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CDC: All Adults Should Be Tested For Hepatitis B At Least Once In Their Lifetime

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Fact checked by Nick Blackmer

The Centers for Disease Control and Prevention has updated its guidance for hepatitis B testing. It now recommends that everyone over age 18 be tested for hepatitis B at least once in their lifetime.

This is the first change in testing recommendations since 2008 and makes testing universal for adults, rather than based on whether a person has any risk factors for hepatitis B infection.

The CDC also recommends that adults aged 18 to 59 get vaccinated against hepatitis B if they haven't already. Vaccination against hepatitis B is already recommended for infants.

If you're 18 or older, the Centers for Disease Control and Prevention (CDC) now recommends getting tested for hepatitis B at least once in your lifetime.

Previously, the CDC only recommended testing for people at risk of hepatitis B infection, including but not limited to men who have sex with men, people with HIV or sexually transmitted infections, people who've injected drugs.

Hepatitis B is a viral infection characterized by inflammation of the liver and transmitted through bodily fluids. While most people can clear the infection on their own, chronic cases can be quite serious and may require medication or even liver transplant. There is no cure for chronic hepatitis, but it can be prevented with a vaccine.

"Liver disease is one for which there's a lot of stigma, and any screening recommendations that move away from risk-based screening really de-stigmatize the disease," Emmanuel Thomas, MD, PhD, chairman of the national board of directors for the American Liver Foundation, told Verywell.

An infection with hepatitis B virus can be acute, which means that the body's immune system fights it off within a few weeks. However, some people develop chronic hepatitis B infection, which is lifelong. Chronic hepatitis B puts a person at increased risk for liver cancer and cirrhosis, and of dying prematurely. That's why testing is so important—knowing your infection status can help you get the antiviral treatment needed to keep symptoms at bay.

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Testing Consists of 3 Parts

A three-panel blood test is needed to identify the multiple parameters of chronic hepatitis B infection. You can get tested at locations like your primary care provider's office, a community health clinic, or chain pharmacies with clinics, like CVS. You can also purchase at-home test kits, which require a blood sample that you sent to a lab for analysis.

"Screening used to just involve checking for hepatitis B surface antigen, which only looks for chronic infection," liver specialist Jama Darling, MD, an assistant professor at the University of North Carolina School of Medicine, told Verywell.

Additional testing allows healthcare providers to determine how infectious a person is, how the virus is replicating, and which type of treatment is necessary.

If a person tests negative for hepatitis, providers can recommend vaccination.

The three tests used to determine hepatitis B infection status look for three different markers:

Hepatitis B surface antigen (HBsAg) indicates that the person with hepatitis B is infectious

Antibody to hepatitis B surface antigen (anti-HBs) indicates that the person has recovered from a hepatitis B infection and can show immunity after vaccination

Antibody to hepatitis B core antigen (anti-HBc) indicates the presence of hepatitis B and persists for life after the initial infection

In addition to the change to universal testing, the CDC is continuing its recommendations that pregnant women be tested for hepatitis B surface antigen (HBsAg) during each pregnancy, whether they have been vaccinated against hepatitis B or have been previously tested for the virus.

Susceptible people who have ongoing risk for hepatitis B should be tested periodically if they continue to be at risk.

Who Is Most At-Risk for a Hepatitis B Infection?

Hepatitis B is transmitted through contact with infected blood or body fluids, including through pregnancy and childbirth. In fact, transmission of the virus during childbirth is considered the greatest risk for chronic infection.

For people with a history of increased risk for hepatitis B, the CDC still recommends risk-based testing, which may require more than just one test per lifetime. Other risk factors for being infected with hepatitis B virus include having been in jail, prison, or other detention; having a history of sexually transmitted infections or multiple sex partners; using intravenous drugs; or being infected with hepatitis C virus.

People born outside of the United States are more likely to have chronic hepatitis B infection, and account for nearly 70% of those with a known chronic infection.

Anyone who asks to be tested for hepatitis B should also be tested without having to disclose if they have a risk factor for infection, the CDC says.

Related:Hepatitis B vs. Hepatitis C: What Are the Differences?

The opioid crisis and intravenous drug use gives the new universal recommendation for testing increased importance, Darling said. Patients don't necessarily tell their healthcare providers if they use or have used injected drugs, she noted.

