What is the History of Hepatitis B in America and Other Countries?
The U.S. and Western Europe have always had among the lowest rates of hepatitis B disease in the world, affecting less than one percent of the general population compared to countries in the Far East and Africa, where the disease affects 5 to 10 percent or more of the population.1
According to the CDC, from 1985 through 1993, the reported incidence of hepatitis B decreased 59% in the U.S. This decline was caused by the decrease in number of reported cases among homosexual men between 1985 and 1989 and IV drug users between 1989 through 1992.2 The CDC has attributed the decrease in hepatitis B to the increase in AIDS awareness that resulted in behavioral changes such use of condoms, and safer needle use and sex practices.
Notably, the significant decline in hepatitis B disease in the U.S. occurred prior to the CDC’s Advisory Committee on Immunization Practices (ACIP) 1991 recommendation that all infants be administered a birth dose of hepatitis B vaccine before being discharged from the hospital newborn nursery.3
In 1985, the number of cases of hepatitis B peaked at 26,611 and subsequently declined annually.4 When, in 1991 the ACIP recommended all infants receive a birth dose of the hepatitis B vaccination, the number of reported cases of hepatitis B had already decreased to 18,003.5 By 1996, there were only 10,637 cases of hepatitis B reported in the U.S. with 279 cases reported in children under the age of 14 and the CDC stated that "Hepatitis B continues to decline in most states, primarily because of a decrease in the number of cases among injecting drug users and, to a lesser extent, among both homosexuals and heterosexuals of both sexes."6
By 2006, the number of Hepatitis B cases decreased to 4,713 with only 14 cases reported in children less than 14 years of age.7 In 2015, there were 3,370 reported cases of acute hepatitis B in the U.S.8 with 3 cases of chronic hepatitis B reported in children ages 0-14.9
From 2000 through 2015 reported cases of acute hepatitis B in the U.S. is highest in adults aged 30-39 years of age and lowest among individuals 0-19 years of age.10 There was one reported outbreak of hepatitis B that occurred in a health care setting in 2015.11 During 2016, there was one outbreak reported in a health care setting, due to multiple infection control breaches, which resulted in two staff members being infected.12
According to the CDC, for cases hepatitis B reported in 2015,
- Of the 1,657 case reports that included information about injection-drug use, 502 cases (over 30 percent) indicated use of injection drugs;
- Of the 1,025 case reports that included information about sexual contact, 34 cases (3.3 percent) indicated sexual contact with a person with confirmed or suspected hepatitis B;
- Of the 500 case reports from males that included information about sexual preference/practices, 59 (almost 12 percent) indicated sex with another man;
- Of the 1,588 case reports that had information about number of sex partners, 419 (about 26 percent) indicated individuals having more than 2 sex partners;
- Of the 1,025 case reports that included information about household contact, 17 (almost 2 percent) indicated household contact with a person with confirmed or suspected hepatitis B.13
Additionally, the CDC reports that of the 48 reporting states, 38 (79.2 percent) states have met Healthy People 2020 goal of reducing incidence of hepatitis B to <1.5 cases/100,000 population.14
IMPORTANT NOTE: NVIC encourages you to become fully informed about Hepatitis B and the Hepatitis B vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 World Health Organization (WHO). Media Centre Fact Sheets. Hepatitis B. July 2016.
2 Centers for Disease Control MMWR Summary of Notifiable Diseases, United States, 1993. MMWR Oct. 21, 1994, 42(53);1-73
3 CDC. Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Committee (ACIP). Nov. 22, 1991, 40(RR-13);1-19
4 CDC. Summary of Notifiable Diseases, United States, 1993. MMWR Oct. 21, 1994. 42(53);1-73
6 CDC Summary of Notifiable Diseases, United States, 1996. MMWR October 31, 1997 45(53);1-87
7 CDC. Summary of Notifiable Diseases, United States, 2006. MMWR Mar. 21, 2008 55(53);1-94
8 CDC. Viral Hepatitis- Statistics and Surveillance - Surveillance for Viral Hepatitis – United States, 2015. Table 3.1.
9 CDC. Viral Hepatitis- Statistics and Surveillance - Surveillance for Viral Hepatitis – United States, 2015. Table 3.4.
10 CDC. Select Clinical Characteristics of Acute Hepatitis B Cases Reported in the United States, 2015. Table 3.2.
11 CDC. Healthcare- Associated Hepatitis B and C Outbreaks (≥ 2 cases) Reported to the Centers for Disease Control and Prevention (CDC) 2008-2016.
13 CDC. Acute hepatitis B reports, by risk exposure/behavior — United States, 2015.
14 CDC. 2015 State Acute Hepatitis B Incidence Compared to Healthy People 2020 National Goal. Map 3.1.