Who Needs Hepatitis B Serologic Testing before or after Vaccination?

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

• A 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

• Hepatitis B Facts: Testing and Vaccination
• Hepatitis B and Healthcare Personnel
• Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing