ACP, CDC issue HBV vaccination, screening best practice advice
medwireNews: The American College of Physicians (ACP) and Centers for Disease Control and Prevention (CDC) have released best practice guidance for hepatitis B virus (HBV) vaccination, screening, and linkage to care.
Amir Qaseem (ACP, Philadelphia, Pennsylvania, USA) and team explain that although various organizations “have addressed these topics, their recommendations vary and implementation has been suboptimal.”
They add that the advice in the current statement amplifies and complements existing clinical guidelines by reiterating the importance of these aspects of HBV care.
“Evidence-based strategies that effectively implement this advice are critical to accomplishing the goals of the national hepatitis B elimination plan,” the authors write.
The statement, published in the Annals of Internal Medicine, advises clinicians to vaccinate all individuals, including pregnant women, at risk for HBV infection as a result of sexual, percutaneous, or mucosal exposure to the virus (such as current or recent users of injectable drugs, incarcerated persons, and healthcare and public safety workers). Adults with chronic liver disease, end-stage renal disease, or HIV should also be vaccinated, as should individuals planning to travel to areas with high or intermediate endemic HBV infection and those seeking protection against the infection.
The best practice advice regarding screening applies to much the same groups that require vaccination, but also includes individuals born in countries with an HBV prevalence of at least 2%, those requiring immunosuppression, blood and tissue donors, persons positive for hepatitis C virus, and infants born to HBV-positive mothers.
Qaseem and colleagues note that vaccination and screening are not only cost-effective, but also cost-saving, with prices that are “substantially lower” than the medical costs of treating the infection in the initial and progressive stages.
Finally, the ACP High Value Care Task Force and CDC guidance emphasizes the need for linkage to care and advises clinicians to provide counseling, directed care, and treatment for individuals who test positive or referral as appropriate.
The authors write: “Linkage to care ensures that patients with chronic HBV infection receive treatment when they become eligible (elevated HBV DNA and liver aminotransferase levels), hepatocellular carcinoma surveillance, behavioral risk reduction counseling, and vaccination of susceptible sexual and household contacts.”
The best practice statement is based on a comprehensive literature review of available guidelines, systematic reviews, meta-analyses, and randomized and nonrandomized intervention studies, and was approved by consensus.
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