Trends in Hepatitis B Infection and Immunity Among Women of Childbearing Age in the United States

Clin Infect Dis. 2020 Jul 27;71(3):586-592. doi: 10.1093/cid/ciz841.


Background: The current opioid injection drug use epidemic has been associated with an increase in hepatitis C virus infections among women of childbearing age in the United States, but changes in hepatitis B virus (HBV) infections have not been studied.

Methods: A retrospective analysis of HBV statuses among women of childbearing age nationally and by state was conducted, utilizing the Quest Diagnostics database. Rates of HBV in women born before and after the implementation of universal HBV vaccination recommendations were determined.

Results: We identified 8 871 965 women tested for HBV from 2011-2017. Nationally, the annual rate of acute HBV infections was stable, but rates increased in Kentucky, Alabama, and Indiana (P < .03). The national prevalence of new, chronic HBV diagnoses decreased significantly, from 0.83% in 2011 to 0.19% in 2017 (P < .0001), but increased in Mississippi, Kentucky, and West Virginia (P ≤ .05). A declining prevalence of HBV seroprotection was evident over time, especially within the birth-dose cohort (which dropped from 48.5% to 38.5%; P < .0001).

Conclusions: National rates of newly diagnosed acute and chronic HBV infections declined or were stable overall, but increased significantly in specific Appalachian states. The HBV vaccine is effective in decreasing infections, but seroprotection wanes over time. These trends in new infections may be related to increased injection drug use and highlight potential gaps in HBV vaccine protection.

Keywords: hepatitis B exposure; hepatitis B vaccination; hepatitis B virus; reproductive age; testing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alabama
  • Female
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Hepatitis B virus
  • Hepatitis B* / epidemiology
  • Hepatitis B* / prevention & control
  • Humans
  • Kentucky
  • Mississippi
  • Prevalence
  • Retrospective Studies
  • United States / epidemiology


  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines