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Hepatitis B Decision Tool – Initial Screening
Sep 10, 2011
•
Mark Morgan
categories:
Gastroenterology & Hepatology
Infectious Disease
Hepatitis B Decision Tool - Initial Screening
Summary: A Hepatitis B decision tool for interpretation of initial screening tests.
See cliniborg's Hepatitis B Screening Decision Tool
here
and Hepatitis B Chronic Decision Tool
here
negative
positive
<-- HBsAg - Hepatitis B surface antigen
negative
positive
<-- HBsAb - Hepatitis B surface antibody
negative
positive
<-- HBcAb - Hepatitis B core antibody
Susceptible to HBV infection
Interpretation - Susceptible to Hepatitis B infection.
Recommendation - Vaccination.
Immune to HBV infection (vaccinated)
Interpretation - Immune to Hepatitis B infection due to vaccination.
Recommendation - No intervention required.
Immune to HBV infection (resolved natural infection)
Interpretation - Immune to Hepatitis B infection due to natural infection.
Recommendation - No intervention required.
Acute or chronic HBV infection
Interpretation - Acute or chronic Hepatitis B infection.
Recommendation -
Obtain Hepatitis B IgM to clarify whether acute (positive IgM) or chronic (negative IgM).
This isn't an ordinary finding. Hepatitis B surface antigen and Hepatitis B surface antibody shouldn't both be positive.
Interpretation unclear
Interpretation - Unclear; four possibilities:
1. Resolved infection (most common)
2. False-positive anti-HBc, thus susceptible
3. "Low level" chronic infection
4. Resolving acute infection
Recommendation -
To evaluate for possible low level chronic hepatitis infection, obtain quantitative Hepatitis B DNA level, serum ALT, and Hepatitis B e antigen and antibody.
To detect possible acute infection in window phase, obtain Hepatitis B core antibody IgM level (positive in acute disease).
Unusual and transient finding.
Interpretation - Unclear; two possibilities:
1. Early acute infection
2. Transient finding up to 18 days after vaccination
Recommendation - Clinical judgement can guide further investigation, such as short interval retesting.
You may wish to proceed to evaluation and treatment of Chronic Hepatitis B. This is located at https://medicaltext.org/infectious/hepatitis-b-chronic
(link)
display/hide references
references:
AFP article on diagnosis and treatment of hepatitis B - Wilkins (2010) Am Fam Phys 81: 965-72:
#1
CDC Hepatitis B page
#2
CDC serology chart
#3
American Association for Study of Liver Diseases (AASLD) - Hepatitis B Guidelines
#4
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