Who Needs Hepatitis B Serologic Testing before or after Vaccination?

November 2016

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Who Needs Hepatitis B Serologic Testing before or after Vaccination?
Published November 2016
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit www.immunize.org/acip/acip_vax.asp.
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 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

IAC-related resources

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