Hepatitis B: Epidemiology Presentation Prepared by: David Spach, MD and Nina Kim, MD Last Updated: May 31, 2011

Incidence and Prevalence Data HEPATITIS B : EPIDEMIOLOGY Incidence and Prevalence Data

Hepatitis B Incidence and Prevalence HEPATITIS B : EPIDEMIOLOGY Hepatitis B Incidence and Prevalence Source: Hall HI, et al. JAMA. 2008;300:520-9. HBV Incidence. The number of people who become newly infected with HBV in a given period. HBV Prevalence. The number of people living with HBV in a population at a point in time. Source: CDC Division of Viral Hepatitis. Statistics and Surveillance.

Incidence* of Acute Hepatitis B in U.S., by County, 2007 HEPATITIS B : EPIDEMIOLOGY Incidence* of Acute Hepatitis B in U.S., by County, 2007 *Per 100,000 population NYC DC <4 4-<8 8-<12 >12 NYC DC Source: CDC. MMWR 2009;58(SS03):1-27.

Acute Hepatitis B : 2011 Case Definition HEPATITIS B : EPIDEMIOLOGY Acute Hepatitis B : 2011 Case Definition Clinical Case Definition An acute illness with: (a) discrete onset of symptoms and (b) jaundice or elevated serum ALT (> 200 IU/L) Laboratory Criteria for Diagnosis (a) IgM antibody to hepatitis B core antigen (anti-HBc) positive or Hepatitis B surface antigen (HBsAg) positive and
(b) IgM anti-HAV negative (if done) Case Classification Confirmed: a case that meets the clinical case definition, is laboratory confirmed, and is not know to have chronic hepatitis B

Chronic Hepatitis B : 2011 Case Definition HEPATITIS B : EPIDEMIOLOGY Chronic Hepatitis B : 2011 Case Definition Clinical Evidence No symptoms are required. Persons with chronic HBV infection may have no evidence of liver disease or may have a spectrum of disease ranging from chronic hepatitis to cirrhosis or liver cancer. Laboratory Criteria for Diagnosis IgM antibodies to hepatitis B core antigen (IgM anti-HBc) negative AND a positive result on one of the following tests: hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), or hepatitis B virus (HBV) DNA OR HBsAg positive or HBV DNA positive or HBeAg positive two times at least 6 months apart (Any combination of these tests performed 6 months apart is acceptable Case Classification Confirmed: a case that meets either of the above laboratory criteria for diagnosis Probable: a person with a single HBsAg positive or HBV DNA positive or HBeAg positive lab result and does not meet the case definition for acute hepatitis B. Source: CDC and Prevention. CSTE Position Statement Number: 10-ID-10.

Incidence of Acute Hepatitis B in U.S., 1980-2008 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., 1980-2008 Source: CDC Division of Viral Hepatitis. Statistics and Surveillance.

Incidence of Acute Hepatitis B in U.S., 1980-2008 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., 1980-2008 Source: CDC Division of Viral Hepatitis. Statistics and Surveillance.

Incidence of Acute Hepatitis B in U.S., 1980-2008 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., 1980-2008 Source: CDC Division of Viral Hepatitis. Statistics and Surveillance.

Hepatitis B Incidence by Race/Ethnicity in U.S.,1990-2007 HEPATITIS B : EPIDEMIOLOGY Hepatitis B Incidence by Race/Ethnicity in U.S.,1990-2007 Source: CDC. MMWR 2009;58(SS03):1-27.

Hepatitis B Incidence in U.S., by Age Group and Race/Ethnicity, 2006 HEPATITIS B : EPIDEMIOLOGY Hepatitis B Incidence in U.S., by Age Group and Race/Ethnicity, 2006 Source: National Notifiable Diseases Surveillance System (NNDSS), CDC, NCPHI.

HEPATITIS B : EPIDEMIOLOGY Patients with Acute Hepatitis B who Report Selected Epidemiologic Characteristics, by age group, U.S. 2007 The percentage of cases for which a specific risk factor was reported was calculated on the basis of the total number of cases for which any information for that exposure was reported. Percentages might not total 100% because multiple risk factors might have been reported for a single case. The epidemiologic characteristic (risk factor) was determined for exposures that occurred during the 6 weeks-6 months before the onset of illness. Among males, 18% reported homosexual activity. *The percentage of cases for which a specific risk factor was reported was calculated on the basis of the total number of cases for which any information for that exposure was reported. Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

United States Immigrants, 1820-2004 HEPATITIS B : EPIDEMIOLOGY United States Immigrants, 1820-2004 Source: CDC and Prevention. Division of Viral Hepatitis. Statistics & Surveillance.

