Test anyone who asks, without making them say why

Chronic hepatitis B causes substantial illness and death. Treatment is
not curative, but **antiviral treatment, monitoring and liver cancer
surveillance reduce both** — and effective vaccines exist.

The 2023 update to CDC's recommendations does three things.

One: screen every adult, once

**Hepatitis B screening using three laboratory tests, at least once during a
lifetime, for adults aged ≥18 years.**

Three tests rather than one, because hepatitis B serology distinguishes
current infection, past infection and vaccine-induced immunity — and a single
marker cannot tell a person which of those they are.

Two: widen the risk-based list

Added as populations, activities, exposures or conditions carrying increased
risk:

• People incarcerated or formerly incarcerated in a jail, prison or other
  detention setting
• **People with a history of sexually transmitted infections, or multiple sex
  partners**
• People with a history of hepatitis C virus infection

The third is the kind of addition that only comes from looking at the data:
the two infections share transmission routes, so a hepatitis C diagnosis is
itself a risk marker.

Three: the one that changes what happens in a room

**To provide increased access to testing, anyone who requests HBV testing
should receive it, regardless of disclosure of risk, because many persons
might be reluctant to disclose stigmatizing risks.**

Risk-based screening has a structural flaw nobody can fix by improving the
risk list: it requires the patient to say something about themselves. The
categories above include incarceration, injection drug use and sexual history —
things people decline to tell a clinician they have just met, in a room with a
door that may not be closed.

So the recommendation removes the requirement. Asking is sufficient. A patient
who wants the test does not have to explain, and a clinician does not have to
establish eligibility.

That also quietly protects the people the list is supposed to reach: someone
who says "I'd like a hepatitis B test" has disclosed nothing at all.

*Source: Centers for Disease Control and Prevention, MMWR Recommendations and
Reports.*