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

Photo of a pregnant woman and a doctor (PantherMedia / Lev Dolgachov)

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 3,600 new cases of hepatitis B were reported in Germany in 2017. 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.

In Germany, people who would like to have a hepatitis B test might have to pay for it themselves. Statutory health insurers generally only cover the costs of the test if the person has a high risk of infection or signs of a liver infection, such as high levels of certain enzymes and proteins in their blood. They also cover the costs of hepatitis B tests for all pregnant women: It’s a part of the standard prenatal care package.