaccination for adults between 19 and 59 years of age, as well as vaccination for adults 60 years of age or older if they have an additional risk factor or other indication.2 According to a press release from the CDC, the recommendation specified that 2, 3, or 4 HBV vaccine dosages could be used, depending on the vaccine or condition of the patient. Three doses were recommended for pregnant patients, whereas the recommendations say “2, 3, or 4 doses” for patients with other risk factors.

Furthermore, language was added to the “routine vaccination” recommendations stating that any patients 60 years of age or older who do not meet risk-based recommendations can still receive HBV vaccination.2

In November 2021, ACIP recommended universal vaccinations within that age group, while removing the risk factor assessment previously in place to determine vaccine eligibility. The recommendations followed more than 2 years of work evaluating HBV incidence, morbidity and mortality related to HBV, and vaccine-related serious adverse events (AEs).

HBV vaccination recommendations were previously based on individual risk factors, which were found to be inefficient for both providers and patients. Approximately 30% of US adults have been vaccinated against HBV, even as rates of acute HBV have risen steadily over the past decade, particularly among those aged 40 years and older.

“It has been frustrating to watch rates of infection rise when we know that there is a safe and effective vaccine that can prevent hepatitis B and liver cancer,” Michaela Jackson, MS, MPH, prevention policy manager at the Hepatitis B Foundation, said in a press release. “This recommendation will help remedy a very significant health inequity for marginalized groups and it will serve to make many adults in the US safer.”

The recommendations for those aged 60 years and older are expected to continue to follow risk-based guidelines to determine vaccination.

According to the National Health and Nutrition Examination Survey, the estimated prevalence of chronic HBV infection in the United States is 880,000 individuals (95% CI: 580,000–1,170,000) with a modeled estimate of 1.89 million (range, 1.49–2.40 million), which accounts for potential underrepresentation of those not born in the United States. In 2018, reported HBV vaccination coverage was only 30.0% among adults 19 years of age or older, which represents a small increase over the past 4 decades.1

In 2018, self-reported coverage (≥3 doses) among adults with chronic liver disease was 33.0%.

The CDC states that universal recommendation for HBV vaccination could increase the number of individuals vaccinated before the onset of chronic liver disease and other comorbidities, such as obesity or diabetes, which may make vaccination less effective.1

“This is a major step forward that the Hepatitis B Foundation had strongly advocated for over many years,” said Chari Cohen, DrPH, MPH, senior vice president of the Hepatitis B Foundation, in a press release. “These greatly expanded and simplified recommendations will improve access and make it easier to protect millions more Americans from hepatitis B. This will save countless lives and ultimately reduce health care costs.”

References

1. Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. CDC Morbidity and Mortality Weekly Report. April 1, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7113a1.htm?s_cid=mm7113a1_w

2. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2022. CDC Morbidity and Mortality Weekly Report; February 18, 2022. Accessed February 22, 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7107a1.htm?s_cid=mm7107a1_w