How to screen for and diagnose HBV.

Ending hep B begins with screening and diagnosing your at-risk patients. With just one blood draw, you can measure three virologic markers of hepatitis B virus infection.1

HBV=hepatitis B virus.

How to screen for and diagnose HBV.

Ending hep B begins with screening and diagnosing your at-risk patients. With just one blood draw, you can measure three virologic markers of hepatitis B virus infection.1

HBV=hepatitis B virus.

CDC-recommended Hep B screening tests

HBsAg

Hepatitis B surface antigen
Hallmark of infection

HBsAg is a protein on the surface of HBV; it can be detected in high levels in serum during acute or chronic HBV infection. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.1

Anti-HBs

Hepatitis B surface antibody
Marker of immunitya

The presence of anti-HBs is generally interpreted as indicating recovery and immunity from HBV infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.1

Anti-HBc

Hepatitis B core antibody
Marker of prior exposure

Anti-HBc appears at the onset of symptoms in acute HBV infection and persists for life. The presence of anti-HBc indicates previous or ongoing infection with HBV for an undefined time frame.1


Note: All three tests are required to correctly determine next steps.
Anti-HBc=antibody to HBcAg; Anti-HBs=antibody to HBsAg; CDC=Centers for Disease Control and Prevention; HBsAg=hepatitis B surface antigen.
aThrough vaccination or recovery from previous HBV infection.

HBV Screening is covered by most insurance plans

The USPSTF has given a grade B recommendation for HBV screening in persons at high risk for infection2,b

Most private health insurance plans cover recommended preventive services with an A or B recommendation without cost-sharing3

Medicare typically covers all USPSTF-recommended services with an A or B recommendation without cost-sharing3

Medicaid programs are either required to cover services without cost-sharing or incentivised to cover all USPSTF-recommended services with an A or B recommendation without cost-sharing3

USPSTF=U.S. Preventive Services Task Force.
bConfirm with patient's insurance plan to ensure reimbursement eligibility.

“Tests for HBV infection are widely available, cheap, and accurate.”

–Ruma Rajbhandari, MD, MPH and Raymond T. Chung, MD, Annals of Internal Medicine4

Interpretation and management based on screening test results (AASLD, ACP/CDC)

Possible HBV serologic test results5,6

Screening Tests
HBsAgAnti‑HBsAnti‑HBccInterpretationManagement
 Acute or chronic infectiond Additional testing and management needed 
 Exposure to HBV
Risk for reactivatione
 Follow up as appropriatef 
 Immunity from vaccination No further testing required 
 Uninfected and not immune (at risk for infection) No further testing required; vaccinate 
AASLD=American Association for the Study of Liver Diseases; Anti-HBs=antibody to HBsAg; HBsAg=hepatitis B surface antigen; HCC=hepatocellular carcinoma.
cAnti-HBc refers to total anti-HBc.7
dPatient is chronically infected if HBsAg+ for ≥6 months; patients with acute infection will be positive for anti-HBc IgM.7
ePatients undergoing immunosuppressive therapy or treatment with direct-acting antivirals for HCV coinfection should be monitored for HBV reactivation.5
fPatients with cirrhosis should be screened every 6 months for hepatocellular carcinoma per the AASLD guidance.5

Following an initial evaluation, all patients with chronic HBV infection should be monitored to assess liver disease progression and the need for treatment. Not all chronically infected patients are indicated for treatment, but all will require lifelong monitoring.7,8

Learn about managing chronic hepatitis B.

Educate patients to prevent HBV transmission

Myths about HBV transmission abound. Educate your patients on the facts to help prevent the spread of HBV.

