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What is the history of Hepatitis B in America and other countries?

Updated February 16, 2023

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The U.S. and Western Europe have always had among the lowest rates of hepatitis B disease in the world, affecting less than two 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. 

According to the CDC, from 1985 through 1993, the reported incidence of hepatitis B decreased 59 percent 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.  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. 

In 1985, the number of cases of hepatitis B peaked at 26,611 and subsequently declined annually.  In 1991, when 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.  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." 

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.  In 2020, there were 2,157 reported cases of acute hepatitis B.  Nineteen cases of perinatal hepatitis B were reported to the CDC in 2019. 

From 2005 through 2020, reported cases of acute hepatitis B in the U.S. were highest in adults aged 30-49 years of age and lowest among individuals 0-19 years of age.  There was one reported outbreak of hepatitis B that occurred in a health care setting in 2015.  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. 

According to the CDC, for cases of hepatitis B reported in 2020: 

  • Of the 1,115 case reports that included information about injection-drug use, 36 percent indicated use of injection drugs;
  • Of the 636 case reports that included information about sexual contact, 19 percent indicated sexual contact with multiple partners.

In 2020, the rate of acute hepatitis B infection ranged from a high of 3.2 cases per 100,000 population in West Virginia to a low of 0.1 cases in California, Kansas, Minnesota, Nebraska, and South Dakota. The largest decrease in rates occurred in Kentucky while the largest increase occurred in South Carolina. 

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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