|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
- 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
- Household, sex, and needle-sharing contacts of HBsAg-positive
- 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