Hepatitis B seroprevalence in the U.S. military and its impact on potential screening strategies

Author:

Scott Paul T1,Cohen Robert L23,Brett-Major David M4,Hakre Shilpa15,Malia Jennifer A1,Okulicz Jason F6,Beckett Charmagne G7,Blaylock Jason M8,Forgione Michael A6,Harrison Stephen A6,Murray Clinton K6,Rentas Francisco J9,Fahie Roland L9,Armstrong Adam W10,Hayat Aatif M2,Pacha Laura A211,Dawson Peter12,Blackwell Beth12,Eick-Cost Angelia A1314,Maktabi Hala H1315,Michael Nelson L1,Jagodzinski Linda L1,Cersovsky Steven B2,Peel Sheila A1

Affiliation:

1. Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910

2. U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010

3. United States Agency for International Development, Ronald Reagan Building, Washington, DC 20523-1000

4. Department of Epidemiology University of Nebraska Medical Center College of Public Health 984395 Nebraska Medical Center Omaha NE 68198-4395

5. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, 6720A Rockledge Drive, Bethesda, MD 20817

6. San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234

7. Navy Bloodborne Infection Management Center, 8901 Wisconsin Avenue, Bethesda, MD 20889

8. Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889

9. Armed Services Blood Program Office, 7700 Arlington Boulevard, Falls Church, VA 22042-5143

10. Naval Medical Research Center, 8901 Wisconsin Ave, Bethesda, MD 20889

11. Regional Health Command, Central, 2899 Schofield Road, San Antonio, TX 78234

12. The Emmes Corporation, 401 N Washington, Rockville, MD 20850

13. Defense Health Agency, Armed Forces Health Surveillance Branch, 11800 Tech Road, Silver Spring, MD 20904

14. Cherokee Nation Technology Solutions, 10838 E Marshall Street, Tulsa, OK 74116

15. Office of Assistant Secretary for Policy & Planning, Washington, DC

Abstract

Abstract Introduction Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies. Materials and Methods HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections. Results The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession. Conclusions Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice.

Funder

Henry M. Jackson Foundation for the Advancement of Military Medicine

U.S. Department of Defense

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,General Medicine

Reference25 articles.

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