http://www.immunize.org/catg.d/p2021b.htm
How do I interpret hepatitis B panel
results?
|
Interpretation of the hepatitis B panel
|
| Tests
|
Results
|
Interpretation |
HBsAg
anti-HBc
anti-HBs |
negative
negative
negative |
susceptible |
HBsAg
anti-HBc
anti-HBs |
negative
negative
positive with >10mIU/mL* |
immune due
to vaccination |
HBsAg
anti-HBc
anti-HBs |
negative
positive
positive |
immune due
to natural infection |
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs |
positive
positive
positive
negative |
acutely
infected |
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs |
positive
positive
negative
negative |
chronically infected |
HBsAg
anti-HBc
anti-HBs |
negative
positive
negative |
four
interpretations possible |
| * |
Postvaccination testing, when
it is recommended, should be performed 12 months following dose #3. |
| 1. |
May be recovering from acute
HBV infection. |
| 2. |
May be distantly immune and
the test is not sensitive enough to detect a very low level of anti-HBs in
serum. |
| 3. |
May be susceptible with a
false positive anti-HBc. |
| 4. |
May be chronically infected
and have an undetectable level of HBsAg present in the serum.
|
| Hepatitis B lab
nomenclature |
| HBsAg: |
Hepatitis B surface antigen
is a marker of infectivity. Its presence
indicates either acute or chronic HBV
infection. |
| anti-HBs: |
Antibody to hepatitis B surface
antigen is a marker of immunity. Its presence indicates an immune
response to HBV infection, an immune response to vaccination, or the
presence of passively acquired antibody. (It is also known as
HBsAb, but this abbreviation is best avoided since it is
often confused with abbreviations such as HBsAg.) |
| anti-HBc: |
Antibody to hepatitis B core antigen
is a marker of acute, chronic, or resolved HBV infection. It is not
a marker of vaccine-induced immunity. It may be used in
prevaccination testing to determine previous exposure to HBV infection.
(It is also known as HBcAb, but this
abbreviation is best avoided since it is often confused with other
abbreviations). |
| IgM anti-HBc:
|
IgM antibody subclass of anti-HBc.
Positivity indicates recent infection with HBV (<6
mos). Its presence indicates acute infection. |
| IgG anti-HBc: |
IgG antibody subclass of anti-HBc
is a marker of past or current infection
with HBV. If it and HBsAg are both positive (in the absence of IgM anti-HBc),
this indicates chronic HBV infection. |
| HBeAg: |
Hepatitis B "e" antigen
is a marker of a high degree of HBV infectivity and it
correlates with a high level of HBV replication. It is primarily used to
help determine the clinical management of patients with chronic HBV
infection. |
| Anti-HBe: |
Antibody to hepatitis B "e"
antigen may be present in an infected or
immune person. In persons with chronic HBV infection, its presence
suggests a low viral titer and a low degree of infectivity. |
| HBV-DNA: |
HBV Deoxyribonucleic acid
is a marker of viral replication. It correlates
well with infectivity. It is used to assess and monitor the treatment of
patients with chronic hepatitis B infection. |
Where can I find a CDC document that
states that hepatitis B vaccine doesn't have to be restarted if the series is
interrupted?
Discussion regarding an interrupted
hepatitis B vaccine schedule can be found in the original hepatitis B vaccine
recommendation: "Hepatitis B Virus: A Comprehensive Strategy for Eliminating
Transmission in the United States Through Universal Childhood Vaccination:
Recommendations of the ACIP" (MMWR 1991;40[RR-13]) under the heading
Vaccine Usage. (7/00)
I understand that if a person is HBeAg
negative and HBsAg positive s/he is not infectious. Am I wrong?
Yes, you are wrong. HBeAg is an
indicator of high viral replication activity, so an individual who is actively
replicating hepatitis B virus (HBV) will be highly infectious. HBsAg positivity
accompanied by HBeAg negativity indicates continued viral replication, though at
a less intense level than if the patient were HBeAg positive. Hence, a person
who is HBsAg positive is infectious. (7/00)