According to the report announcing the change in recommendations, which appeared in Morbidity and Mortality Weekly Report, up to 2.4 million persons are living with hepatitis B virus infection in the United States. Two out of three of these people may be unaware of their infection.

The good news is the prevalence of hepatitis B is declining in the U.S. Thanks to the availability of a three-shot vaccine for the virus that is recommended for all newborns, Thomas said. Last year, the CDC recommended that everyone over age 18 and under age 59 be vaccinated against hepatitis B. These recommendations are in line with the World Health Organization guidelines.

"It is startlingly rare to see a 20-year-old who hasn't been vaccinated," Darling said, crediting the advent of newborn vaccinations for hepatitis B. "But it's … uncommon to see a 40-year-old vaccinated for B."

The CDC recommends that you be tested for hepatitis B at least once in your life if you are over age 18. The agency also recommends that anyone over age 18 be vaccinated against the virus.

How Long It Took To Develop 13 Vaccines In History

Smallpox

A teenage boy is vaccinated against smallpox by a school doctor and a county health nurse, Gasport, New York, 15th March 1938. Harry Chamberlain/FPG/Hulton Archive/Getty Images

The eradication of smallpox through a vaccine is seen as one of the biggest achievements in public health history — but it took several centuries to get there.

The origins of smallpox are unknown, though scientists believe it dates all the way back to the Egyptian Empire of the 3rd Century BCE. By the 18th century, colonization spread the disease across the globe. It had a devastating mortality rate of up to 30%.

In 1796, Edward Jenner in the UK created the first successful smallpox vaccine, but it wasn't until the 1950s that vaccine treatments began to effectively eradicate the disease in some parts of the world.

Then, in 1967, a global effort that provided a higher level of vaccine production and advancement in needle technology eventually lead to the eradication of the disease by 1980.

To date, smallpox remains the only disease to have been completely eliminated around the world through vaccination efforts.

Plague

People praying for relief from the bubonic plague, circa 1350. Hulton Archive/Getty Images

Plague is one of the world's oldest and most lethal diseases, culminating in nearly 200 million deaths throughout human history. But to date, no licensed vaccine is available.

Plague is perhaps most notorious for killing millions of people during the Middle Ages, but the disease is still active in areas around the world. As recent as 2017, a plague outbreak in Madagascar attracted widespread attention and panic.

However, since plague is a disease spread by bacteria, the advent of modern antibiotics can be used as treatment. Even so, researchers believe that vaccination development is the most viable option to prevent the spread of disease in the long term.

Many failed attempts have been made to create a plague vaccine in the past – including one that was made in the US to inoculate soldiers during the Vietnam War.

But in 2018, the WHO created a Plague Vaccine Target Product Profile, which lists 17 possible candidates for vaccine approval, which are undergoing clinical trials and moving toward FDA approval. 

Typhoid Fever

Mary Mallon (1870?-1938), known as "Typhoid Mary", in New York City. She was the first person identified as a carrier of typhoid bacilli in the United States. Getty Images

Typhoid fever is a deadly disease that can be spread widely through food and water. Though relatively uncommon in industrialized areas, it remains a significant threat in developing nations throughout Southeast Asia, Africa, and Latin America.

Two vaccines are commercially available to prevent typhoid fever. After the bacteria responsible for the disease was discovered in 1880, German scientists first began research into these efforts in 1896.

In 1909, US Army physician Frederick F. Russell developed the first US typhoid vaccination. For the next several years, the vaccine would be used for military purposes, but in 1914, it became available among the general American public.

Today, Typhoid fever is uncommon in the US and vaccinations are not commonly recommended for routine use.

Yellow Fever

A nurse prepares a vaccine against yellow fever at an outpatient clinic in Sao Paulo, Brazil, on January 12, 2018. MIGUEL SCHINCARIOL/AFP via Getty Images

In 1951, Max Theiler became the first and only scientist to receive a Nobel Prize for the development of a vaccine. His efforts to control yellow fever are widely praised by the scientific community, and he helped to correct years of misled research.

Yellow fever has caused deadly epidemics throughout human history for more than 500 years, and by the end of the 19th century, it was well known to be a threat around the world. But little was known about the disease itself, and early vaccination efforts at the close of the century mistakenly focused on bacterial transmission when it's actually caused by a virus.

