Recommendations for Routine Testing and Follow-up for Chronic Hepatitis B Virus (HBV) Infection

Population Recommendation
Testing Vaccination/Follow-up
Recommendations
Persons born in regions of high and intermediate HBV endemicity (HBsAg prevalence 2%) Test for HBsAg, regardless of vaccination status in their country of origin, including
– immigrants
– refugees
– asylum seekers
– internationally adopted children
If HBsAg-positive, refer for medical management.
If negative, assess for on-going risk for hepatitis B and vaccinate if indicated.
US born persons not vaccinated as infants whose parents were born in regions with high HBV endemicity ( 8%) Test for HBsAg regardless of maternal HBsAg status if not vaccinated as infants in the United States. If HBsAg-positive, refer for medical management.
If negative, assess for on-going risk for hepatitis B and vaccinate if indicated.

Geographic Distribution of Chronic HBV Infection — Worldwide, 2006*

World map, indicating HBsAg prevalence

* For multiple countries, estimates of prevalence of hepatitis B surface antigen (HBsAg), a marker of chronic HBV infection, are based on limited data and might not reflect current prevalence in countries that have implemented childhood hepatitis B vaccination. In addition, HBsAg prevalence might vary within countries by subpopulation and locality. Source: CDC. Travellers’ Health; Yellow Book. http://wwwn.cdc.gov/travel/yellowbookch4-HepB.aspx.

Source: CDC. Travellers’ Health; Yellow Book.

Population Recommendation
Testing Vaccination/Follow-up
Recommendations
Injection-drug users Test for HBsAg, as well as for anti-HBc or anti-HBs to identify susceptible persons. First vaccine dose should be given at the same visit as testing. Susceptible persons should complete a 3-dose hepatitis B vaccine series to prevent infection from ongoing exposure.
Men who have sex with men Test for HBsAg, as well as for anti-HBc or anti-HBs to identify susceptible persons. First vaccine dose should be given at the same visit as testing. Susceptible persons should complete a 3-dose hepatitis B vaccine series to prevent infection from ongoing exposure.
Persons needing immunosuppressive therapy, including chemotherapy, immunosuppression related to organ transplantation, and immunosuppression for rheumatologic or gastroenterologic disorders Test for all markers of HBV infection (HBsAg, anti-HBc, and anti-HBs). Treat persons who are HBsAg-positive.
Monitor closely persons who are anti-HBc positive for signs of liver disease.
Persons with elevated ALT/AST of unknown etiology Test for HBsAg along with other appropriate medical evaluation. Follow-up as indicated.
Donors of blood, plasma, organs, tissues, or semen Test for HBsAg, anti-HBc, and HBV-DNA as required.
Hemodialysis patients Test for all markers of HBV infection (HBsAg, anti-HBc, and anti-HBs).
Test vaccine nonresponders monthly for HBsAg. HBsAg-positive hemodialysis patients should be          cohorted.
Vaccinate against hepatitis B to prevent transmission and revaccinate when serum anti-HBs titer falls below 10mIU/mL.
All pregnant women Test for HBsAg during each pregnancy, preferably in the first trimester.
Test at the time of admission for delivery if prenatal HBsAg test result is not available or if mother was at risk for infection during pregnancy.
If HBsAg-positive, refer for medical management.
To prevent perinatal transmission, infants of HBsAg-positive mothers and unknown HBsAg status mothers should receive vaccination and postexposure immunoprophylaxis in accordance
with recommendations and within 12 hours of delivery.
Infants born to HBsAg-positive mothers Test for HBsAg and anti-HBs 1–2 mos after completion of at least 3 doses of a licensed hepatitis B vaccine series (i.e., at age 9–18 months, generally at the next well-child visit to assess effectiveness of postexposure immunoprophylaxis). Testing should not be performed before age 9 months or within 1 month of the most recent vaccine dose. Vaccinate in accordance with recommendations.
Household, needle-sharing, or sex contacts of persons known to be HBsAg positive Test for HBsAg, as well as anti-HBc or anti-HBs to identify susceptible persons. First vaccine dose should be given at the same visit as testing. Susceptible persons should complete a 3-dose hepatitis B vaccine series to prevent transmission from ongoing exposure.
Persons who are the sources of blood or body fluids resulting in an exposure (e.g., needlestick, sexual assault) that might require postexposure prophylaxis Test source for HBsAg. Vaccinate healthcare and public safety workers with reasonably anticipated occupational exposures to blood or infectious body fluids.
Provide postexposure prophylaxis to exposed person if needed.
HIV-positive persons Test for HBsAg, as well as for anti-HBc or anti-HBs to identify susceptible persons. Vaccinate susceptible persons against hepatitis B to prevent transmission.

Adapted from: Centers for Disease Control and Prevention. Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection. MMWR 2008; 57 (No. RR-8).