Dr Charoen, a gastroenterologist, emphasises that early detection through screening plays a critical role in managing Hepatitis B (HBV), particularly in regions where the infection remains common. Around 60% of people living with HBV are unaware that they’re infected, as the virus can remain silent for many years while gradually damaging the liver. During this time, individuals may feel completely well, yet the infection can progress to serious complications such as cirrhosis, liver failure, or liver cancer¹ if it goes undetected. For this reason, screening remains important even for people who don’t experience symptoms. When HBV is identified earlier, doctors can initiate antiviral treatment when appropriate and monitor liver health closely, which can significantly improve long-term outcomes for patients.

Early identification also plays an important role in protecting others. Detecting infection provides an opportunity to vaccinate family members and partners before exposure occurs, helping to reduce further transmission. This is particularly relevant in high-prevalence regions where the virus is commonly passed from mother to baby at birth. Without appropriate protection immediately after delivery, infants born to mothers who are HBeAg-positive face up to a 90% risk of developing lifelong HBV infection².

Screening recommendations have broadened in recent years, particularly when it comes to who should be tested. The Centers for Disease Control and Prevention (CDC) now recommends that all adults be screened for Hepatitis B at least once in their lifetime, regardless of perceived risk². At the same time, additional attention is still given to higher-risk groups, including people born in countries where HBV prevalence is higher (HBsAg ≥2%), individuals who inject drugs, and patients living with conditions such as HIV or chronic liver disease.

Ultimately, expanding screening recommendations helps ensure that more people are tested earlier, including those who may not realise they are at risk. As Dr Charoen explains, anyone who requests an HBV test should be able to receive one, so that individuals who might otherwise go unnoticed aren’t overlooked³.

One persistent challenge in Hepatitis B prevention is the number of misconceptions surrounding the vaccine. Many people believe the vaccine is only necessary for “high-risk” groups or assume that protection fades quickly without regular booster doses. In reality, while antibody levels may decline over time, the immune system retains memory of the virus and can continue to provide protection for 30 years or longer. The vaccine’s safety profile is also well established. Reported side effects are typically mild and temporary, most commonly soreness at the injection site (about 3–29%) or a low-grade fever (about 1–6%)^4,5.

Historically, vaccination strategies relied heavily on identifying individuals with specific risk factors. However, this approach has proven difficult to implement effectively in real-world clinical settings. One reason is that many patients may not disclose risk factors during routine consultations, with surveys suggesting that around 68% of physicians report incomplete disclosure in these situations.

Recognising these challenges, the 2022 Advisory Committee on Immunization Practices (ACIP) guidelines now recommend universal Hepatitis B vaccination for all adults aged 19 to 59. This shift places greater responsibility on healthcare systems and clinicians to offer vaccination proactively rather than relying on patients to identify themselves as being at risk.

Improving vaccination coverage among adults, particularly in underserved communities, may require additional strategies. These include simplified vaccine schedules, such as the two-dose Heplisav-B regimen, which has shown strong seroprotection rates in older adults (around 90%, compared with approximately 70.5–90.2% for traditional vaccines). Practical system-level measures can also help increase uptake, including electronic health record reminders, culturally sensitive patient navigation, and reducing financial or access barriers, all of which may help close remaining gaps in Hepatitis B prevention^6,7.

For individuals diagnosed with chronic hepatitis B, treatment currently relies on nucleos(t)ide analogues such as entecavir or tenofovir, which remain the standard of care. Dr Charoen explains that these antiviral medications are highly effective at suppressing viral replication, often reducing HBV DNA to undetectable levels. By keeping the virus under control, treatment can significantly lower the risk of cirrhosis and liver cancer and help preserve long-term liver health.

However, these medications rarely provide a true “exit strategy.” They don’t eliminate the virus’s underlying reservoir, known as covalently closed circular DNA (cccDNA), a persistent viral template that allows HBV to remain inside liver cells. As a result, fewer than 12% of patients currently achieve a functional cure, meaning the virus remains suppressed but treatment often needs to continue long term^8-10.

Even so, the therapeutic landscape is beginning to shift. Researchers are increasingly exploring combination therapies that aim to silence the virus while also strengthening the body’s immune response. Early results from the Phase 2 Piranga trial are particularly encouraging. In this study, viral-silencing small interfering RNAs such as xalnesiran are combined with immune-modulating therapy like pegylated interferon alfa-2a, and early findings suggest that a higher proportion of patients may achieve loss of hepatitis B surface antigen (HBsAg)^11,12.

While these therapies remain under investigation and may still be five to ten years away from widespread clinical use, they represent an important step forward. As Dr Charoen notes, the long-term goal is to move beyond lifelong viral suppression toward treatments capable of achieving functional cures, which could significantly improve outcomes for people living with chronic hepatitis B.

Preventing hepatitis B transmission from mother to baby relies on a well-established three-step strategy during pregnancy and birth. First, all pregnant women are screened for hepatitis B at their first prenatal visit. If a mother is found to carry the virus, the newborn should receive the hepatitis B vaccine together with hepatitis B immune globulin (HBIG) within 12 hours of birth. When the mother has a high viral load, typically above 200,000 IU/mL, antiviral medication such as tenofovir may be started in the third trimester to further reduce the risk of transmission^12-17.

This approach has proven to be highly effective. The birth-dose vaccine combined with HBIG prevents infection in about 95% of cases, and when maternal antiviral therapy is added, some, studies show that the risk of mother-to-child transmission can reduce to almost zero. In fact, tenofovir can cut the remaining transmission risk by around 90%^12-15.

After delivery, antiviral treatment is often discontinued about four weeks postpartum, and breastfeeding is generally considered safe. But it’s very important that doctors follow the mother closely for a few months, because up to one in four women can experience a postpartum “flare,” which refers to a sudden increase in liver inflammation after delivery. Careful monitoring helps ensure that any changes in liver function are detected and managed promptly^13-17.

Concerns about a potential resurgence of hepatitis B have grown in recent years, particularly as global vaccination efforts were disrupted during the COVID-19 pandemic. Dr Charoen notes that after many years of steady progress, the positive trajectory of hepatitis B prevention began to reverse around 2020. In several high-risk regions, including parts of Africa and the Western Pacific, even small declines in childhood vaccination coverage have translated into hundreds of thousands of preventable infections and deaths^18-20.

Despite the availability of a highly effective vaccine, hepatitis B continues to cause around 1.5 million new infections each year. One important reason is that less than half of newborns worldwide receive the recommended birth-dose vaccine on time, which remains a critical step in preventing transmission early in life.

Addressing this challenge requires renewed focus on several public health priorities. Catch-up vaccination programmes are essential to reach children and adolescents who may have missed routine immunisation during the pandemic. At the same time, ensuring that every newborn receives the hepatitis B birth dose remains a key strategy, particularly in regions where implementation is still limited. For example, in parts of Africa, only around 30% of countries currently have birth-dose vaccination programmes in place, highlighting a significant gap in prevention efforts.

Expanding adult vaccination and screening is also important, especially as many people living with hepatitis B remain undiagnosed. Sustained international funding commitments will be critical to support vaccination programmes, strengthen health systems, and maintain progress toward global elimination targets.

Finally, effective prevention efforts must reach those who face the greatest barriers to care. This includes immigrant populations and other marginalised communities, where underdiagnosis is often more common. Improving access requires more than offering vaccination alone. It involves culturally adapted screening programmes, community engagement, and addressing broader social factors that influence health, such as unstable housing, financial insecurity, and limited access to healthcare services^21-23.