II. Indications
- Universal screening for U.S. Adults is recommended as of 2023
- Triple Screen (HBsAg, HBsAb, HBcAb) at least once in all adults regardless of risk factors
- Conners (2023) MMWR Recomm Rep 72(1):1-25 +PMID: 36893044 [PubMed]
- Risk Factor Based Screening
- Pregnant women at first Prenatal Visit
- HIV Positive patients
- IV Drug Abuse
- Men who have Sex with Men
- Household contacts or sexual partners of infected persons
- People born in countries with high Prevalence of Hepatitis B Infection (2% or greater Prevalence per CDC)
- U.S. born children (but not HepB vaccinated) to parents from countries with Prevalence of Hepatitis B Infection (>8%)
- Donors of plasma, organs, tissue or semen
- Infants born to mothers who are HBsAg positive
- Patients on Hemodialysis or cytotoxic or immunosuppressive therapy
- Patients at risk for exposing others to their blood or body fluids and hence requiring Postexposure Prophylaxis
- Liver Function Test Abnormality (specifically ALT and AST transaminase increases) of unknown reason
- Chou (2014) Ann Intern Med 161(1): 31-45 [PubMed]
III. Lab: Screening Protocol
- Step 1: Hepatitis B Surface Antigen (HBsAg)
- Positive: Go to Step 2
- Negative: May still represent Hepatitis B inactive carrier state
- Step 2: Differentiate Chronic Infection vs Immunity
- Hepatitis B Core Antibody
- Hepatitis B Surface Antibody (immune)
IV. Labs: Detectable Antigens
- Hepatitis B Surface Antigen: HBsAg
- Protein found on the surface of the Hepatitis BVirus
- First detectable agent in Acute Hepatitis B Infection
- Present as early as Incubation Period
- Found in high serum levels in both acute and Chronic Hepatitis B, and indicates the patient is infectious
- Hepatitis B Envelope Antigen: HBeAg
- Highly Infectious State
- Chronic Infection
V. Labs: Detectable Antibodies
- Hepatitis B Surface Antibody: xHBsAb IgG
- Prior Hepatitis B Infection with recovery and Immunity OR
- Prior Hepatitis B Vaccine with Immunity
- Hepatitis B Core Antibody: xHBcAb IgM and IgG
- Present at the time of Acute Hepatitis B symptoms
- Core IgM Antibody suggests recent Hepatitis B Infection within the last 6 months
- Core IgG Antibody persists lifelong (regardless of recovery)
- Covers Convalescent period
- Window between HBsAg clearance to xHBsAb conversion
- HBsAg negative during this time
- Present at the time of Acute Hepatitis B symptoms
- Hepatitis B Envelope Antibody: xHBeAb IgM and IgG
- Low Infectivity
- Predicts Hepatitis B Resolution
VI. Labs: Serology Interpretation
- Susceptible
- HBsAg negative
- xHBcAb negative
- xHBsAb negative
- Immune from natural Hepatitis B Infection
- HBsAg negative
- xHBcAb positive
- xHBsAb positive
- Immune from Hepatitis B Vaccine
- HBsAg negative
- xHBcAb negative
- xHBsAb positive
-
Acute Hepatitis B Infection
- HBsAg positive
- xHBcAb IgM positive
- xHBcAb IgG positive
- xHBsAb negative
-
Chronic Hepatitis B Infection
- HBsAg positive
- xHBcAb IgM negative
- xHBcAb IgG positive
- xHBsAb negative
- Indeterminate (resolved or resolving infection, False Positive xHBcAb, Chronic Hepatitis B)
- HBsAg negative
- xHBcAb positive
- xHBsAb negative
