II. Indications

  1. Pregnant women at first Prenatal Visit
  2. HIV Positive patients
  3. IV Drug Abuse
  4. Men who have Sex with Men
  5. Household contacts or sexual partners of infected persons
  6. People born in countries with high Prevalence of Hepatitis B Infection (2% or greater Prevalence per CDC)
  7. U.S. born children (but not HepB vaccinated) to parents from countries with Prevalence of Hepatitis B Infection (>8%)
  8. Donors of plasma, organs, tissue or semen
  9. Infants born to mothers who are HBsAg positive
  10. Patients on Hemodialysis or cytotoxic or immunosuppressive therapy
  11. Patients at risk for exposing others to their blood or body fluids and hence requiring Postexposure Prophylaxis
  12. Liver Function Test Abnormality (specifically ALT and AST transaminase increases) of unknown reason
  13. References
  14. Chou (2014) Ann Intern Med 161(1): 31-45 [PubMed]

III. Lab: Screening Protocol

  1. Step 1: Hepatitis B Surface Antigen (HBsAg)
    1. Positive: Go to Step 2
    2. Negative: May still represent Hepatitis B inactive carrier state
  2. Step 2: Differentiate Chronic Infection vs Immunity
    1. Hepatitis B Core Antibody
    2. Hepatitis B Surface Antibody (immune)

IV. Labs: Detectable Antigens

  1. Hepatitis B Surface Antigen: HBsAg
    1. First detectable agent in Acute Hepatitis B Infection
    2. Present as early as incubation period
  2. Hepatitis B Envelope Antigen: HBeAg
    1. Highly Infectious State
    2. Chronic Infection

V. Labs: Detectable Antibodies

  1. Hepatitis B Surface Antibody: xHBsAb IgG
    1. Prior Hepatitis B Infection with Immunity
    2. Prior Hepatitis B Vaccine with Immunity
  2. Hepatitis B Core Antibody: xHBcAb IgM and IgG
    1. Covers Convalescent period
      1. Window between HBsAg clearance to xHBsAb conversion
      2. HBsAg negative during this time
  3. Hepatitis B Envelope Antibody: xHBeAb IgM and IgG
    1. Low Infectivity
    2. Predicts Hepatitis B Resolution

VI. Course: Serology progression

  1. Stage 1: Immune Tolerant or Incubation Period
    1. Characteristics
      1. DNA replication very active in this stage
      2. Prolonged stage in newborns
      3. Asymptomatic (Serum Aminotransferases normal)
    2. Incubation (4-12 weeks)
    3. Late incubation (1-2 weeks)
      1. HBsAg Positive
  2. Stage 2: Immune Response
    1. Characteristics
      1. Immune response causes hepatic cell destruction
        1. Serum Aminotransferases increased
      2. High risk stage for Chronic Hepatitis B progression
      3. Symptom flares may occur if immunocompromised
      4. Conversion to Stage 3
        1. Occurs in most adults rapidly
        2. Others convert 5-15% per year
    2. Early Acute
      1. HBsAg Positive
      2. HBeAg Positive
    3. Acute (2-12 weeks)
      1. HBsAg Positive
      2. HBeAg Positive
      3. xHBc IgM Antibody Positive
      4. xHBc IgG Antibody Positive
    4. Acute and Seroconversion (transitions into Stage 3)
      1. HBsAg Positive
      2. xHBc IgM Antibody Positive
      3. xHBc IgG Antibody Positive
      4. xHBe IgG Antibody Positive
  3. Stage 3: Inactive carrier state (3-6 months)
    1. Characteristics
      1. Viral replication stops and transaminases normalize
      2. Possibly infectious and convalescent stage
      3. Conversion to Stage 4: 3% per year
    2. HBsAg Negative (but positive in chronic active infection)
    3. xHBc IgM Antibody Positive
    4. xHBc IgG Antibody Positive
    5. xHBe IgG Antibody Positive
  4. Stage 4: Immune and Early Recovery
    1. xHBc IgG Antibody Positive
    2. xHBe IgG Antibody Positive
    3. xHBs IgG Antibody Positive

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Related Studies

Ontology: Hepatitis B Antibodies (C0019164)

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