Understanding New Clinical Screening Recommendations: Chronic Hepatitis B Infections

This article was adapted from one that originally appeared in The Journal of Family Practice: McHugh JA, Cullison S, Appuzio J, et al. Chronic hepatitis B infection: A workshop consensus statement and algorithm. J Fam Pract. 2011;60:E1-E8. © Quadrant HealthCom, Inc.

 

Case managers interact with all kinds of patients, including patients with hepatitis B virus (HBV) infection. New screening guidelines are now available and are simple and relatively inexpensive to implement. Since most patients do not exhibit overt clinical signs and symptoms of HBV infection, testing is underused in many healthcare settings, leaving many HBV-infected patients unaware and at risk for serious health consequences, including cirrhosis, liver failure, and liver cancer or hepatocellular carcinoma (HCC), according to a study in the Annals of Internal Medicine. Case managers have the opportunity to review new guidelines for HBV screening and management. As a patient advocate, the role of case managers is key to assisting the medical care team, patient/family and other members of the team to provide the best care for these patients.

 

Stats on Chronic Hepatitis B

Although the incidence of acute HBV infection has declined significantly as a result of universal infant vaccination in the United States, chronic infections are still prevalent and on the rise. In the U.S., factors such as immigration from areas where HBV is endemic, perinatal transmission, unprotected sex among young adults, and, increasingly, nosocomial infection due to breakdowns in infection control practices all play a part in the spread of the disease. In most healthy adults, HBV infection leads to acute hepatitis from which they fully recover, and only 5-10 percent will be unable to get rid of the virus and will develop a chronic HBV infection, according to the Institute of Medicine’s Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Since most people with chronic HBV infection do not exhibit any signs of clinical illness, this makes screening all the more important, especially since effective antiviral treatments are available.

 

New HBV Screening Algorithm

To address the need to improve screening practices in the busy primary care setting, a panel of prominent primary care practitioners and specialists in viral hepatitis was convened by the Hepatitis B Foundation, the nation’s leading nonprofit research and disease advocacy organization. The workshop panel reviewed evidence-based guidelines and reports from the American Association for the Study of Liver Diseases (AASLD), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Institute of Medicine (IOM), and the Hepatitis B Foundation’s national recommendations for pediatric HBV screening and management as well as other relevant publications. The resultant new recommendations presented below can assist case managers in applying evidence-based guidelines for HBV infection to everyday practice.