- References
- CDC Hepatitis B Serologic Chart
VII. Labs: Serology Progression
- Stage 1: Immune Tolerant or Incubation Period
- Characteristics
- DNA Replication very active in this stage
- Prolonged stage in newborns
- Asymptomatic (Serum Aminotransferases normal)
- Incubation (4-12 weeks)
- Late incubation (1-2 weeks)
- HBsAg Positive
- Characteristics
- Stage 2: Immune Response
- Characteristics
- Immune response causes hepatic cell destruction
- Serum Aminotransferases increased
- High risk stage for Chronic Hepatitis B progression
- Symptom flares may occur if Immunocompromised
- Conversion to Stage 3
- Occurs in most adults rapidly
- Others convert 5-15% per year
- Immune response causes hepatic cell destruction
- Early Acute
- HBsAg Positive
- HBeAg Positive
- Acute (2-12 weeks)
- Acute and Seroconversion (transitions into Stage 3)
- Characteristics
- Stage 3: Inactive carrier state (3-6 months)
- Stage 4: Immune and Early Recovery
VIII. Resources
IX. References
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | An antibody produced by B lymphocytes in response to hepatitis B hepadnaviral infection. |
Definition (MSH) | Antibodies to the HEPATITIS B ANTIGENS, including antibodies to the surface (Australia) and core of the Dane particle and those to the "e" antigens. |
Concepts | Immunologic Factor (T129) |
MSH | D006510 |
SnomedCT | 122450004 |
English | Anti Australia Antigens, Anti HBAg, Anti Hepatitis B Antigens, Anti-Australia Antigens, Anti-HBAg, Anti-Hepatitis B Antigens, Antibodies, Hepatitis B, Antigens, Anti-Australia, Antigens, Anti-Hepatitis B, B Antibodies, Hepatitis, B Antigens, Anti-Hepatitis, HBAg, Anti, Hepatitis B Antibodies, Hepatitis B Virus Antibodies, ANTIAUSTRALIA ANTIGENS, ANTIHBAG, ANTIHEPATITIS B ANTIGENS, Hepatitis B Virus Antibody, hepatitis B antibodies, Hepatitis B Antibodies [Chemical/Ingredient], b antibodies hepatitis, hepatitis b antibodies, hepatitis b antibody, Hepatitis B Antibody, Hepatitis B antibody, Hepatitis B virus antibody, Antibody to hepatitis B virus (substance), Antibody to hepatitis B virus, Antibody to hepatitis B |
Swedish | Hepatit B-antikroppar |
Czech | hepatitida B - protilátky |
Finnish | B-hepatiittivasta-aineet |
Italian | Anti-HBAg, Anticorpi del virus dell'epatite B, Antigeni anti-Australia, Anti HBAg, Antigeni anti-epatite B, Anticorpi dell'epatite B |
Russian | GEPATITA B VIRUSA ANTITELA, ANTI-ANTIGENY GEPATITA B, ANTI-ANTIGEN AVSTRALIISKII, ANTI-HBAG, АНТИ-HBAG, АНТИ-АНТИГЕН АВСТРАЛИЙСКИЙ, АНТИ-АНТИГЕНЫ ГЕПАТИТА B, ГЕПАТИТА B ВИРУСА АНТИТЕЛА |
Japanese | B型肝炎抗体, HBs抗体, HB抗体, 抗B型肝炎抗原, 抗HBAg, 抗オーストラリア抗原, 抗体-HB, HBV抗体, 抗体-B型肝炎, 肝炎抗体-B型 |
German | ANTIAUSTRALIA ANTIGENE, ANTIHBAG, ANTIHEPATITIS B ANTIGENE, Anti-Australia-Antigene, Anti-HBAg, Anti-Hepatitis-B-Antigene, Hepatitis-B-Antikörper |
French | Anticorps antivirus de l'hépatite B, Anticorps contre le virus de l'hépatite B, Anticorps du virus de l'hépatite B, Anticorps de l'hépatite B, Anticorps anti-VHB, Anticorps anti-virus de l'hépatite B |
Polish | Przeciwciała przeciw zapaleniu wątroby B |
