Closing the Gap: Hepatitis B Vaccination and Liver Cancer Prevention in Adults

May is Hepatitis Awareness Month, an annual observance that serves as a critical reminder that the hepatitis A, B, and C viruses (HAV, HBV, and HCV) remain major public health threats. According to the CDC, hundreds of thousands of individuals in the US are infected and do not know it. Left undetected and untreated, chronic HBV and chronic HCV can cause liver damage, liver cancer, and death.¹

HBV in particular represents a significant and often underappreciated risk in the adult population. An estimated 580,000 to 2.4 million individuals are living with HBV infection in the US, and roughly two-thirds may be unaware of their status. The consequences of undiagnosed chronic HBV infection are serious, and individuals with chronic infection are 70% to 85% more likely to die prematurely than the general population,² and approximately 15% to 25% of those with chronic infection will develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.^2,3

HBV and Liver Cancer: A Direct Link

Hepatocellular carcinoma (HCC), the most common form of liver cancer, is among the deadliest malignancies, with a 5-year survival rate of less than 20%. Chronic HBV infection is one of the strongest known risk factors for HCC. Studies have suggested that the risk of a person with chronic HBV developing liver cancer can be greater than the risk of a heavy smoker dying from lung cancer.^3,4

The link between HBV and liver cancer underscores why prevention is important. Although treatments are available that can delay or reduce the risk of developing liver cancer in those already infected, there is no cure for HBV. Vaccination remains the most powerful tool to prevent HBV infection before it begins, and by extension, to reduce the downstream risk of HCC.¹

Updated CDC Recommendations: Universal Adult Vaccination

In 2022, the CDC’s Advisory Committee on Immunization Practices issued an updated universal recommendation, suggesting that all adults aged 19 to 59 years should receive HBV vaccination, regardless of risk factors. Adults 60 years or older with risk factors are also recommended to be vaccinated; those without known risk factors may receive the vaccine. In addition, the CDC updated its HBV screening recommendations in 2023, advising that all adults aged 18 or older be screened at least once.^2,5,6

These updates are significant for pharmacy practice. By removing the requirement for prior risk assessment before recommending vaccination or screening, the CDC has made it easier than ever for pharmacists to act on every eligible patient encounter. Importantly, the rate of acute HBV is highest among adults aged 40 to 59 years, an age group that accounts for nearly half of all reported acute cases.⁶

HEPLISAV-B: A 2-Dose Option for Adult Patients

One of the most meaningful advances in adult HBV immunization is the hepatitis B vaccine (recombinant), adjuvanted (HEPLISAV-B; Dynavax), which is now being acquired by Sanofi. The recombinant hepatitis B vaccine is the first and only adult hepatitis B vaccine approved in the US, the European Union, and the United Kingdom that enables series completion with just 2 doses administered 1 month apart.⁷

Traditional hepatitis B vaccine regimens require 3 doses over a 6-month period—a schedule that presents real adherence challenges in adult populations. A nested cohort study comparing adults who initiated a 2-dose series with HEPLISAV-B vs a 3-dose series with a standard hepatitis B vaccine found that HEPLISAV-B was associated with a 77% greater likelihood of completing the series. Series completion rates were 45% for HEPLISAV-B vs 26% for the comparator.⁷

The recombinant hepatitis B vaccine achieves its enhanced immunogenicity through Dynavax's proprietary CpG 1018 adjuvant, which stimulates the toll-like receptor 9 (TLR9) pathway to boost the immune response to the hepatitis B surface antigen. It is indicated for adults 18 years and older. The most common adverse effects include injection site pain, fatigue, and headache.⁸

The Pharmacist’s Role: Identification, Recommendation, and Administration

Beyond vaccination, pharmacists can reinforce the CDC’s call for universal hepatitis B screening, direct patients to testing resources, counsel those on antiviral therapy on adherence and lifestyle modifications such as alcohol avoidance, and refer patients with abnormal results to appropriate hepatology follow-up. May 19, which is National Hepatitis Testing Day, offers an ideal annual hook for targeted patient outreach and point-of-care testing promotion.²

This Hepatitis Awareness Month, pharmacists can close the vaccination gap, remind patients that hepatitis B is vaccine-preventable, and ensure that the connection between chronic HBV and liver cancer becomes part of every adult immunization conversation.

REFERENCES

1. About Viral Hepatitis Awareness Month and National Hepatitis Testing Day. CDC. Updated April 23, 2026. Accessed May 1, 2026. https://www.cdc.gov/hepatitis-awareness/about/index.html

2. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC recommendations for hepatitis C screening among adults - United States, 2020. MMWR Recomm Rep. 2020;69(2):1-17. doi:10.15585/mmwr.rr6902a1

3. Risk factors for liver cancer. Hepatitis B Foundation. Accessed May 1, 2026. https://www.hepb.org/research-and-programs/liver/risk-factors-for-liver-cancer/

4. Rizzo GEM, Cabibbo G, Craxì A. Hepatitis B virus–associated hepatocellular carcinoma. Viruses. 2022;14(5):986. doi:10.3390/v14050986

5. Weng MK, Doshani M, Khan MA, et al. Universal hepatitis B vaccination in adults aged 19-59 years: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(13):477-483. doi:10.15585/mmwr.mm7113a1

6. Hepatitis B surveillance. CDC. Updated April 15, 2025. Accessed May 1, 2026. https://www.cdc.gov/hepatitis-surveillance-2023/hepatitis-b/

7. HEPLISAV-B [Hepatitis B Vaccine (Recombinant), Adjuvanted]. Prescribing information. Dynavax Technologies Corporation; 2025. https://www.heplisavbhcp.com/pdfs/Prescribing_Information_HEPLISAV-B_Hepatitis_B_Vaccine_Recombinant_Adjuvanted.pdf

8. 2022 CDC hepatitis B vaccination recommendations for the community pharmacist. Pharmacy Times. Published June 1, 2022. Accessed May 5, 2026. https://www.pharmacytimes.com/view/2022-cdc-hepatitis-b-vaccination-recommendations-for-the-community-pharmacist