Current state of and needs for hepatitis B screening: results of a large screening study in a low-prevalent, metropolitan region

PLoS One. 2014 Mar 24;9(3):e92266. doi: 10.1371/journal.pone.0092266. eCollection 2014.


Background: In low hepatitis B virus (HBV)-prevalent countries, most HBV-infected persons are unaware of their status. We aimed to evaluate whether (i) previous HBV-testing, (ii) physicians decision to screen, and (iii) CDC's recommendations identified infected individuals and which risk-factor groups needing testing.

Methods: During a mass, multi-center HBV-screening study from September 2010-August 2011, 3929 participants were screened for hepatitis B surface antigen (HBsAg), anti-HBs and anti-Hepatitis B core antibodies (anti-HBcAb). Questions on HBV risk-factors and testing practices were asked to participants, while participants' eligibility for HBV-testing was asked to study medical professionals.

Results: 85 (2.2%) participants were HBsAg-positive, while 659 (16.8%) had either resolved HBV infection or isolated anti-HBcAb. When comparing practices, HBV-testing was more likely to occur in HBV-infected participants if Centers for Disease Control and Prevention (CDC) recommendations were used (Sensitivity = 100%, 95%CI: 95.8-100) than physicians' discretion (Sensitivity = 87.1%, 95%CI: 78.0-93.4) or previous HBV-test (Sensitivity = 36.5%, 95%CI: 26.3-47.6) (p<0.0001). Nevertheless, many non-infected individuals would still have been screened using CDC-recommendations (Specificity = 31.1%, 95%CI: 29.6-32.6). Using multivariable logistic regression, HBsAg-positive status was significantly associated with the following: males, originating from high HBV-endemic region, contact with HBV-infected individual, without national healthcare, and intravenous-drug user (IDU). Of these risk-factors, physician's discretion for testing HBV was not significantly associated with participants' geographical origin or IDU.

Conclusions: Missed opportunities of HBV-screening are largely due to underestimating country of origin as a risk-factor. Applying CDC-recommendations could improve HBV-screening, but with the disadvantage of many tests. Further development of HBV-testing strategies is necessary, especially before severe disease occurs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Centers for Disease Control and Prevention, U.S.
  • Cities / epidemiology*
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Hepatitis B / blood
  • Hepatitis B / diagnosis*
  • Hepatitis B / epidemiology
  • Hepatitis B Surface Antigens / blood
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Physicians
  • Prevalence
  • Risk Factors
  • Surveys and Questionnaires
  • United States


  • Hepatitis B Surface Antigens

Grant support

This study was funded largely in part by the Agence Nationale de Recherche sur le Sida et les Hépatites virales (grant number: 2010-334), Gilead Sciences and Roche. Material support was also provided from the Mairie de Paris. AB was awarded a post-doctoral fellowship from the ANRS. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.