Portuguese | Antiantígenos da Hepatite B, Antiantígenos Austrália, Anticorpos Antivírus da Hepatite B, Anticorpos contra o Vírus da Hepatite B, Anticorpos contra a Hepatite B, Anticorpos Anti-Hepatite B, Anti-HBAg |
Spanish | Anticuerpos Anti el Virus de la Hepatitis B, Anticuerpos Anti-Hepatitis B, Anticuerpos contra el Virus de la Hepatitis B, anticuerpo anti - HBV, anticuerpo anti - VHB, anticuerpo anti - hepatitis B, anticuerpo anti - virus de la hepatitis B (sustancia), anticuerpo anti - virus de la hepatitis B, Anti-AgHB, Anti-Antígenos Australia, Anti-Antígenos de la Hepatitis B, Anticuerpos contra la Hepatitis B |
Ontology: Hepatitis B Antigens (C0019165)
Definition (MSH) | Antigens of the virion of the HEPATITIS B VIRUS or the Dane particle, its surface (HEPATITIS B SURFACE ANTIGENS), core (HEPATITIS B CORE ANTIGENS), and other associated antigens, including the HEPATITIS B E ANTIGENS. |
Definition (CSP) | antigens of the virion of the Hepatitis B virus or the Dane particle, its surface, core, and other associated antigens, including the hepatitis Be antigens. |
Concepts | Immunologic Factor (T129) |
MSH | D006511 |
SnomedCT | 303233001 |
English | Antigens, Hepatitis B, B Antigens, Hepatitis, HBAg, hepatitis B antigen, Hepatitis B Antigens [Chemical/Ingredient], hepatitis b antigens, hbag, hepatitis b antigen, Hepatitis B Antigen, Hepatitis B antigen, Hepatitis B antigen (substance), Hepatitis B Antigens |
Swedish | Hepatit B-antigener |
Czech | hepatitida B - antigeny |
Finnish | B-hepatiittiantigeenit |
Russian | GEPATITA B ANTIGENY, GEPATITA B VIRUSA ANTIGENY, HBAG, ГЕПАТИТА B АНТИГЕНЫ, ГЕПАТИТА B ВИРУСА АНТИГЕНЫ |
Japanese | B型肝炎抗原, HB抗原, 抗原-HB, HBV抗原, HBV関連抗原, 肝炎抗原-B型 |
French | Antigènes du virus de l'hépatite B, Antigènes de l'hépatite virale B, Antigènes HB, Ag HB, Antigène de l'hépatite virale B, Antigène VHB, Antigènes associés à l'hépatite B, Antigènes de l'hépatite B, Antigènes VHB |
Croatian | HEPATITIS B ANTIGENI |
Polish | Antygeny HB, Antygeny zapalenia wątroby B |
Spanish | antígeno del virus de la hepatitis B (sustancia), antígeno del virus de la hepatitis B, AgHB, Antígenos de la Hepatitis B |
German | HBAg, Hepatitis-B-Antigene |
Italian | Antigeni del virus dell'epatite B |
Portuguese | Antígenos da Hepatite B, HBAg |
Ontology: Hepatitis B e Antigens (C0019167)
Definition (MSH) | A closely related group of antigens found in the plasma only during the infective phase of hepatitis B or in virulent chronic hepatitis B, probably indicating active virus replication; there are three subtypes which may exist in a complex with immunoglobulins G. |
Concepts | Immunologic Factor (T129) |
MSH | D006513 |
SnomedCT | 60605004 |
LNC | LP38329-6, LP28795-0, MTHU004548 |
English | Antigens, Hepatitis Be, Be Antigens, Hepatitis, HBeAg, Hepatitis B e Antigens, Hepatitis Be Antigens, Antigens, e, e Antigens, Hepatitis E antigen, Hepatitis e antigen, Hepatitis B e Antigens [Chemical/Ingredient], e antigens, hepatitis b e antigen, hbeag, Hepatitis B virus e Antigen, Hepatitis B virus little e Ag, Hepatitis B E Antigen, Hbe Ag, Hepatitis B associated e antigen, Hepatitis B e antigen, Hepatitis B e antigen (substance) |
Swedish | Hepatit B e-antigener |
