I have a patient who is positive for anti-HBc (hepatitis B core antibody) but negative for other hepatitis B serologic markers. Should he receive hepatitis B vaccine?

Some isolated positive anti-HBc results are false positives (it is the most common false positive HBV marker). If that can be established, the individual can and likely should be vaccinated, assuming there is an indication or desire to be protected. If the positive anti-HBc is believed to be a true positive, the individual would not require vaccination since they have already (presumably) had HBV infection. Isolated positive anti-HBc could indicate low-level chronic infection. In an infant isolated anti-HBc could indicate passive transfer of antibody from a mother who is HBsAg positive, which is why anti-HBc testing of infants is not recommended.

Additional resources for the evaluation of isolated anti-HBc antibody results are available from the University of Washington: www.hepatitisb.uw.edu/go/screening-diagnosis/diagnosis-hbv/core-concept/all and from CDC: www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/#cdc_hcp_diagnosis_interpreting-how-to-interpret-test-results.