Although the incidence of hepatitis B virus (HBV) in the United States is decreasing, it remains an important health issue, with nearly 2 million people currently infected and a 7% to 30% lifetime mortality rate. Vaccination has markedly decreased the number of acute HBV cases, especially in children and adolescents; however, there continues to be a substantial incidence of new infections in intravenous drug users and persons with high-risk sexual behavior and of newly recognized disease in immigrants. Perinatal transmission has been significantly reduced with universal infant vaccination, and transfusion/iatrogenic infection has been nearly eradicated by screening blood products and vaccinating at-risk medical professionals. HBV infection rates vary with respect to racial and geographic distribution as well as known risk factors. The Asian/Pacific Islander population continues to have the highest rate (prevalence) of infection in the United States. Further advances in screening and vaccination must be made to further reduce the incidence and prevalence of HBV in the United States.