How is HBV most commonly transmitted in the US?
  1. Childbirth - Perinatal transmission is the major route by which hepatitis B infection is perpetuated in endemic populations.9
  2. Sexual contact - Both acute an chronic hepatitis B infection may also be transmitted through any type of exposure to bodily fluids, such as blood and semen.1

Routes of HBV transmission


Progression to CHB occurs in >90% of infants, approximately 25%–50% of children aged 1–5 years, and <5% of older children and adults.7

Vaccinate patients as recommended

Vaccination is the most effective way to help prevent HBV infection and its complications.6

Populations recommended for HBV vaccination by the CDC10:

  • All Newbornsg
  • All unvaccinated children and adolescents <19 years of age
  • All unvaccinated adults at risk for infection and those seeking protection from HBV infection
  • Primary vaccination consists of 3 intramuscular doses given at 0, 1, and 6 months;1A 2-dose series given at 0 and 1 months is also available for adults11
  • A full 3-dose vaccine series is associated with immunity in up to 90% of healthy adults11
CDC=Centers for Disease Control and Prevention.
gInfants born to HBsAG+ mothers should also receive hepatitis B immune globulin by ≤12 hours of birth.10
First dose
(0 month)
Second dose
(1 month)
Third dose
(6 month)
30%-55% with protective immunity1275% with protective immunity12Up to 90% with protective immunity11
Screen for HBV infection before vaccination.10

Implementing HBV infection screening protocols

Consider implementing screening protocols in your practice to identify, follow, refer, and treat appropriately persons with CHB. Taking these steps can have a major impact on reducing complications associated with chronic hepatitis B.13

Implement clinical protocols to:

Identify high-risk patients in populations identified as high-risk by the AASLD, ACP and CDC, USPSTF

Test for the three markers of HBV infection through a simple blood draw1

Counsel infected patients about risks, including liver complications and transmission to others

Refer or treat patients as indicated by AASLD, AATA, and EASL guidelines5,14,15

AASLD=American Association for the Study of Liver DiseasesAATA=Asian American Treatment AlgorithmACP=American College of PhysiciansCDC=Centers for Disease Control and PreventionEASL=European Association for the Study of the LiverUSPSTF=U.S. Preventive Services Task Force.

Information for healthcare professionals

References:
  • Centers for Disease Control and Prevention. Hepatitis B. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine - Preventable Diseases. 13th ed. Washington, D.C.: Public Health Foundation; 2015:149-174.
  • U.S. Preventive Services Task Force Final Recommendation Statement: Hepatitis B Virus Infection: Screening. May 2014. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/hepatitis-b-virus-infection-screening-2014. Updated May 2014. Accessed October 8, 2019.
  • Centers for Disease Control and Prevention. Viral Hepatitis Preventive Services. https://www.cdc.gov/nchhstp/preventionthroughhealthcare/preventiveservices/hepatitis.htm. Last reviewed May 2, 2018. Accessed October 8, 2019.
  • Rajbhandari R, Chung R. Screening for hepatitis B virus infection: A public health imperative. Ann Intern Med. 2014;161:76-77.
  • Terrault N, Lok A, McMahon B, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599.
  • Abara W, Qaseem A, Schillie S, et al. Hepatitis B vaccination, screening, and linkage to care: best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2017;167(11):794-804.
  • Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2008;57:1-20.
  • Martin P, Lau DT, Nguyen MH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2015 update. Clin Gastroenterol Hepatol. 2015;13(12):2071-2087.e16.
  • World Health Organization. Hepatitis B. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. Updated July 18, 2019. Accessed October 15, 2019.
  • Centers for Disease Control and Prevention. Hepatitis B Questions and Answers for Professionals. Hepatitis B Serology. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm. Last reviewed October 25, 2019. Accessed October 29, 2019.
  • Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2018;67:455-458.
  • Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2006;55:1-40.
  • McMahon, BJ. Implementing evidenced-based practice guidelines for the management of chronic hepatitis B virus infection. Am J Med. 2008 Dec;121(12 Suppl):S45-52.
  • Tong MJ, Pan CQ, Han SB, et al. An expert consensus for the management of chronic hepatitis B in Asian Americans. Aliment Pharmacol Ther. 2018;47(8):1181-1200.
  • European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398.