Spanish | antígeno e de la hepatitis, Hbe Ag, antígeno e asociado con la hepatitis B, antígeno e de la hepatitis (sustancia), antígeno e de la hepatitis B (sustancia), antígeno e de la hepatitis B, AgeHB, Antígenos E, Antígenos e de la Hepatitis B |
Czech | hepatitida B - antigeny e |
Finnish | B-hepatitti-e-antigeenit |
Russian | GEPATITA B VIRUSA ANTIGENY E, GEPATITA B E-ANTIGENY, E-ANTIGENY, HBEAG, E-АНТИГЕНЫ, ГЕПАТИТА B E-АНТИГЕНЫ, ГЕПАТИТА B ВИРУСА АНТИГЕНЫ E |
Japanese | B型肝炎e抗原, HBe抗原, e抗原, 抗原-HBe |
French | Antigène HBe, Ag HBe, Antigène HBe de l'hépatite B, Antigènes e du virus de l'hépatite virale B, Antigènes e, Antigènes e de l'hépatite B, Antigènes e associés à l'hépatite B, Antigènes HBe de l'hépatite B |
Polish | Antygeny E, HBeAg, Antygeny HBE |
German | E-Antigene, HBeAg, Hepatitis-B-e-Antigene |
Italian | Antigeni dell'epatite B e |
Portuguese | Antígenos E da Hepatite B, Antígenos E, HBeAg |
Ontology: Hepatitis B Surface Antigens (C0019168)
Definition (NCI) | Any one of the hepatitis B antigens found on the surface of the Dane particle and on the 20 nm spherical and tubular particles. Several subspecificities of the surface antigen are known. These were formerly called the Australia antigen. |
Definition (MSH) | Those hepatitis B antigens found on the surface of the Dane particle and on the 20 nm spherical and tubular particles. Several subspecificities of the surface antigen are known. These were formerly called the Australia antigen. |
Concepts | Immunologic Factor (T129) , Pharmacologic Substance (T121) |
MSH | D006514 |
SnomedCT | 22290004 |
LNC | LP38331-2, MTHU001814 |
English | Antigen, Australia, Australia Antigen, HBsAg, Hepatitis B Surface Antigen, Hepatitis B Surface Antigens, hepatitis B surface antigen, Hb s Ag, Hb<sub>s</sub> Ag, Hepatitis B virus surface antigen, AUSTRALIA ANTIGEN, HAA (hepatitis associated antigen), HBsAg (hepatitis B surface antigen), Hepatitis surface antigen, hepatitis b surface antigen, Hepatitis B Surface Antigens [Chemical/Ingredient], australian antigen, hb s ag, hepatitis surface antigen, hbs ag, antigen australia, australia antigen, hb ag, hbsag, Australia antigen, HbsAg, hepatitis associated antigen, Hepatitis B Virus HBsAg Surface Protein Antigen, Hepatitis B virus surface Ag, Hepatitis B virus surface Antigen, Hepatitis associated antigen, HEPATITIS B VIRUS HBSAG SURFACE PROTEIN ANTIGEN, Australian antigen, Hepatitis B surface antigen, Hb>s< Ag, Hepatitis B surface antigen (substance), HEPATITIS B SURFACE ANTIGEN |
Swedish | Hepatit B-ytantigener |
Spanish | antígeno de superficie de la hepatitis, antígeno australiano, antígeno de superficie de la hepatitis (sustancia), antígeno de superficie de la hepatitis B (sustancia), antígeno de superficie de la hepatitis B, AgsHB, Antígeno Australia, Antígenos de Superficie de la Hepatitis B |
Czech | HBsAg, hepatitida B - antigeny povrchové |
Finnish | Hepatiitti B:n pinta-antigeenit |
Italian | HBsAg, Antigene Australia, Antigene di superficie dell'epatite B, Antigeni di superficie dell'epatite B |
