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Background <p>Chronic hepatitis B virus (HBV) infection remains a major cause of cirrhosis and hepatocellular carcinoma worldwide. In aging societies, however, the residual burden of chronic HBV is increasingly concentrated among people infected before the era of universal infant vaccination, including residents of long-term care facilities (LTCFs).</p> Methods <p>We conducted a focused narrative review of PubMed-indexed literature and major international guidance documents published through March 2026 on HBV epidemiology, aging, immunosenescence, long-term care, reactivation, stigma, and the epidemiological characteristics of Okinawa, Japan.</p> Results <p>Available evidence indicates that, in Japan, HBV burden is concentrated in pre-vaccination birth cohorts, with hepatitis B surface antigen (HBsAg) prevalence peaking among persons born in 1941–1950 and with genotype B/C carriers shifting into older age groups. Okinawa remains epidemiologically distinctive because genotype B is overrepresented and older carriers predominate. Contemporary screening and reactivation guidelines increasingly favor universal adult HBV testing and universal HBV testing before risk-based reactivation assessment in patients exposed to immunosuppression. Although direct evidence for routine LTCF admission screening is limited, nursing-home outbreak investigations have documented intrainstitutional HBV transmission associated with infection-control lapses, while qualitative studies show that HBV-related stigma and discrimination remain important implementation concerns. These findings support a model in which LTCF admission screening is paired with confidentiality safeguards, vaccination review, infection-control reinforcement, and targeted hepatology referral. Residents who are HBsAg-negative but anti-HBc-positive, as well as those with HBsAg seroclearance, may still require monitoring when immunosuppression or residual hepatocellular carcinoma risk is present.</p> Conclusions <p>In super-aging societies, chronic HBV should be viewed not only as a liver disease issue but also as a geriatric public health and health-systems issue. At LTCF admission, testing with HBsAg and total anti-HBc—and ideally anti-HBs where feasible—could improve risk stratification; however, implementation should avoid stigma and should be evaluated prospectively for feasibility, outcomes, and cost-effectiveness.</p>

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Chronic hepatitis B in aging societies and its public health implications for screening and care in Okinawa

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Norifumi Kudeken

摘要

Background

Chronic hepatitis B virus (HBV) infection remains a major cause of cirrhosis and hepatocellular carcinoma worldwide. In aging societies, however, the residual burden of chronic HBV is increasingly concentrated among people infected before the era of universal infant vaccination, including residents of long-term care facilities (LTCFs).

Methods

We conducted a focused narrative review of PubMed-indexed literature and major international guidance documents published through March 2026 on HBV epidemiology, aging, immunosenescence, long-term care, reactivation, stigma, and the epidemiological characteristics of Okinawa, Japan.

Results

Available evidence indicates that, in Japan, HBV burden is concentrated in pre-vaccination birth cohorts, with hepatitis B surface antigen (HBsAg) prevalence peaking among persons born in 1941–1950 and with genotype B/C carriers shifting into older age groups. Okinawa remains epidemiologically distinctive because genotype B is overrepresented and older carriers predominate. Contemporary screening and reactivation guidelines increasingly favor universal adult HBV testing and universal HBV testing before risk-based reactivation assessment in patients exposed to immunosuppression. Although direct evidence for routine LTCF admission screening is limited, nursing-home outbreak investigations have documented intrainstitutional HBV transmission associated with infection-control lapses, while qualitative studies show that HBV-related stigma and discrimination remain important implementation concerns. These findings support a model in which LTCF admission screening is paired with confidentiality safeguards, vaccination review, infection-control reinforcement, and targeted hepatology referral. Residents who are HBsAg-negative but anti-HBc-positive, as well as those with HBsAg seroclearance, may still require monitoring when immunosuppression or residual hepatocellular carcinoma risk is present.

Conclusions

In super-aging societies, chronic HBV should be viewed not only as a liver disease issue but also as a geriatric public health and health-systems issue. At LTCF admission, testing with HBsAg and total anti-HBc—and ideally anti-HBs where feasible—could improve risk stratification; however, implementation should avoid stigma and should be evaluated prospectively for feasibility, outcomes, and cost-effectiveness.