Sunday, December 3, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for infectious disease clinicians, family medicine/primary care clinicians, internists, gastroenterologists, public health and prevention officials, nurses, nurse practitioners, pharmacists, physician assistants, and other members of the healthcare team involved in hepatitis B testing in adults.
The goal of this activity is for members of the healthcare team to be better able to describe updated guidelines from the Centers for Disease Control and Prevention (CDC) for hepatitis B virus (HBV) testing of adults, according to an update of their 2008 recommendations for risk-based testing and management of persons with chronic HBV infection in the United States.
Upon completion of this activity, participants will:
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Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-125-H01-P).
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CME / ABIM MOC / CE Released: 4/14/2023
Valid for credit through: 4/14/2024, 11:59 PM EST
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Persons with chronic hepatitis B virus (HBV) infection are at greater risk for liver cancer and cirrhosis and are 70% to 85% more likely to die prematurely than the general population. Of an estimated 580,000 to 2.4 million persons living with HBV infection in the United States, two-thirds may be unaware of their infection.
Chronic HBV infection disproportionately affects persons born outside the United States, as non--US–born persons account for 14% of the general US population but 69% of persons living with chronic HBV infection. Treatment is not considered curative, but antiviral treatment, monitoring, and liver cancer surveillance can lower morbidity and mortality.
Adults should be tested for HBV at least once in their lifetime, according to updated guidelines from the Centers for Disease Control and Prevention (CDC).
This is the first update to HBV screening guidelines since 2008, the agency said.
"Risk-based testing alone has not identified most persons living with chronic HBV infection and is considered inefficient for providers to implement,” the authors wrote in the new guidance, published in the CDC's Morbidity and Mortality Weekly Report. "Universal screening of adults for HBV infection is cost-effective compared with risk-based screening and averts liver disease and death. Although a curative treatment is not yet available, early diagnosis and treatment of chronic HBV infections reduces the risk for cirrhosis, liver cancer, and death.”
An estimated 580,000 to 2.4 million individuals are living with HBV infection in the United States, and two-thirds may be unaware they are infected, the agency said.
The virus spreads through contact with blood, semen, and other body fluids of an infected person.
The guidance now recommends using the triple panel (hepatitis B surface antigen [HBsAg], anti-hepatitis B [HB], total anti-hepatitis B core [antigen] [HBc]) for initial screening.
"It can help identify persons who have an active HBV infection and could be linked to care; have [a] resolved infection and might be susceptible to reactivation (eg, immunosuppressed persons); are susceptible and need vaccination; or are vaccinated,” the authors wrote.
Pregnant women should be screened ideally in the first trimester of each pregnancy, regardless of vaccination status or testing history. Pregnant women who have already received timely triple-panel screening for HBV and who have no new HBV exposures only need HBsAg screening, the guidelines state.
The document added 3 groups at higher risk for HBV infection: persons incarcerated or formerly incarcerated, people with current or past hepatitis C virus (HCV) infection, and people with current or past sexually transmitted infections (STIs) and multiple sex partners. Persons at higher risk for HBV should be screened periodically, based on shared decision making between the provider and patient as well as individual risk and immune status.
Additional research into the optimal frequency of periodic testing is necessary, the authors said.
"Along with vaccination strategies, universal screening of adults and appropriate testing of persons at increased risk for HBV infection will improve health outcomes, reduce the prevalence of HBV infection in the United States, and advance viral hepatitis elimination goals," the authors wrote.
MMWR Recomm Rep. 2023;72:1-25.[1]
