National Association of County and City Health Officials (NACCHO), the voice of our country’s local health departments, applauds the Centers for Disease Control and Prevention (CDC) for updating its hepatitis B vaccination guidelines. The CDC is recommending universal hepatitis B vaccination for all adults aged 19 to 59 in the United States. The CDC announced these updated recommendations in a recent edition of its Morbidity and Mortality Weekly Report, following a recommendation from its Advisory Committee on Immunization Practice in November 2021.
Hepatitis B virus (HBV) remains a significant public health threat in the U.S. An estimated 862,000 people are living with HBV, and there are 21,600 new cases each year. HBV can cause significant damage to the liver, resulting in cirrhosis and liver cancer. HBV is primarily spread through sexual contact, through the sharing of syringes and other injection equipment, or through parent-to-child transmission at birth. The previous vaccination recommendations were based on risk factors for HBV. However, the stigma associated with key risk factors, including injection drug use, could deter patients from disclosing their risk and consequently limit opportunities for vaccination.
The expanded recommendations will help to close the gap. Currently only 25% of adults are vaccinated against HBV in the U.S. Furthermore, the updated recommendations support our national goal to eliminate viral hepatitis in the U.S.
The updated vaccination recommendations will complement existing recommendations for universal infant vaccination, which began in 1991. Expanded vaccination will be critical to addressing the burden of HBV in the US and the inequitable impact of HBV on people who inject
drugs; men who have sex with men; people with a history of incarceration; refugee, immigrant, and migrant populations; and Black, Indigenous and other people of color in the U.S. Notably, the updated recommendations will ensure expanded health insurance coverage and the elimination of financial and other barriers to HBV vaccination for many adults.
Local health departments (LHDs) are ideally situated to support the implementation of the new recommendations, and they will play a key role in increasing adult HBV vaccination coverage nationwide. According to NACCHO’s 2019 Profile assessment, 88% of LHDs provide adult vaccination, making vaccination the most frequently provided clinical service. LHDs also coordinate with a variety of local stakeholders to prevent and eliminate viral hepatitis. They provide and assure access to HBV vaccination, testing, and treatment; conducting outreach to healthcare providers and populations at high risk for hepatitis and providing hepatitis services in STI, harm reduction, and correctional settings. The expanded recommendations will enable LHDs to offer the HBV vaccine more widely and encourage more providers to offer the vaccine, expanding access in a variety of settings.
A universal adult HBV vaccination recommendation is an important step toward increasing access to HBV vaccination and reducing preventable morbidity and mortality. However, scaling up HBV vaccination and implementing tailored and innovative approaches to outreach and messaging will require a multidisciplinary effort ranging from the local to national level. Coordination at all levels will be necessary to incorporate universal HBV vaccination into routine vaccination programs, especially as immunizers continue to provide COVID-19 vaccination and strive to improve vaccination rates that have decreased during the pandemic. It is imperative for policymakers to ensure that all partners and stakeholders, including LHDs, receive the needed resources and support to efficiently and effectively operationalize this critically important recommendation.