Department of Internal Medicine, Mayo Clinic, USA.
Chronic hepatitis B viral (HBV) infection can lead to cirrhosis, liver failure, or hepatocellular carcinoma. In the United States, HBV infection is commonly associated with high-risk behaviors such as intravenous drug use or unprotected sex; but it is not as well-known among health care providers that HBV can be transmitted from mother to baby during birth. Worldwide, the majority of cases of chronic HBV infection are in people who contracted the virus during birth. There is a lack of awareness in the United States that immigrants from HBV-endemic countries may be at high risk for chronic HBV. Thus, at-risk individuals may not be screened for HBV. The most recent Centers for Disease Control and Prevention guidelines recommend HBV screening for all people born in Asia, all U.S.-born persons who were unvaccinated as infants and whose parents were born in regions of high HBV endemicity (> or = 8%), and individuals with parenteral risk factors. Screening for HBV starts with HBsAg (hepatitis B surface antigen), HBsAb (antibody to hepatitis B surface antigen), and total anti-HBc (total antibody to hepatitis B core antigen) testing. For those who are HBV-negative (HBsAg-negative) and have no evidence of prior immunity, the three-part HBV vaccination series is recommended.