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

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

3. 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.

4. 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.

5. 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

6. 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.

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

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

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

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

11. 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.

12. 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.

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

14. 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,
Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

15. 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,
Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

16. 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,
Source: CDC and Prevention. MMWR 2009;58(SS03):1-27.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. Hepatitis B, Disease Burden
HEPATITIS B : EPIDEMIOLOGY
Hepatitis B, Disease Burden
% 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

26. 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
( )
(30-50)
Foreign-born
37.5
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
,405
Source: Population estimates from the American Community Survey, US Census Bureau, 2006, and Bureau of Justice Statistics, 2007.

27. 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.

28. 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

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

30. Questions?