Russian | AVSTRALIISKII ANTIGEN, GEPATIT-ASSOTSIIROVANNYI ANTIGEN, GEPATITA B VIRUSA ANTIGENY POVERKHNOSTNYE, GEPATITA B POVERKHNOSTNYE ANTIGENY, ANTIGEN SYVOROTOCHNOGO GEPATITA, HBSAG, АВСТРАЛИЙСКИЙ АНТИГЕН, АНТИГЕН СЫВОРОТОЧНОГО ГЕПАТИТА, ГЕПАТИТА B ВИРУСА АНТИГЕНЫ ПОВЕРХНОСТНЫЕ, ГЕПАТИТА B ПОВЕРХНОСТНЫЕ АНТИГЕНЫ, ГЕПАТИТ-АССОЦИИРОВАННЫЙ АНТИГЕН |
Japanese | B型肝炎表面抗原, HBs抗原, HB表面抗原, SH抗原, オーストラリア抗原, 抗原-HB表面 |
French | Antigènes s de l'hépatite B, Antigènes de surface du virus de l'hépatite B, Antigène HBs, Antigène de surface de l'hépatite B, Antigènes de surface de l'hépatite B, Antigène Australie, Antigène Australia, Antigènes HBs de l'hépatite B, Ag HBs, Antigène HBs de l'hépatite B |
Croatian | HEPATITIS B POVRŠINSKI ANTIGENI |
Polish | Antygeny zapalenia wątroby B powierzchniowe, Antygeny Australia, Antygeny HBS, HBsAg |
Portuguese | Antígeno Hbs, Antígeno Austrália, Antígenos de Superfície da Hepatite B, HBsAg |
German | Australia-Antigen, HBsAg, Hepatitis-B-Oberflächenantigene |
Ontology: Hepatitis B surface antibody measurement (C0201478)
Definition (NCI_CDISC) | A measurement of the surface antibody reaction of a biological specimen to the Hepatitis B virus. |
Definition (NCI) | The determination of the surface antibody reaction of a sample to the Hepatitis B virus. |
Concepts | Laboratory Procedure (T059) |
SnomedCT | 143473009, 166105007, 65911000 |
CPT | 86706 |
English | Hepatitis B surface antibody measurement, Hepatitis B Surface Antibody Measurement, Hepatitis B surface antibody (HBsAb), Hepatitis B surface antibody, HEPATITIS B SURF ANTIBODY HBSAB, Assay for Hepatitis B surface antibody (HBsAb), HBsAg antibody level (procedure), HBsAg antibody level, HBSAB, Anti-HBs, Hepatitis B Virus Surface Antibody, HBsAb, hepatitis B surface antibody test, serum hepatitis B surface antibody (lab test), serum hepatitis B surface antibody, HBsAb measurement, Hepatitis B surface antibody measurement (procedure), HEP B SURFACE ANTIBODY, Hep b surface antibody |
Spanish | Anticuerpos anti antígeno superficial de hepatitis B, medición de HBsAb, medición del anticuerpo de superficie anti - hepatitis B (procedimiento), medición del anticuerpo de superficie anti - hepatitis B |
Portuguese | Anticorpo de superfície de hepatite B |
Dutch | hepatitis-B-oppervlakteantistof |
French | Anticorps de surface de l'hépatite B |
German | Antikoerper gegen Hepatitis B Surface Antigen |
Hungarian | Hepatitis B felületi antitest |
Czech | Protilátky proti povrchovému antigenu viru hepatitidy B |
Italian | Anticorpo di superficie dell'epatite B |
Japanese | B型肝炎表面抗体, Bガタカンエンヒョウメンコウタイ |
Ontology: Hepatitis B core antibody measurement (C0201480)
Concepts | Laboratory Procedure (T059) |
SnomedCT | 59582004 |
CPT | 86704 |
English | Hepatitis B core antibody measurement, Hepatitis B core antibody, Assay for total Hepatitis B core antibody (HBcAb), HBcAB measurement, Hepatitis B core antibody measurement (procedure) |
Spanish | Anticuerpos anti antígeno central de hepatitis B, medición de HBcAB, medición del anticuerpo antinuclear de la hepatitis B (procedimiento), medición del anticuerpo antinuclear de la hepatitis B |
Portuguese | Anticorpo anti-nuclear da hepatite B |
Dutch | hepatitis-B-kernantistof |
