Testing and Public Health Management of Persons with Chronic Hepatitis B Virus Infection

On September 19, 2008, CDC published updated and expanded guidelines for testing for chronic hepatitis B virus (HBV) infection and recommendations for public health evaluation and management for chronically infected persons and their contacts. Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to identify persons with chronic HBV infection.

Testing for HBsAg is recommended for:

• persons born in geographic regions with HBsAg prevalence of ≥2%
• US born persons not vaccinated as infants whose parents were born in geographic regions with HBsAg prevalence of ≥8%
• persons who inject drugs
• men who have sex with men
• persons with elevated ALT/AST of unknown etiology
• persons with selected medical conditions who require immunosuppressive therapy

Testing continues to be recommended for:

• pregnant persons
• infants born to persons who test positive for HBsAg
• household contacts and sex partners of persons with HBV infection
• persons who are the source of blood or body fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick injury to a health care worker)
• persons with HIV infection

Guidelines and Recommendations

Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022, MMWR 2022;71(13);477-483.

Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, MMWR 2018;67(1).

Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant, MMWR 2018;67(15);455–458.

Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection, MMWR 2008;57(RR-8)

Recommendations for Routine Testing and Vaccination for Chronic Hepatitis B virus (HBV) Infection
Printable document pdf icon[PDF – 2 page]

Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and CDCexternal icon

AASLD Practice Guidelinesexternal icon
American Association for the Study of Liver Diseases

Sexually Transmitted Infections Treatment Guidelines, 2021, MMWR 2021;70(No.4)pdf icon
CDC guidance on the treatment of sexually transmitted diseases, including hepatitis B

Serology

Interpretation of Hepatitis B Serologic Test Results – Table pdf icon[PDF – 1 page]

Online Serology Training – Hepatitis A–E

Patient Education Tools