Trends in Prevalence and Characteristics of Resolved and Current Hepatitis B Among US-Born Persons: National Health and Nutrition Examination Survey, 2001-2018

J Infect Dis. 2021 Sep 1;224(5):804-812. doi: 10.1093/infdis/jiab224.


Background: After decades of decline, US acute hepatitis B incidence flattened since 2011. In persons aged ≥40 years and in jurisdictions affected by the opioid crisis, there is an increase in new cases. Data suggest new infections are occurring among US-born persons.

Methods: We used National Health and Nutrition Examination Survey data during 2001-2018 to examine changes in total antibody to hepatitis B virus core antigen (anti-HBc) prevalence in US-born persons. During 2013-2018, the distribution of characteristics was examined.

Results: During 2001-2006, 2007-2012, and 2013-2018, anti-HBc prevalence was 3.5%, 2.5%, and 2.6% among US-born persons, respectively. This corresponded to 5.7 (range, 4.8-6.6) million US-born persons with resolved or current HBV infection during 2013-2018, including 344 600 persons aged 6-29 years. The largest increase and highest prevalence was among persons who reported injection drug use (IDU), which increased from 35.3% during 2001-2006 to 58.4% during 2013-2018 (P = .07).

Conclusions: Anti-HBc prevalence among US-born persons remained flat during the most recent period, coinciding with a doubling of prevalence among persons reporting IDU. These data are consistent with acute hepatitis B surveillance trends, showing increasing incidence in subpopulations where prevention could be strengthened.Anti-HBc prevalence among US-born persons decreased from 2001-2006 to 2007-2012 and remained flat during 2013-2018, coinciding with a near doubling of prevalence among US-born persons reporting a history of injection drug use.

Keywords: US born; hepatitis B core antibody; hepatitis B virus; injection drug use; prevalence.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Viral / blood
  • Child
  • Female
  • Health Surveys
  • Hepatitis B / epidemiology*
  • Hepatitis B Antibodies / blood
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Male
  • Middle Aged
  • Nutrition Surveys
  • Prevalence
  • United States / epidemiology
  • Young Adult


  • Antibodies, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens