for Health Care Providers
Prevalence of Hepatitis B Virus Exposure in the Veterans Health Administration and Association With Military-related Risk Factors
An estimated 850,000 to 2.2 million people in the U.S. suffer from chronic hepatitis B virus (HBV) infection, a treatable cause of liver failure, cirrhosis and liver cancer. HBV is responsible for 2,000-4,000 deaths annually in the U.S. Although not all individuals exposed to HBV go on to develop a chronic infection, evidence of past contact with the virus will remain detectable in the blood even among those who clear the infection.
Earlier studies report that military Veterans have higher odds of HBV exposure than similar non-Veterans, but it is unclear whether this is due to military-related exposures or due to other risk factors or behaviors. The military began universally vaccinating servicemembers for HBV starting in 2001, thereby providing effective protection against the virus among those who served after this time.
A study by Beste et al. examined a random sample of veterans receiving care from 1998 through 2000 in the national Veterans Health Administration system. Each patient completed a risk factor survey and underwent blood testing for HBV (n=1146). The prevalence values for infection, exposure, and immunity were 0.7% (95% CI, 0.3-1.5), 13.% (95% CI, 11.5-16.1), and 6.2% (95% CI, 4.7-8.2), respectively. Evidence of HBV exposure was highest among respondents with "traditional" risk factors (such as drug use or high-risk sexual practices). More than half the individuals with HBV exposure (53%) reported no history of "traditional" risk factors; of these, 59.5% reported a history of combat exposure. After adjustment for demographic and traditional risk factors, service in a combat zone (adjusted odds ratio,1.56; 95% CI, 1.01-2.41) and being wounded in combat (adjusted odds ratio, 1.79; 95% CI, 1.04-3.08) were independently associated with exposure to HBV.
The study concluded that the prevalence of exposure to HBV is highest among Veterans with "traditional" risk factors but also independently related to self-reported military combat or being wounded in combat. The authors caution that it is not yet known whether Veterans with combat exposure prior to the era of universal vaccination should be screened for HBV.
Read the full article, Prevalence of Hepatitis B Virus Exposure in the Veterans Health Administration and Association With Military-related Risk Factors,
in Clinical Gastroenterology and Hepatology