All adults ages 19 to 59 should be vaccinated against the hepatitis B virus (HBV), according to updated federal guidelines by the Centers for Disease Control and Prevention (CDC). The new recommendations were published in the April 1 issue of Morbidity and Mortality Weekly Report.

The move follows the recommendations given to the CDC last fall by its Advisory Committee on Immunization Practices.

“These greatly expanded and simplified recommendations will improve access and make it easier to protect millions more Americans from hepatitis B,” said Chari Cohen, DrPH, MPH, senior vice president of the Hepatitis B Foundation, in a statement. “This will save countless lives and ultimately reduce health care costs.”

Hepatitis refers to inflammation of the liver, an organ that acts as the body’s filtration system. Hepatitis can be caused by several factors, including toxins, excess alcohol use, autoimmune diseases, fat in the liver and viruses, including hepatitis A, B and C. The most common hepatitis viruses are spread via contaminated food and water (hepatitis A) and shared needles and sex (hepatitis B and C). Transmission via blood transfusion is now very rare. Folks living with HIV are at higher risk for coinfection with viral hepatitis.

Hepatitis B can be chronic, and, over years or decades, it can lead to severe liver complications, including cirrhosis (scarring of the liver), liver cancer, the need for a liver transplant and death.

There is no cure for hep B, though medications can help manage the condition and keep it from progressing. Hepatitis B vaccinations are effective and safe; however, they didn’t became a standard recommendation for children until 1991, which means many Americans born before then are not vaccinated.

The most recently approved hep B vaccine is given in two doses one month apart. Older versions require a series of three shots administered over a six-month period. For more, details, see the Hepatitis B Prevention section of HepMag.com’s Basics on Hepatitis B.

Currently, only about 30% of adults in the United States have been vaccinated against the virus, and hep B cases are on the rise, according to the Hepatitis B Foundation, which adds that up to 2.4 million Americans are living with chronic hep B and thousands die of the disease each year. What’s more, the foundation points out that people with untreated chronic infection have a 25% to 40% lifetime risk of developing liver cancer, which is often fatal.

To get the word out about the CDC’s new guidelines and to ensure that more people get vaccinated, the foundation and its partners will convene an advisory council of stakeholders later this month to strategize ways to educate the public about vaccinations.

Before the guidelines issued today, the CDC had recommended hep B vaccinations for people considered to be at higher risk.

Hep’s Basics on Hepatitis B Transmission explains in part:

Hepatitis B virus (HBV) is highly contagious and may be present in blood and body fluids, including semen and vaginal secretions. The saliva of people with hep B may contain evidence of the virus but in such small concentrations that kissing does not spread HBV. Here are the most common ways hepatitis B is transmitted:

• Sex with an infected partner


• Acquired at birth from an infected mother


• Sharing injection drug equipment (including needles, syringes, cookers, drug-preparation equipment)


• Contact with blood or open sores of an infected person


• Needle stick or other skin puncture

• Sharing items such as glucose monitors, razors or toothbrushes with an infected person.

Hepatitis B may also be spread through non-injection drugs (for example, through cocaine straws and crack pipes) as a result of exposure to blood. An unsterilized instrument may transmit HBV during acupuncture, tattooing and body piercing. A human bite may spread hepatitis B.

Hep B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing or sneezing.

HBV may live outside the body for at least seven days and still be potentially infectious.

According to the Hep B Foundation, the CDC’s updated guidelines mean that:

  • All adults ages 19 to 59 can receive the HBV vaccination with no cost sharing. Those who are 60 and older who wish to receive the hepatitis B vaccine but have no identified risk factors may still have to pay for the vaccine based upon insurance coverage.

  • Financial and other systemic barriers to vaccine access will be eliminated for many adults.

  • Access to the hepatitis B vaccine will increase; more providers will offer the vaccine, and it will be easier to get vaccinated.

  • Health insurance coverage for the vaccine will improve.

  • Progress toward our shared goal of eliminating viral hepatitis in the United States by 2030 will accelerate.

  • Health disparities and new hepatitis B infections will be reduced.