Viral hepatitis caused by A to E imposes a substantial global burden of liver disease. Despite US control strategies, long-term national data covering serologic markers of all five hepatitis viruses remain limited. In this study, we analyzed epidemiologic trends from 2011 to 2023 and aimed to identify prevention gaps.
We analyzed National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2023 using weighted logistic regression, with stratification by age, sex, and race/ethnicity.
Current hepatitis B virus (HBV) infection remained stable at 0.3%, while HBV susceptibility was 71.3%. Among individuals born in 1991 or later, HBV vaccination coverage declined from 90.0% to 83.6% during 2011–2020 (P for trend = 0.012); 57.0% of participants reporting vaccination were serologically susceptible. Anti-HDV positivity among participants with current HBV infection was 1.3%. Anti-hepatitis C virus (HCV) seroprevalence remained 1.6%, while active HCV viremia decreased from 0.8% to 0.4%, and viremia among anti-HCV-positive participants fell from 65.5% to 31.3% (P = 0.004). Hepatitis A virus antibody seroprevalence increased from 41.6% to 48.0% (P < 0.001) with stable vaccination coverage. Anti-HEV IgM positivity increased from 1.6% to 1.7% (P = 0.004).
US viral hepatitis trends diverged from 2011 to 2023. The decrease in detectable HCV RNA was consistent with progress in HCV control, whereas persistent HBV susceptibility, declining vaccination coverage in younger birth cohorts, and increasing hepatitis A virus seroprevalence and hepatitis E virus IgM positivity indicate ongoing prevention and surveillance needs.
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