Testing for hepatitis B

Serological testing determines the presence of acute or chronic hepatitis B, resolved hepatitis B, immunity through vaccination, and susceptibility to hepatitis B, as outlined in Patterns of serological test results for hepatitis B infection ¹.

Table 1. Patterns of serological test results for hepatitis B infection
	HBsAg	Anti-HBc [NB1]	Anti-HBs
acute hepatitis B infection	positive	IgM positive [NB2]	negative
chronic hepatitis B infection	positive	IgG positive [NB2]	negative
resolved hepatitis B infection	negative	IgG positive	positive
vaccinated patients	negative	negative	positive [NB3]
susceptible patients	negative	negative	negative [NB3]
Note: anti-HBc = hepatitis B core antibody; anti-HBs = hepatitis B surface antibody; HBsAg = hepatitis B surface antigen; IgG = immunoglobulin G; IgM = immunoglobulin M NB1: An isolated positive anti-HBc may reflect: previous hepatitis B infection with subsequent immunity (where anti-HBs has fallen below the level of detection), occult hepatitis B infection (where HBsAg is negative but hepatitis B virus DNA is detectable in blood), a false-positive result, or resolving acute hepatitis B infection. NB2: Anti-HBc IgM may also be positive in acute flares of chronic hepatitis B. NB3: Anti-HBs titres wane over time. A person with normal immune function who has ever had a documented anti-HBs titre of 10 mIU/mL or more after completing vaccination is considered to have memory immunity, even if the anti-HBs titre later falls below 10 mIU/mL. Booster vaccination is not required in those with memory immunity.

Detailed information about testing for hepatitis B virus (HBV), including who to screen (eg migrants from intermediate- or high-prevalence countries, Aboriginal and Torres Strait Islander peoples, pregnant females), is provided in the National HBV testing policy and on the Hep B Help website.

All pregnant females should have antenatal screening for hepatitis B. Identifying those who are positive for hepatitis B surface antigen (HBsAg) allows referral for treatment and care for the patient, testing for her sexual and household contacts, and interventions to prevent mother-to-child transmission. For more information, see Hepatitis B and pregnancy.

Co-infection with hepatitis C virus, hepatitis D virus (HDV) or human immunodeficiency virus (HIV) is common in people with chronic hepatitis B infection. All people diagnosed with hepatitis B infection should be tested for hepatitis C, hepatitis D (HDV antibodies) and HIV² at baselineAustralian hepatitis B consensus statement 2022 Shadur 2013. See also Hepatitis B and HIV co-infection.

Note: All people diagnosed with hepatitis B infection should be tested for hepatitis C, hepatitis D and HIV.

Testing of household and sexual contacts of people with hepatitis B, and vaccination of those who are susceptible, is a key aspect of the management of a person newly diagnosed with chronic hepatitis B.

Notification of acute hepatitis B to public health authorities by the diagnosing clinician is required in all Australian jurisdictions, while notification of newly diagnosed chronic (or unspecified) hepatitis B is required in most jurisdictions. For information about jurisdictional notification requirements, see the Hep B Help website. Contact details for Australian state and territory government health departments and public health units are available here.

¹ Further information about serological markers for hepatitis B is available on the B positive website and the Hep B Help website.Return

² Hepatitis B infection has been identified as an indicator condition for HIV testing. If hepatitis B is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.Return