In 1918, researchers working for the Rockefeller Institute developed what they thought was the first successful yellow fever vaccination — but in 1926 Theiler proved otherwise and the faulty vaccine ceased production.

Over a decade later, in 1937, Theiler created the first safe and effective yellow fever vaccination, which has since become the universal standard.

Influenza

Volunteer nurses from the American Red Cross tend to people with the flu in the Oakland Auditorium in Oakland, California, during the influenza pandemic of 1918. Edward A. "Doc" Rogers

Influenza has a long, tragic history of killing millions of people worldwide. During the 1918 influenza pandemic, there were no known cures or vaccinations for the virus.

Starting in the 1930s, it took decades of research to understand the complexities of the influenza virus, and it wasn't until 1945 that the first vaccine was approved for use in the US.

But just two years later, in 1947, researchers concluded that seasonal changes in the composition of the virus rendered existing vaccinations ineffective.

Researchers realized that two main types of influenza viruses occur — influenza A and influenza B, along with multiple new strains of the virus each year. Because of this, scientists have to tweak the influenza vaccine every year.

Today, seasonal flu vaccines are designed by the WHO using data gathered from influenza surveillance centers to develop a new vaccination based off the three strains most likely to circulate in the upcoming season.

Polio

A boy receives polio vaccine drops, during an anti-polio campaign, in a low-income neighborhood in Karachi, Pakistan, on April 9, 2018. Reuters

While polio has likely affected human populations for thousands of years, it wasn't until the late 1800s that the disease reached epidemic proportions. At the turn of the century, polio tore through the US, leaving many infected patients paralyzed or disabled for life.

Research to understand polio was gradual for the first few decades of the 20th century. In 1935, a vaccination was attempted, first on monkeys and then on children in California. Though this vaccine yielded poor results, two more decades of research paved the way for the development of vaccines by Jonas Salk in 1953, and Albert Sabin in 1956.

After a trial of more than 1.6 million children, Salk's vaccine was adopted in the US by 1955. Continuous research through the 1980s made way for an even more effective and efficient production of vaccines, and by 1994 polio was eliminated in the Americas.

As recently as 1988, 350,000 people had the debilitating disease, the majority of whom were children. By 2018, there were only 33 cases of polio in the whole world.

One study estimated that the polio vaccine prevented 24 million people from getting the disease from 1988 to 2021.

Polio could become the second human disease we wipe from the planet.

Anthrax

A biological technician wearing a Level C PAPR protective suit climbs up a ladder to inspect a decontamination tent covering Smailholm village hall in southern Scotland March 6, 2007. The technician is part of a team that decontaminated the scene of an Anthrax outbreak in July 2006. REUTERS/David Moir

Anthrax is thought to have been around since 700 BC, but the first clinical account of the disease was recorded in the 1700s.

Throughout the 1800s, a series of studies to determine where the disease originated from, how long the bacteria could survive, and how the disease was transmitted through animals paved the way for the first attempts at a vaccine in 1881.

In 1937, scientist Max Sterne created a successful Anthrax vaccination to be used in livestock, a version of which is still used today, in order to reduce transmission from animals to humans. Thirteen years later, the first human vaccine was created and made available for people working in animal processing mills in the United States.

An updated anthrax vaccine was developed in 1970, which is largely what's used to prevent the disease in humans today.

Measles, Mumps, and Rubella (MMR)

A nurse displays vials of measles vaccine at the Orange County Health Department on May 6, 2019 in Orlando, Florida. NurPhoto/Paul Hennessy via Getty Images

Measles, Mumps, and Rubella are viral infections that have each caused widespread, deadly disease outbreaks. Throughout the 1960s, individual vaccines were developed for each of them, but a decade later, they were combined into one.

Measles was the first of the three to receive its own vaccine in 1963, followed by mumps in 1967, and rubella in 1969. Two years later, in 1971, Maurice Hilleman of the  Merck Institute of Therapeutic Research developed a combined vaccination that would provide immunity for all three viruses.

Hilleman was credited with creating the first measles and mumps vaccine and began researching ways to incorporate a system of immunity for each virus. Using his previous research and a rubella vaccine developed by Stanley Plotkin in 1969, he created the first successful MMR vaccine in just two years.

According to the CDC, "One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella."

"Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps."

Varicella (Chicken Pox)

Kiara Boisvert, 5, gets a varicella booster vaccination from Amy Moran, a clinical assistant at Intermed in South Portland on Thursday, June 4, 2015. Gregory Rec/Portland Portland Press Herald via Getty Images

Primary varicella infection, commonly known as chickenpox, was misdiagnosed as smallpox until the end of the 1800s.

In the 1950s, scientists distinguished varicella from herpes zoster (shingles), and subsequent research lead to the development of first vaccine for chickenpox in Japan in the 1970s.

The vaccine was licensed for use in the US in 1995.

Shingles (herpes zoster)

Frank Bienewald/LightRocket via Getty Images

Shingles, or herpes zoster, stems from the same virus that causes chickenpox. The only two ways shingles can develop is after an initial infection of chickenpox, or (uncommonly) exposure to a chickenpox vaccination.

The connection between shingles and chickenpox was first observed in 1953, and throughout the 1960s, studies indicated that shingles was much more common in older populations. But it wasn't until 2006 that the first commercially available vaccine was licensed in the US.

A more recent licensed vaccine for shingles came with a recommendation by the US Advisory Committee on Immunization Practices in 2018 that adults age 60 or older should be vaccinated for the disease.

Hepatitis B

Vaccinations to help prevent Hepatitis A and B were given by HEP Team to those interested free of cost. Carlos Chavez/Los Angeles Times via Getty Images

Hepatitis B is a more recent virus and was discovered by Dr. Baruch Blumberg in 1965. Just four years later, he created the first hepatitis B vaccine using a heat-treated form of the virus.

Twelve years later, in 1981, the FDA approved the first commercially available hepatitis B vaccination, which involved blood samples from infected donors.

Then, in 1986, a new synthetically prepared vaccine that does not use blood products replaced the original model.

Since Hepatitis B can cause liver cancer, the vaccine was also considered the first anti-cancer vaccine.

Human papillomavirus (HPV)

Pediatrician Richard K. Ohnmacht prepares a shot of the HPV vaccine Gardasil for a patient at his office in Cranston, Rhode Island, on Sept. 3, 2015. Keith Bedford/The Boston Globe via Getty Images

Human papillomavirus is the most commonly sexually transmitted disease in the US, and studies show that more than 80% of women will have contracted the virus at some point in their lives.

Two strains of HPV are thought to cause up to 70% of cervical cancer, which can result in hundreds of thousands of deaths each year. The link between HPV and cervical cancer was first made in 1981, and over two decades of research followed before a viable vaccine hit the market.

The first HPV vaccine was developed in the US in 2006, and subsequent research has led to the development of two more vaccines since.

Today, recommendations on what type of vaccine to get largely depend on age.

COVID-19

Pfizer, along with BioNTech, used breakthrough mRNA technology to create its COVID-19 vaccine. The potential of this new tech could transform science, leaders at the company said. Vincent Kalut / Photonews via Getty Images

The COVID-19 outbreak caused billions of people across the world to go on lockdown — disputing everyday life — to curb the spread of the highly contagious virus.

The coronavirus resulted in overcrowded hospitals, stressed out health workers, and pressure on officials who were pushed to create a vaccine to end the pandemic.

During the early stages of the pandemic, Dr. Anthony Fauci, the nation's top disease expert, said in front of Congress that a vaccine could be developed by the end of 2020 or available for use in 2021.

In December 2020, Sandra Lindsay, a critical care nurse,  became the first person in the US to receive the jab outside clinical trials.

"As a minority, I wanted to instill confidence in my people that look like me to say that it is safe, be guided by science, don't be afraid," Lindsay told Insider at the time.

According to the Centers for Disease Control and Prevention, four vaccines have been greenlit in the US, including Pfizer-BioNTech, Moderna, Johnson & Johnson, and Novavax. 

More than 13 billion vaccine doses have been administered worldwide, including 676 million in the US.

What's In The RSV Vaccine, Its Side Effects And When You Can Get One

The Washington Post 5/4/2023 Carolyn Y. Johnson

© iStock/iStock The FDA has approved the GSK vaccine for respiratory syncytial virus for people ages 60 and older.

The first vaccine to prevent the respiratory disease caused by RSV was approved this week by U.S. Regulators for use in adults 60 and older.

