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Life sciences · Journal article
JAMA Internal Medicine · August 17, 2026
Well-designed and adequately powered for the question it asks.
This cross-sectional analysis of NHANES data (2017–2023) found that only 39.5% of US adults have serologic immunity to hepatitis A and 27.1% to hepatitis B, with substantial gaps persisting in high-risk clinical subgroups. The study identifies demographic, socioeconomic, and clinical factors associated with immunity status, supporting the need for targeted vaccination strategies.
Cross-sectional survey analysis. US adults aged 20 years or older enrolled in NHANES 2017–2023 with available HAV and HBV serologic test results; including high-risk subgroups with chronic liver disease, chronic kidney disease, diabetes, immunosuppression, and pregnant people. Intervention: Serologic testing for hepatitis A antibody (HAV) and hepatitis B surface antibody (HBsAb) and core antibody (anti-HBc). n = 13,514. United States.
HAV serologic immunity present in 39.5% (95% CI, 37.7%–41.3%) of US adults, representing approximately 89.4 million individuals HBV serologic immunity present in 27.1% (95% CI, 25.8%–28.4%), with vaccine-derived immunity in 25.2% (95% CI, 23.9%–26.5%) HAV immunity associated with younger age, non-Hispanic Black race (AOR 1.67), Mexican American ethnicity (AOR 4.22), and being born outside the US (AOR 4.54)
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These findings indicate substantial gaps in hepatitis A and B immunity across the general US population and particularly among high-risk groups, supporting systematic vaccination and identification of underimmunized subgroups in clinical practice. Clinicians should prioritize vaccination counseling for younger adults, those with lower educational attainment, and high-risk populations with chronic kidney disease and immunosuppression.
Large, nationally representative cross-sectional survey with rigorous weighting and multivariable analysis identifying prevalence and risk factors for hepatitis A and B immunity across the US adult population and high-risk subgroups.
As stated by the source record.
Quoted from the source exactly as published.
These findings indicate substantial gaps in hepatitis A and B immunity across the general US population and particularly among high-risk groups, supporting systematic vaccination and identification of underimmunized subgroups in clinical practice. Clinicians should prioritize vaccination counseling for younger adults, those with lower educational attainment, and high-risk populations with chronic kidney disease and immunosuppression.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Importance Serologic immunity to hepatitis A virus (HAV) and hepatitis B virus (HBV) protects against acute infection and severe outcomes among high-risk groups; however, contemporary data on population-level immunity remain limited, especially in high-risk populations. Objective To estimate the prevalence and factors associated with serologic immunity in the overall population and across high-risk subgroups, including those with chronic liver disease (CLD), chronic kidney disease, diabetes, and immunosuppression and pregnant people. Design, Setting, and Participants This cross-sectional study used data from the National Health and Nutrition Examination Survey from January 2017 to August 2023 and included adults aged 20 years or older with available HAV and HBV serologic test results. Data were analyzed from January 3 to May 10, 2026. Main Outcomes and Measures The primary outcomes were the prevalence of serologic immunity to HAV, defined by hepatitis A antibody positivity, and HBV, defined by hepatitis B surface antibody positivity, with vaccine-derived immunity specifically identified by surface antibody positivity in the absence of hepatitis B core antibodies. Data were weighted to generate nationally representative estimates of the US adult population. Multivariable survey-weighted logistic regression models were used to identify independent factors associated with viral hepatitis immunity. Results Among 13 514 individuals, representing an estimated 226.1 million US adults (mean [SE] age, 48.65 [0.40] years; 51.76% female), 39.5% (95% CI, 37.7%-41.3%) demonstrated serologic immunity to hepatitis A, corresponding to approximately 89.4 million individuals. For HBV, 27.1% (95% CI, 25.8%-28.4%) demonstrated serologic immunity, corresponding to approximately 61.3 million individuals, while vaccine-derived immunity was present in 25.2% (95% CI, 23.9%-26.5%). In adjusted models, HAV immunity was associated with younger age (eg, 20-29 vs ≥65 years: adjusted odds ratio [AOR], 0.51; 95% CI, 0.44-0.60); lower educational attainment (eg, lt;grade 9 vs college graduate or above: AOR, 0.32; 95% CI, 0.24-0.42); non-Hispanic Black (AOR, 1.67; 95% CI, 1.34-2.09), Mexican American (AOR, 4.22; 95% CI, 3.42-5.21), other Hispanic (AOR, 2.01; 95% CI, 1.60-2.54), non-Hispanic Asian (AOR, 3.03; 95% CI, 2.45-3.76), and multiracial or other (AOR, 1.36; 95% CI, 1.04-1.79) race and ethnicity; being born outside the US (AOR, 4.54; 95% CI, 3.74-5.52); and liver disease awareness (OR, 1.65; 95% CI, 1.29-2.09). Obesity was associated with lower odds of HAV immunity (AOR, 0.83; 95% CI, 0.72-0.96). Vaccine-derived HBV immunity was associated with younger age (eg, 20-29 vs ≥65 years: AOR, 0.18; 95% CI, 0.15-0.23), female sex (AOR, 1.36; 95% CI, 1.18-1.56), non-Hispanic Asian (AOR, 1.47; 95% CI, 1.17-1.86) and non-Hispanic Black (AOR, 1.15; 95% CI, 1.00-1.32) race and ethnicity, and higher educational attainment (eg, lt;grade 9 vs college graduate or above: AOR, 3.29; 95% CI, 2.35-4.61). In high-risk subgroups, HAV immunity ranged from 26.7% (95% CI, 18.9%-34.4%) for metabolic dysfunction–associated alcohol-related liver disease to 63.7% (95% CI, 50.0%-77.4%) for chronic HBV infection, while HBV vaccine-derived immunity ranged from 14.0% (95% CI, 11.3%-16.6%) for chronic kidney disease to 38.6% (95% CI, 28.0%-49.1%) for pregnancy. Conclusions and Relevance This cross-sectional study found that population-level serologic immunity to HAV and HBV was suboptimal and substantial susceptibility persisted across high-risk clinical subgroups. These findings highlight persistent gaps in viral hepatitis protection and support targeted, systematic vaccination strategies for HAV and HBV, especially among high-risk populations.
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