National Progress Report 2025 Goal: Reduce reported rate* of new hepatitis B virus infections among persons who inject drugs† by ≥25%

Source: CDC, National Notifiable Diseases Surveillance System (1)
*Rate per 100,000 population.
†Persons aged 18–40 years were used as a proxy for persons who inject drugs.

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 1.2 in 2019, below the target rate of 1.3 per 100,000 population. 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: A 16.7% reduction from the 2019 rate of reported new hepatitis B cases is needed to meet the 2025 goal of 1.0 case per 100,000 population.

This reduction can best be achieved by

• Promoting implementation of vaccine recommendations through provider education, strategic partnerships, and other measures, particularly among those who work with persons who inject drugs (PWID).
• Supporting implementation of comprehensive community-level programs for people who inject drugs (e.g., access to syringe services programs, linkage to medication-assisted treatment programs, testing, and treatment).
• Building capacity for states to collect and use a core set of surveillance data to detect populations at higher risk of infection and gaps in vaccination coverage, such as among PWID.
• Conducting prevention research to demonstrate how best to provide hepatitis B vaccination, testing, and treatment as part of a comprehensive set of interventions for PWID.
• Continuing to promote routine childhood vaccination schedules and vaccination of adults at increased risk for hepatitis B according to Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations and Guidelines.

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) The 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 Planexternal icon. 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 the 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.

References

1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2019. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2021. Available at: https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm.
2. Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health. 2014;104(3):482-7.