The shot, developed by pharmaceutical giant GSK, will be rolled out ahead of the fall and winter RSV season, when transmission peaks. Most people are infected by respiratory syncytial virus repeatedly over a lifetime and experience only a mild cold, but babies and vulnerable older adults can become severely ill.

Depending on the season, 60,000 to 120,000 older adults are hospitalized in the United States with RSV each year, and 6,000 to 10,000 die, according to the Centers for Disease Control and Prevention. In an earnings presentation released last week, GSK said it has "millions of [vaccine] doses ready to be shipped."

Here's what you need to know about the newly approved vaccine, from how it works to what happens next.

What's in the RSV vaccine?

The new vaccine, called Arexvy, contains a harmless version of a protein found on the outside of the virus. That viral protein shape-shifts after it infects a person's cells, so the vaccine uses a version that has been locked into a lollipop shape — in effect, training the immune system to block the virus before it can enter.

The vaccine also contains an adjuvant, an ingredient used to rev up the immune system. Arexvy uses the same adjuvant that's in GSK's shingles shot, Shingrix, but half of the dose.

For decades, fear and failure in the hunt for an RSV vaccine. Now, success. Does this vaccine use a new technology?

No. This is a protein-based vaccine, similar to ones that are used against other diseases, including a hepatitis B vaccine, a shingles shot and an influenza vaccine. The protein in the vaccine is produced by cells in a laboratory.

How effective is the new RSV vaccine?

RSV causes trouble when it gets deep into the lungs, resulting in lower respiratory tract disease. That can develop into pneumonia.

In a clinical trial with nearly 25,000 participants, Arexvy was shown to be 83 percent effective in preventing lower respiratory tract disease caused by RSV in older adults. It was 94 percent effective against severe disease. The results were published this year in the New England Journal of Medicine.

Whom is this vaccine for?

Although people of all ages can become infected with RSV, this vaccine is approved for people 60 and older, who are at risk for severe illness because of their declining immune responses.

"Older adults, in particular those with underlying health conditions, such as heart or lung disease or weakened immune systems, are at high risk for severe disease caused by RSV," Peter Marks, director of the Food and Drug Administration's Center for Biologics Evaluation and Research, said in a statement.

GSK is conducting a clinical trial to test the vaccine in people as young as 50.

Does the vaccine have side effects?

As with many vaccines, common side effects included pain at the injection site, fatigue, muscle pain, headache and joint stiffness.

There were 10 cases of atrial fibrillation, a heart condition, within a month of vaccination in participants who received the shot, compared with just four cases in the placebo group.

There was also one case of Guillain-Barré syndrome, a rare neurological disorder in which the body's immune system attacks nerve cells. In two patients who received the vaccine alongside the influenza vaccine, there were cases of acute disseminated encephalomyelitis, inflammation that affects the brain and spinal cord. One of those patients died.

The FDA is requiring the company to study the potential risk of Guillain-Barré and the brain and spinal cord inflammation as the vaccine goes into wider use. GSK will also track cases of atrial fibrillation.

Are more RSV vaccines coming?

Yes. Some experts call this the beginning of a renaissance for RSV. After decades of failure, new insights into the shape of a key RSV protein allowed scientists to create successful vaccines and a better preventive treatment.

A Pfizer RSV vaccine for older adults is under review, with a decision expected this month. The FDA is also reviewing the safety and effectiveness of Pfizer's vaccine as a maternal vaccination, given during pregnancy. Virus-blocking antibodies are passed from mother to baby, providing the developing infant with temporary protection.

Moderna reported in January that its RSV vaccine was successful in protecting older adults and has said it plans to submit its data to regulators by the end of June. Another company, Bavarian Nordic, expects results from its RSV vaccine trial in the middle of this year, with plans to request approval from regulators if it is successful.

A monoclonal antibody developed by AstraZeneca and Sanofi also is under review; it can be used to provide vaccine-like protection to babies over an entire season. At this time, a monoclonal antibody made by Sobi is available to high-risk children and must be given once a month.

When will I be able to get this vaccine?

GSK plans to make the vaccine available in advance of the fall and winter RSV season.

In June, experts who advise the CDC on vaccines are anticipated to meet to make recommendations on how approved RSV vaccines should be integrated into public health care.

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