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

The table below provides recommendations for testing and vaccination based on population groups. Testing should not be a barrier to vaccination of susceptible persons, especially in populations that are difficult to access. Testing is not a requirement for vaccination, and in settings where testing is not feasible, vaccination of recommended persons should proceed.

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, vaccinate. Susceptible persons should complete a hepatitis B vaccine series.
U.S.-born persons not vaccinated as infants whose parents were born in regions with high HBV endemicity (≥8%). Learn more about prevalence of HBV infection around the world. 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, vaccinate. Susceptible persons should complete a hepatitis B vaccine series.
Persons who inject drugs Test for HBsAg, as well as for anti-HBc or anti-HBs to identify susceptible persons. If HBsAg-positive, refer for medical management.
If negative, vaccinate. Susceptible persons should complete a hepatitis B vaccine series to prevent infection from ongoing exposure.
First vaccine dose should be given at the same visit as testing.
Men who have sex with men Test for HBsAg, as well as for anti-HBc or anti-HBs to identify susceptible persons. If HBsAg-positive, refer for medical management.
If negative, vaccinate. Susceptible persons should complete a hepatitis B vaccine series to prevent infection from ongoing exposure.
First vaccine dose should be given at the same visit as testing.
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 test positive for HBsAg.
Monitor closely persons who test positive for anti-HBc for signs of liver disease.
If negative, vaccinate. Susceptible persons should complete a hepatitis B vaccine series.
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.
Persons on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and persons who are predialysis Test for all markers of HBV infection (HBsAg, anti-HBc, and anti-HBs).
Test vaccine nonresponders monthly for HBsAg. Patients on hemodialysis who test positive for HBsAg should be cohorted.
Vaccinate against hepatitis B to prevent transmission and revaccinate when serum anti-HBs titer falls below 10mIU/mL.
All pregnant persons 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 person was at risk for infection during pregnancy.
If HBsAg-positive, refer for medical management.
To prevent perinatal transmission, infants of persons who test positive for HBsAg and persons with unknown HBsAg status should receive vaccination and postexposure immunoprophylaxis in accordance
with recommendations and within 12 hours of delivery.
Infants born to persons who test positive for HBsAg 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 have tested positive for HBsAg 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 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 health care and public safety workers with reasonably anticipated occupational exposures to blood or infectious body fluids.
Provide postexposure prophylaxis to exposed person if needed.
Persons with HIV infection 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).