Hepatitis B: What are the pros and cons of screening?

A blood test can be done to find out whether someone has been infected with the hepatitis B virus. But it’s not clear whether population-wide hepatitis B screening would be worthwhile.

Hepatitis B infections can lead to a liver inflammation. About 6,800 new cases of hepatitis B were reported in Germany in 2020. But some people don’t know that they have hepatitis B because it doesn’t always cause symptoms. The symptoms that do occur – such as lack of appetite, nausea or feeling unwell – could also be signs of many other illnesses. In very rare cases hepatitis B can lead to sudden liver failure.

To find out whether someone has been infected with the hepatitis B virus, a multi-step blood test can be done. First, a test is done to look for certain parts of the virus in the blood and for antibodies that are made in reaction to the virus. Depending on the outcome, other blood tests may follow.

Acute hepatitis infections usually clear up on their own and don't have to be treated. In some people, though, the infection becomes permanent (chronic). Over time, chronic hepatitis B can lead to liver damage (liver cirrhosis) or liver cancer.

Pros and cons of screening not clear

The aim of screening tests is to detect diseases early enough to prevent serious health problems.

The Institute for Quality and Efficiency in Health Care (IQWiG, Germany) wanted to find out whether it makes sense to screen for hepatitis B in adults who don't know whether they have already come into contact with the virus. The IQWiG researchers looked into whether screening can prevent long-term consequences such as liver cirrhosis and liver cancer if chronic hepatitis B is discovered and treated sooner. They also wanted to find out whether screening can reduce the risk of passing the virus on to partners or other people.

The researchers were unable to find any good studies with which to answer these questions, though. They concluded that it's still not clear whether screening for hepatitis B has any pros or cons. Two new research summaries have come to the same conclusion.

Statutory health insurers in Germany cover the costs of being tested once for the hepatitis B virus for people aged 35 and over as part of a general check-up. They also cover the costs of hepatitis B tests for all pregnant women: It is a part of the standard prenatal care package.

Chou R, Blazina I, Bougatsos C et al. Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: A Systematic Review for the U.S. Preventive Services Task Force (AHRQ Evidence Syntheses; No. 194). 2020.

Gemeinsamer Bundesausschuss (G-BA). Gesundheitsuntersuchungs-Richtlinie: Einführung eines Screenings auf Hepatitis-B- und auf Hepatitis-C-Virusinfektion. 2021.

Gemeinsamer Bundesausschuss (G-BA). Richtlinien über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“). 2022.

Henderson JT, Webber EM, Bean SI. Screening for Hepatitis B Virus Infection in Pregnant Women: An Updated Systematic Review for the U.S. Preventive Services Task Force (AHRQ Evidence Syntheses; No. 179). 2019.

Institute for Quality and Efficiecy in Healthcare (IQWiG, Germany). Screening for hepatitis B: Final report; Commission S16-03. 2018.

Robert Koch-Institut (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2020. 2021.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Hepatitis B: What are the pros and cons of screening?

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Updated on March 2, 2023

Next planned update: 2026

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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