Hepatitis B Epidemiology: Closing the Screening and Diagnosis Gap

This episode, "Hepatitis B Epidemiology: Closing the Screening and Diagnosis Gap," features the panel examining why so many cases go undiagnosed despite new universal screening guidance.

Dr. Chung asks Dr. Dieterich to characterize the epidemiology of chronic hepatitis B in the United States and how it compares with the global picture, noting the disease remains highly prevalent worldwide yet draws less attention domestically.

Dr. Dieterich says an estimated one billion people globally have been exposed to hepatitis B, with 400 to 500 million carrying detectable surface antigen. U.S. numbers are far less certain: official estimates put the figure at two to three million, though he believes the realistic number is two to three times higher. He stresses that the vast majority of cases, both in the U.S. and globally, remain undiagnosed.

He credits recent CDC guidance recommending universal surface antigen testing for all adults, paired with vaccination for those who test negative, as a meaningful step forward. Mount Sinai implemented universal testing before the CDC guidance was finalized, rolling it out across roughly 60 primary care practices and pairing it with patient navigators who coordinate care for anyone not already receiving treatment.

Dr. Dieterich cites New York City Department of Health data showing a 3.1% hepatitis B surface antigen prevalence citywide, translating to roughly 250,000 of the city's 8 million residents. Since the World Health Organization defines an endemic country as having 2% prevalence or higher, he argues New York City qualifies as endemic, and Dr. Chung suggests it may even be better described as epidemic. Dr. Dieterich agrees that prior risk-factor-based screening approaches were largely unproductive, reinforcing the rationale behind the CDC's newer recommendation for one-time universal adult screening. Dr. Chung calls this shift the most important development in hepatitis B epidemiology and case identification in a long time.

Our next episode, "Monitoring Disease Progression and Liver Cancer Risk in Hepatitis B," turns to how disease progression unfolds once a patient is diagnosed.