Significant Update to Hepatitis B Screening and Testing Recommendations

March 10, 2023

Dear Colleague:

Today, in a significant step toward viral hepatitis elimination, the Centers for Disease Control and Prevention (CDC) published CDC Recommendations for Hepatitis B Screening and Testing — United States, 2023. The updated recommendations advise hepatitis B screening for all adults at least once in their lifetime. Full implementation of the recommendations will substantially improve timely diagnosis and facilitate linkage to care for persons with hepatitis B.

Previous CDC recommendations for hepatitis B testing were based on identified risk for infection. Unfortunately, far too many people with hepatitis B in the United States are not aware of their infection. Each of these individuals is a missed opportunity for preventing morbidity and mortality highlighting the need for revised guidance.

The 2023 recommendations provide guidance for three populations:

All adults should be screened at least once in their lifetime with a triple panel test for hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), and total antibody to hepatitis B core antigen (total anti-HBc). Universal screening can avert complications of undiagnosed, untreated hepatitis B and reduce health disparities by eliminating the need for disclosure of potentially stigmatizing risk factors among persons who may be marginalized.

Pregnant Persons
Pregnant persons should receive triple panel screening for hepatitis B— preferably in the first trimester— regardless of vaccination status. Those with prior triple panel screening only need HBsAg screening during each pregnancy. Screening allows for timely prophylaxis for exposed infants. Because prenatal visits might be the earliest opportunity or primary way in which a person interacts with the health care system, prenatal visits are an opportunity to offer the triple panel test to the patient and link them to care or vaccination as needed.

Persons with Identified Risk
The 2023 recommendations expand risk-based testing to include persons currently or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. Persons with ongoing risk factors for hepatitis B should be tested periodically if they remain unvaccinated.

Implementation of updated hepatitis B screening and testing recommendations in concert with updated hepatitis B vaccination recommendations among adults can save lives. Vaccination continues to be the best way to prevent infection with hepatitis B and clinicians should continue to recommend the hepatitis B vaccine to all adult patients through age 59 years who have not been vaccinated or whose vaccination status is unknown. Together, we can actualize a world where viral hepatitis is no longer a public health threat.



/Carolyn Wester/
Carolyn Wester, MD
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention


/Jonathan Mermin/
Jonathan H. Mermin, MD, MPH
RADM and Assistant Surgeon General, USPHS
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Stay connected: @DrMerminCDC & Connections

Get Tested - Find a Testing Site Near You
Atlas Plus - Explore Interactive CDC Data
CDC 24/7 - Protecting America's Safety, Health, and Security