Hepatitis B is less common in the United States than it was 30 years ago, but millions of people worldwide carry the virus

In the United States, roughly 820,000 people are living with chronic hepatitis B infection right now. That number has dropped significantly since the 1980s and 1990s, when infection rates were much higher. The decline happened because of the hepatitis B vaccine, which became part of routine childhood immunizations starting in 1991, and because of better screening of blood donations.

Globally, the picture is different. The World Health Organization estimates that about 296 million people worldwide have chronic hepatitis B. The virus is far more common in parts of Africa, Asia, and the Pacific Islands than it is in North America or Western Europe. In some countries, one in ten people carry the virus.

Most people who get infected as adults clear the virus on their own within six months. But about 5 to 10 percent of adults who catch hepatitis B develop chronic infection, meaning the virus stays in their body for life. Children infected as infants or young children are much more likely to develop chronic infection — up to 90 percent of infected infants will carry the virus long-term.

Key Takeaways

  • Approximately 820,000 people in the United States currently have chronic hepatitis B, down from much higher numbers in previous decades.
  • Globally, about 296 million people carry chronic hepatitis B, with much higher rates in Africa, Asia, and the Pacific Islands.
  • Most adults who catch hepatitis B recover on their own, but 5 to 10 percent develop lifelong infection.
  • Infants and young children infected with hepatitis B are far more likely to develop chronic infection than adults.
  • The hepatitis B vaccine has dramatically reduced new infections in countries with routine childhood vaccination programs.

Why rates dropped in the United States

The hepatitis B vaccine, introduced in 1991, changed the trajectory of the disease in the U.S. Before that, tens of thousands of Americans were infected each year. Now, new infections have fallen by more than 80 percent. Babies born today receive the vaccine as part of their standard newborn care, and older children and adolescents who missed it can still receive it.

Better blood screening also matters. Blood banks now test every donation for hepatitis B, which eliminated transfusion-related infections. Healthcare workers have access to post-exposure prophylaxis — a treatment given after a needle stick or other exposure — which can prevent infection if given quickly enough.

These changes mean that in the U.S., most new hepatitis B infections now occur in adults through sexual contact or sharing of injection equipment, rather than through birth or transfusion. The people living with chronic hepatitis B today are often those who were infected decades ago, before widespread vaccination and screening existed.

Who is most likely to have hepatitis B

In the United States, hepatitis B is more common in certain groups. People born in countries with high hepatitis B rates — including most of Asia, Africa, and the Pacific Islands — are more likely to carry the virus. People born between 1945 and 1965 have higher rates than younger adults, because they were born before the vaccine existed. People with HIV are also at higher risk, as are people who share injection equipment.

Healthcare workers and first responders face occupational risk from needle sticks and blood exposure, though that risk is much lower now than it was before universal precautions became standard. Household contacts of people with chronic hepatitis B can be infected through small cuts or sores, though this is less common than sexual transmission.

People who received blood transfusions or organ transplants before 1992 have a higher chance of carrying the virus, because screening was not yet in place. Testing is recommended for anyone in these groups, even if they have no symptoms.

Hepatitis B rates in different parts of the world

Hepatitis B burden is not evenly distributed. Sub-Saharan Africa and East Asia carry the heaviest load — in some countries, 8 to 15 percent of the population has chronic hepatitis B. In parts of the Pacific Islands, rates can be even higher. These regions have higher rates because of limited access to vaccination, higher rates of mother-to-child transmission, and less access to screening and treatment.

Western Europe, North America, and Australia have the lowest rates, all below 2 percent of the population. This difference reflects decades of routine vaccination programs and better healthcare infrastructure. Middle Eastern countries, Central Asia, and parts of South America fall in the middle, with rates between 2 and 8 percent.

Migration patterns mean that hepatitis B rates in immigrant communities in low-prevalence countries often reflect the rates in their countries of origin. This is why public health agencies in the U.S. and Europe recommend testing for people born in high-prevalence regions, regardless of how long they have lived in a low-prevalence country.

What happens to people who carry hepatitis B long-term

Not everyone with chronic hepatitis B develops serious liver disease. Some people carry the virus but have little or no liver damage and never develop symptoms. Others develop progressive liver damage over decades, leading to cirrhosis or liver cancer. The outcome depends on when infection occurred, the person's age and immune system, and whether they receive treatment.

People with chronic hepatitis B need regular monitoring with blood tests and ultrasound to watch for signs of liver damage. Treatment with antiviral medications can slow or stop the virus from damaging the liver, but it does not cure the infection. Most people who start treatment early, before serious damage occurs, have good long-term outcomes.

Without treatment, chronic hepatitis B can lead to cirrhosis — permanent scarring of the liver — within 5 to 30 years, depending on the individual. Cirrhosis increases the risk of liver failure and liver cancer. This is why people with chronic hepatitis B benefit from knowing their status and connecting with a doctor who can monitor them.

Testing and vaccination rates

In the United States, about 73 percent of children born since 1991 have received the complete hepatitis B vaccine series. Rates are lower in some communities and higher in others, depending on access to healthcare and vaccination programs. Adults who were not vaccinated as children can still receive the vaccine at any age.

Testing rates are lower than vaccination rates. Many people who carry hepatitis B do not know it, because the virus often causes no symptoms. The CDC recommends testing for all adults at least once in their lifetime, and more frequent testing for people at higher risk. Despite this recommendation, many people in high-risk groups have never been tested.

Barriers to testing include lack of awareness, cost, and limited access to healthcare. In countries with strong public health systems, testing and vaccination are more widely available. In lower-income countries, cost and limited healthcare infrastructure mean that many people with hepatitis B never receive a diagnosis or treatment.

Frequently Asked Questions

Is hepatitis B becoming more or less common?

In the United States and other countries with routine vaccination programs, hepatitis B is becoming less common. New infections have dropped by more than 80 percent since the vaccine was introduced. Globally, rates remain high in parts of Africa and Asia, but are slowly declining as vaccination programs expand.

Can you catch hepatitis B from food or water?

No. Hepatitis B spreads through blood and body fluids, not through food or water. You cannot catch it from sharing utensils, drinking from the same glass, or eating food prepared by someone with hepatitis B. It spreads through sexual contact, sharing injection equipment, or exposure to blood.

If I was vaccinated as a child, do I need to worry about hepatitis B?

The hepatitis B vaccine is highly protective. If you completed the full series as a child, you have immunity in the vast majority of cases. Some people lose immunity over time, but reinfection is rare and usually mild. You do not need a booster unless you are immunocompromised or have specific risk factors.

How do I know if I have hepatitis B?

The only way to know is through a blood test. Most people with chronic hepatitis B have no symptoms, so testing is the only way to find out. A simple blood test can detect the virus. If you think you may have been exposed, or if you were born in a country with high hepatitis B rates, ask your doctor about testing.

If someone has hepatitis B, can they spread it to their family?

Hepatitis B can spread to family members through sexual contact or exposure to blood, but not through casual contact like hugging or sharing meals. Household contacts should be vaccinated if they are not already immune. Infants born to mothers with hepatitis B can be protected with vaccination and immunoglobulin given at birth.