Technically Speaking: Who Needs Hepatitis B Serologic Testing before or after Vaccination?
Published on in Vaccine Update for Healthcare Providers
In the August and October Technically Speaking columns, I reviewed CDC’s recommendations for hepatitis B vaccination of infants, children, and teens, as well as adults.
Pre- and/or post-vaccination serologic testing is recommended for some people who are candidates for vaccination.
Pre-vaccination serologic testing
Pre-vaccination testing should be considered for people who are at high risk for past or current hepatitis B virus (HBV) infection who would not benefit from hepatitis B vaccine if found to be currently infected or already immune.
CDC recommends pre-vaccination testing for the following groups:
- All foreign-born people (including immigrants, refugees, asylum seekers, and internationally adopted children) born in Africa, Asia, the Pacific Islands, and other regions with high endemicity of HBV infection (HBsAg prevalence of 8 percent or higher)
- Household, sex, and needle-sharing contacts of HBsAg-positive people
- HIV-infected people
In addition, testing might be cost effective in populations with a prevalence of HBV infection of 20 percent or higher.
Consult the ACIP recommendations below for details about populations at risk and which tests should be ordered. People with chronic HBV infection should be promptly referred to someone experienced in the management of chronic infection.
Note: Serologic testing should not be a barrier to vaccination, and both can be undertaken during a single office visit. The first vaccine dose should be administered after collection of the blood sample for serologic testing. Vaccinating a person who is infected or immune will do no harm.
Post-vaccination serologic testing
Post-vaccination testing is recommended for people whose subsequent clinical management depends on knowledge of their immune status, and includes the following groups:
- Healthcare workers and public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids (e.g., acupuncturists, dentists, dental hygienists and assistants, emergency medical technicians, first responders, laboratory technologists/technicians, nurses, nurse practitioners, phlebotomists, physicians, physician assistants, medical assistants, and students entering these professions)
- Chronic hemodialysis patients
- HIV-infected persons and other immunocompromised persons
- Sex partners of HBsAg-positive persons
- Needle-sharing partners of HBsAg-positive persons
CDC references
- Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Part 1: Immunization of Infants, Children and Adolescents
- A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Part II: Immunization of Adults
- CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management—Recommendations and Reports
IAC-related resources
Contributed by: Deborah Wexler, MD
Categories: Vaccine Update November 2016, Technically Speaking
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.