National Center for HIV, Viral Hepatitis, STD, and TB Prevention

Universal Adult Hepatitis B Vaccination:

Introduction

Kevin Ault, MD

Hepatitis Vaccines Work Group, Advisory Committee on Immunization Practices

November 3, 2021

Division of Viral Hepatitis
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ACIP Hepatitis Work Group Guiding Principles

Rationale for Universal Adult Hepatitis B Vaccination 

Recommendations

• Decrease new infections

• Prevent transmission

• Reduce health disparities
National Viral Hepatitis Elimination Goals

 HHS has called for the elimination of viral hepatitis as a 

public health threat by 20301

 The National Academies of Science, Engineering, and 

Medicine provided a roadmap to achieve viral hepatitis 

elimination2 

o Emphasized the role of vaccination, and

o Called for the expansion and simplification of adult 

hepatitis B immunization

1. https://www.hhs.gov/sites/default/files/Viral-Hepatitis-National-Strategic-Plan-2021-2025.pdf 2. https://www.nationalacademies.org/our-work/a-national-strategy-for-the-elimination-of-hepatitis-b-and-c
Childhood vaccination success: acute hepatitis B on path to 

elimination for <29 year-olds in the United States

Source: https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm
Rates of acute hepatitis B in the United States are highest 

among adults and are rising among >40 year-olds 

Source: https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm

Figure 2.7. Availability of information regarding risk behaviors 

or exposuresassociated with reported cases of acute hepatitis

B virus infection — United States,2019
 For the past 10 years

– Total number of acute hepatitis cases have plateaued 

– Rates have been increasing among middle-aged and older adults

 Risk-based HepB vaccination strategy among adults has 

fallen short

– Numerous risk factors; not easily integrated into provider screening

– Assumes patient recognition and disclosure of risk

– Exacerbates health disparities

Current Status of Hepatitis B in the United States
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Recap of ACIP Hepatitis Discussions

Year 

2016 ACIP suggested the WG examine a universal adult HepB

recommendation

2017 Evaluation of HEPLISAV-B vaccine

2018 Updates to HepA policy

2019

2020 Sept-19 to May-21: 15 Hepatitis Work Group conference calls

2021 Feb-21: Background, Economic Evaluation

Sep-21: EtR + GRADE

Nov-21: ACIP Vote
 The ACIP Hepatitis Vaccine Work Group unanimously agreed 

that the current risk-based recommendations need revision, 

with the majority preferring a universal adult HepB strategy 

with no upper age limit. 

ACIP Hepatitis Work Group Deliberations
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All adults aged ≤59 y and 

previously unvaccinated for 

hepatitis B should receive 

hepatitis B vaccination.

- Adults >59y would continue 

to follow existing risk based 

recommendations.

Alternative

Scenarios for ACIP Consideration

WG Preferred

All adults previously 

unvaccinated for 

hepatitis B should 

receive hepatitis B 

vaccination.

No WG support for retaining current risk-based recommendations

WG Alternative

All adults aged <59 years and 

previously unvaccinated for 

hepatitis B should receive hepatitis 

B vaccination. 

Note: Adults >59 years would 

continue to follow existing riskbased recommendations.
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ACIP Hepatitis Work Group Members

Ex Officio Members 

Marian Major (FDA) 

Darcie Everett (FDA)

Rajen Koshy (NIAID/NIH)

Consultants

Sharon Frey (SLU)

Robert Frenck (CCHMC)

Prabhu Gounder (LA-DPH)

Kathleen Harriman (CDPH)

Brian McMahon (ANTHC)

Kelly Moore (IAC)

David Nace (AMDA)

Jennifer Rosen (NYC-DOH)

Ann Thomas (OR-DHS/OHA)

Jennifer Zipprich (MDPH)

CDC Lead

Mark Weng 

(CDC/Division of Viral Hepatitis)

ACIP Voting Members

Kevin Ault (Chair)

Sybil Cineas

Liaison Representatives

Elizabeth Barnett (AAP)

Marci Drees (SHEA)

Sharon McMullen (ACHA)

Brenna Hughes (ACOG)

Susan Lett (CSTE)

Pamela Rockwell (AAFP)

Matthew Zahn (NACCHO)
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Acknowledgements

 NCHHSTP/Division of Viral Hepatitis

 NCIRD/Immunization Services Division

• Walter Williams

• Peng-Jun Lu

• Mei-Chuan Hung

 Doug Campos-Outcalt 

 Rebecca Morgan

• GRADE and Evidence to Recommendation 

framework

 FDA

 CDC Subject Matter Experts

• Erin Conners

• Mona Doshani

• Penina Haber

• Megan Hofmeister

• Mohammed Khan

• Neil Murthy

• Lakshmi Panagiotakopoulos

• Noele Nelson

• Priti Patel

• Tom Shimabukuro

• Phil Spradling

• Carolyn Wester