Hepatitis B Serology in the U.S. Population: Results From the National Health and Nutrition Examination Survey (NHANES) 2003-2012

Abstract

Introduction: To provide updated data on hepatitis B (HB) serology from a large sample of the U.S. population. Methods: Data from the last 5 cycles of NHANES from 2003-2012 were analyzed. The NHANES is a nationally representative survey of non-institutionalized participants with oversampling of certain minorities. To account for missing data and sampling variation and over-representation, weighted frequencies were used to calculate and report prevalence estimates. Results: Testing for HBV surface antibody (HBsAb), surface antigen (HBsAg), and core antibody (HBcAb) was performed on the sera of 39,461 participants over the 10-year period from 2003-2012. The prevalence of HBsAb has remained relatively stable over the past 5 cycles and ranged from 27.6-30.0% with an average of 28.6%. The prevalence of HBsAg ranged from 0.24-0.39% with an average of 0.31%. The prevalence of HBcAb ranged form 3.7-5.2% with an average of 4.24%. The prevalence of HBcAb appeared to be trending down through the 5 cycles: 5.2% in 2003-2004, 4.3% in 2005-2006, 3.8% in 2007-2008, 4.2% in 2009-2010, and 3.7% in 2011-2012. Conclusion: 28.6% of the U.S. population exhibit evidence of immunity against HBV (natural or due to vaccine), while 0.31% exhibit evidence of chronic infection. In addition, 4.24% of the population has positive HBcAb, which can be an indicator of chronic infection, immunity after resolved HBV, or marker of infection in window phase of acute HBV. Noteworthy, the survey sample did not include participants with potentially higher risk for HBV such as prison and homeless populations, and therefore it might have underestimated the true prevalence of chronic HBV.