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Military combat service linked to an increase in HBV exposure

The prevalence of exposure to hepatitis B among veterans was highest among those with traditional risk factors and independently related to military combat or being wounded in combat, according to study results.

“Potential military-related contributors to HBV exposure have not been thoroughly explored, especially those related to prior exposure to combat, blood transfusion, or travel to endemic regions,” Lauren A. Beste, MD, MSc, from the Veterans Affairs Puget Sound Health Care System in Washington, and colleagues wrote. “Clarifying military risk factors for HBV could affect screening, especially among those who served in the pre-vaccination era.”

Participants were mostly men (96.5%) with a mean age of 62.1 years. Nearly half reported ever serving in a combat zone (43.3%), while 12.5% reported being wounded in combat, 10.6% reported exposure to blood in combat, 26.1% reported any risky sexual practice, and 4.7% reported ever injecting drugs.

Test results from 1,146 samples revealed that the estimated prevalence for chronic HBV infection was 0.7% (95% CI, 0.3-1.5), for exposure it was 13.6% (95% CI, 11.5-16.1) and for immunity it was 6.2% (95% CI, 4.7-8.2).

HBV exposure correlated with service region, body piercing, injection drugs, intranasal drugs, high-risk sexual behaviors, incarceration and health care work.

“While combat is a biologically plausible HBV transmission modality ... it is also associated with behaviors linked to HBV exposure, such as drug use, occurring either before or after military service,” the researchers wrote. “It is possible that incomplete adjustment for traditional risk factors due to missing data led to residual confounding in the relationship between combat and HBV.”

After adjusting for drug use and high-risk sexual behavior as traditional HBV risk factors, the researchers found that history of service in a combat zone (adjusted odds ratio [aOR] = 1.65; 95% CI, 1.01-2.41) and being wounded in combat (aOR = 1.79; 95% CI, 1.04-3.08) were independent predictors of HBV exposure.

“Our study represents an important step toward understanding HBV risk factors and prevalence in veterans and military servicemembers. HBV screening among those with combat service prior to universal military vaccination could be justified, particularly if our findings are confirmed in future studies with more participants.” – by Talitha Bennett

Disclosures: Beste reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.