French | Anticorps de noyau de l'hépatite B |
German | Hepatitis-B-Oberflaechen-Antikoerper |
Hungarian | Hepatitis B mag antitest |
Czech | Anti HBc protilátka |
Italian | Anticorpi anti-core del virus dell'epatite B |
Japanese | B型肝炎コア抗体, Bガタカンエンコアコウタイ |
Ontology: Hepatitis E antibody (laboratory procedure) (C1141913)
Concepts | Laboratory Procedure (T059) |
Italian | Anticorpo anti-epatite E |
Japanese | E型肝炎抗体, Eガタカンエンコウタイ |
English | Hepatitis E antibody (laboratory procedure), Hepatitis E antibody |
Czech | Protilátky proti viru hepatitidy E |
Hungarian | Hepatitis E antitest |
Portuguese | Anticorpo da hepatite E |
Spanish | Anticuerpo anti-hepatitis E |
Dutch | hepatitis E-antistof |
French | Anticorps de l'hépatite E |
German | Hepatitis-E-Antikoerper |
Ontology: Hepatitis B screening test (C1278302)
Definition (NCI) | A test performed to determine the presence or absence of hepatitis B surface antigen. |
Concepts | Laboratory Procedure (T059) |
SnomedCT | 148345009, 168391008, 145583008, 171122006, 314099008 |
Spanish | screening para Hepatitis B, prueba de cribado de hepatitis B, detección selectiva para Hepatitis B, prueba de tamizaje de hepatitis B, cribado para Hepatitis B, cribado de hepatitis B, cribaje mediante prueba para la detección de hepatitis B, tamizaje mediante prueba para la detección de hepatitis B, prueba de pesquisa de hepatitis B, detección selectiva mediante prueba para hepatitis B, screening de hepatitis B, prueba de detección selectiva de hepatitis B (procedimiento), tamizaje para Hepatitis B, detección selectiva de hepatitis B (procedimiento), cribado mediante prueba para la detección de hepatitis B, cribaje para Hepatitis B, screening mediante prueba para la detección de hepatitis B, cribado mediante prueba para la detección de hepatitis B (procedimiento), cribado para la detección de Hepatitis B (procedimiento), cribado para la detección de Hepatitis B, pesquisa de hepatitis B, pesquisa mediante prueba para la detección de hepatitis B, rastreo para Hepatitis B, pequisa para Hepatitis B, rastreo mediante prueba para la detección de hepatitis B, tamizaje de hepatitis B, Analítica de hepatitis B, detección selectiva de hepatitis B, prueba de detección selectiva de hepatitis B |
English | Hepatitis B screen, Hepatitis B Screening, Hepatitis B screening, Hepatitis B screening (procedure), Hepatitis B screening test (procedure), Hepatitis B screening test |
Dutch | hepatitis-B-screening |
Italian | Ricerca dell'epatite B |
German | Hepatitis B Suchtest |
French | Dépistage d'hépatite B |
Portuguese | Exame de Hepatite B |
Czech | Screening hepatitidy B |
Japanese | Bガタカンエンスクリーニング, B型肝炎スクリーニング |
Hungarian | Hepatitis B szűrés |
Ontology: Hepatitis B virus test (C2363788)
Concepts | Laboratory Procedure (T059) |
English | Hepatitis B virus test |
Spanish | Prueba de hepatitis B |
Dutch | hepatitis-B-virustest |
Italian | Test per il virus dell'epatite B |
German | Hepatitis B-Virustest |
French | Test du virus de l'hépatite B |
Portuguese | Teste do vírus da hepatite B |
Czech | Test viru hepatitidy B |
Japanese | Bガタカンエンウイルスケンサ, B型肝炎ウイルス検査 |
Hungarian | Hepatitis B vírus vizsgálat |