The Prevalence of Hepatitis D in the U.S. Population: Results From the National Health and Nutrition Examination Survey (NHANES) 2003-2012

Introduction: To provide estimates of the prevalence of hepatitis D (HDV) in the USA based on prevalence data from a large sample of the U.S. population. Methods: Data from the last 5 cycles of NHANES from 2003-2012 were combined and analyzed. The NHANES is a nationally representative survey of non-institutionalized participants with oversampling of certain minorities. Weighted estimates were calculated and reported. Results: Testing for anti-HDV IgG antibodies (Ab) was performed on the sera of 37,138 participants. The prevalence of hepatitis B surface antigen (HBsAg) in the tested population was 0.31%. Anti-HDV Ab was positive in only 6 participants, resulting in a prevalence of 2.65% in HBsAg-positive participants and 0.0082% in all participants (based on weighted frequency calculation). Eighty-five percent of participants with positive anti-HDV Ab were males corresponding to an odds ratio (OR) of 32 (95% CI 18-55). The prevalence was highest among participants 40-59 year old (0.018%), followed by participants 60 years or older (0.008%). Twenty-four percent of participants with positive anti-HDV Ab were Mexican-American, 33% non-Hispanic black, and 43% of multi-race origin (including Asian). Conclusion: The prevalence of HDV is extremely low in this sample of the U.S. population. The prevalence was highest among 40-59-year-old male participants and among Mexican American, non-Hispanic black and multi-race participants. However, the survey sample did not include participants with potentially higher risk for HDV such as prison and homeless populations, and therefore, it might have underestimated the true prevalence of HDV.