Incidence of Acute Hepatitis B in U.S., by Age Group,1990-2006 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., by Age Group,1990-2006 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

Incidence of Acute Hepatitis B in U.S., by Region,1990-2006 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., by Region,1990-2006 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

Incidence of Acute Hepatitis B in U.S., by Sex, 1990-2006 HEPATITIS B : EPIDEMIOLOGY Incidence of Acute Hepatitis B in U.S., by Sex, 1990-2006 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

Incidence* of Acute Hepatitis B in Females, by Age Group, U.S., 2007 HEPATITIS B : EPIDEMIOLOGY Incidence* of Acute Hepatitis B in Females, by Age Group, U.S., 2007 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

Incidence* of Acute Hepatitis B in Males, by Age Group, U.S., 2007 HEPATITIS B : EPIDEMIOLOGY Incidence* of Acute Hepatitis B in Males, by Age Group, U.S., 2007 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

HEPATITIS B : EPIDEMIOLOGY Incidence* of Acute Hepatitis B in Males and Females, by Age Group, U.S., 2007 Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

Prevalence of Chronic HBV Infection, Worldwide, 2006 HEPATITIS B : EPIDEMIOLOGY Prevalence of Chronic HBV Infection, Worldwide, 2006 Estimated 350 Million Persons Living with HBV Source: CDC and Prevention. MMWR 2008;57(RR-8):1-20.

Prevalence of Chronic HBV Infection, Worldwide, 2006 HEPATITIS B : EPIDEMIOLOGY Prevalence of Chronic HBV Infection, Worldwide, 2006 HBsAg Prevalence >8% = High 2-7% = Intermediate < 2% = Low Source: CDC and Prevention. MMWR 2008;57(RR-8):1-20.

Hepatitis B, Estimated U.S. Prevalence, 2006 HEPATITIS B : EPIDEMIOLOGY Hepatitis B, Estimated U.S. Prevalence, 2006 800,000-1,400,000 in U.S. Living with HBV Source: CDC and Prevention. MMWR 2008;57(RR08):1-20.

Estimated Awareness of Hepatitis B Infection in U.S. HEPATITIS B : EPIDEMIOLOGY Estimated Awareness of Hepatitis B Infection in U.S. Aware of HBV Infection Aware of HBV Infection Unaware of HBV Infection Unaware of HBV Infection Source: Institute of Medicine. Hepatitis and Liver Cancer: A national strategy for prevention and control of hepatitis B and C.

Hepatitis B, Estimated Annual Deaths in U.S. HEPATITIS B : EPIDEMIOLOGY Hepatitis B, Estimated Annual Deaths in U.S. Estimated 2,000-4,000 Deaths Per Year from HBV Source: CDC and Prevention. MMWR 2008;57(RR08):1-20.

Hepatitis B, Disease Burden HEPATITIS B : EPIDEMIOLOGY Hepatitis B, Disease Burden 4.3-5.6% Ever Infected with HBV 800,000-1,400,000 U.S. Residents Living with HBV 3,000 Annual Deaths Associated with chronic liver disease & HBV Source: CDC and Prevention. Division of Viral Hepatitis-Statistic and Surveillance

Estimated HBsAg-Positive Persons, U.S. Resident Population*, 2006 HEPATITIS B : EPIDEMIOLOGY Estimated HBsAg-Positive Persons, U.S. Resident Population*, 2006   Group Estimated 2006 population (in millions) Estimated HBsAg Prevalence (%) Estimated Number HBsAg- positive persons In thousands (range) (%) U.S.- born non-institutionalized 254.3 0.14 356 (229-534) (30-50) Foreign-born 37.5 1 - 2.6 375 – 975 (47-70) Correctional institutions 2.2 2.0 44 (3-5) Other group living quarters 6 0.5 30 (2-3) Total 300 0.3 - 0.5 805 - 1,405 Source: Population estimates from the American Community Survey, US Census Bureau, 2006, and Bureau of Justice Statistics, 2007.

Chronically infected with HBV* Ever infected with HBV** HEPATITIS B : EPIDEMIOLOGY Estimated Prevalence of Hepatitis B Virus (HBV) infection, by Risk Population Population Chronically infected with HBV* Ever infected with HBV** % General U.S. population 0.3 (95% CI : 0.2–0.4) 4.8% (95% CI: 4.2%-5.5%) HIV-positive persons 4 –17 24 – 76 Injection-drug users 3 – 6 20 – 70 Men who have sex with men 1 – 3 10 – 40 Sexual contacts of HBsAg+ persons 3.5 – 9 25 – 59 Household contacts of HBsAg+ persons 3 – 20 15 – 60 Source: Population estimates from the American Community Survey, US Census Bureau, 2006, and Bureau of Justice Statistics, 2007.

Global HBV: Major Genotypes HEPATITIS B : EPIDEMIOLOGY Global HBV: Major Genotypes A, B, C, D, G F A, D, E B, C D G A, B, C, D A

HBV Genotype Prevalence in U.S., 2001-2002 HEPATITIS B : EPIDEMIOLOGY HBV Genotype Prevalence in U.S., 2001-2002 N = 694

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