Thursday, June 16, 2022

Hepatitis B Surface Ab Immunity Qn

What Is The Purpose Of A Hepatitis B Test

Hepatitis B Serology: Surface Antigen (HBsAg), Surface Antibody (anti-HBs), Core Antibody (anti-HBc)

Hepatitis B test is performed to detect, classify, and treat hepatitis B virus infection.

Hepatitis B blood tests involve the measurement of several HBV-specific antigens and antibodies. In addition, HBV blood tests also include liver enzymes and liver function tests to assess and monitor the condition of the liver and provide appropriate treatment.

The HBV specific tests include the following:

  • HBsAg: HBsAg is an antigen found on the surface of hepatitis B virus. HBsAg may be detected in the blood any time after 1 week post-exposure to HB virus, but usually appears after 4 weeks.
  • Anti-HBs: Anti-HBs are antibodies produced by the bodys immune system to fight HBsAg. Anti-HBs from a prior infection or vaccination provides immunity against further infection.
  • Hepatitis B core antigen : HBcAg is an antigen found in the core layer which covers the hepatitis B viral DNA.
  • Hepatitis B core antibody : Anti-HBc is the antibody that fights HBcAg. Anti-HBc is the first detectable antibody after HBV infection. There are two kinds of Anti-HBc:
  • Immunoglobulin M hepatitis B core antibody : IgM anti-HBc indicates acute or reactivated recent infection within the previous 6 months.
  • Immunoglobulin G hepatitis B core antibody : IgG anti-HBc may indicate previous or chronic infection. Once present, IgG anti-HBc persists for a lifetime.
  • HBV DNA: HBV DNA is the genetic material of the HB virus and this test is a measure of the actual viral load and replication.
  • Hepatitis B Blood Tests

    The Hepatitis B Panel of Blood Tests

    Only one sample of blood is needed for a hepatitis B blood test, but the Hepatitis B Panel includes three parts. All three test results are needed to fully understand whether a person is infected or not. Below is an explanation of the 3-part Hepatitis B Panel of blood test results.

  • HBsAg – A “positive” or “reactive” HBsAg test result means that the person is infected with hepatitis B. This test can detect the actual presence of the hepatitis B virus in your blood. If a person tests positive, then further testing is needed to determine if this is a new acute infection or a chronic hepatitis B infection. A positive HBsAg test result means that you are infected and can spread the hepatitis B virus to others through your blood.
  • anti-HBs or HBsAb – A “positive” or “reactive” anti-HBs test result indicates that a person is protected against the hepatitis B virus. This protection can be the result of receiving the hepatitis B vaccine or successfully recovering from a past hepatitis B infection. This test is not routinely included in blood bank screenings. A positive anti-HBs test result means you are immune and protected against the hepatitis B virus and cannot be infected. You are not infected and cannot spread hepatitis B to others.
  • Sequence Following An Initial Negative Hepatitis B Surface Antibody Titer

    As you obtain documentation, please submit documentation of each step to CastleBranch

    • Initial Hepatitis B titer negative for immunity
    • Receive Hepatitis B challenge dose/booster
    • Repeat Hepatitis B titer 4-6 weeks after challenge/booster vaccine
  • If Repeat Hepatitis B titer is positive for immunity requirement will be marked Complete
  • If Repeat Hepatitis B titer is negative for immunity
  • Receive the remainder of the vaccines in the Hepatitis B vaccine series
  • If challenge dose/booster was Engerix-B or Recombivax HB
  • 2 additional vaccines are needed
  • Receive one as soon as possible after you receive notice that the repeat titer is negative
  • Receive final vaccine 5-6 months after the challenge dose/booster.
  • If challenge dose/booster was Heplisav-B
  • 1 additional vaccine is needed
  • Receive as soon as possible after you receive notice that the repeat titer was negative.
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    Does Hepatitis B Show Up In Routine Blood Tests

    Routine blood tests do not detect hepatitis B virus infection. Hepatitis B tests are specifically done if blood tests show abnormal liver function results, or if a person experiences symptoms or falls into the high-risk category for HBV infection.

    A panel of HBV-specific blood tests are required to detect HBV infection.

    Whats The Hepatitis B Titer Test Used For

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    A hepatitis B titer test measures antibodies in your blood to see if youre immune either due to vaccination or previous infection.

    Hepatitis B is a viral infection that targets your liver. It can be transmitted by coming into contact with the bodily fluids of an infected person. A person with the virus can also infect their child during birth.

    Hepatitis B can develop into a chronic infection. Chronic infection occurs when your body cant fight off the virus within six months. Chronic hepatitis B infections most commonly develop less than six years old, especially in infants.

    Hepatitis B titer tests can be used to evaluate:

    • whether a high-risk person is immune to hepatitis B
    • whether hepatitis B immunoglobulin is needed after a needle prick
    • men who have sex with men
    • people born in countries with a hepatitis B prevalence greater than 2 percent
    • people born in the United States not vaccinated as children and with parents born in regions with more than 8 percent hepatitis B prevalence

    You may need your titer test results as proof of hepatitis B immunity in order to get into healthcare programs at many schools for example, the nursing program at Lone Star College. In the United States, employers are not allowed to withdraw a job offer if they learn you have hepatitis B.

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    Eligibility Criteria For Study Selection

    The eligibility criteria were as follows: a cross-sectional, case control or cohort study design HBV as the exposure factor and NAFLD as the outcome and odds ratio /risk ratio values and corresponding 95% confidence intervals in the HBV-positive and HBV-negative groups described or sufficient information to calculate them. If two studies reported the same data, we selected the study with the larger sample.

    When And How To Perform Post

    Which test to use: If testing is needed following vaccination, use quantitated HBsAb only

    • Post-vaccination testing is needed for certain groups who are at especially high risk for HBV infection
    • The purpose of post-vaccination testing is to confirm if patients have achieved adequate immune response as measured by hepatitis B surface antibody
    • Perform testing 1-2 months after final dose of the HBV vaccine series
    • Persons with HBsAb concentrations of > 10 mIU/ml are considered immune
    • Post-vaccination testing is recommended for some patients:
    • Infants born to HBsAg+ women
    • Infants born to women whose HBSAg status remains unknown
    • Health care personnel and public safety workers at risk for blood or body fluid exposure
    • Hemodialysis patients
    • Other immunocompromised persons such as hematopoietic stem-cell transplant patients or persons receiving chemotherapy
    • Sex partners of HBSAg+ persons

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    Question 5 What Is The Natural History Of Hepatitis B Surface Antibody During Acute Hepatitis B Infection And Convalescence

    HBsAg can be detected in the blood 4 to 10 weeks after exposure. This corresponds to onset of symptoms and viremia detectable by nucleic acid amplification methods. Most hepatitis B infections are self-limited and are associated with disappearance of HBsAg within 4 weeks of onset of symptoms. The anti-HBs then appears and increases to a plateau level that persists indefinitely.2

    Subgroup And Sensitivity Analyses

    Quantitative HBsAg and its Role in Chronic Hepatitis B Patient Management

    The results of the subgroup analyses and sensitivity analyses are shown in Table √ĘTable2.2. When the analysis was stratified by study quality, study design and adjustment for cholesterol level or diabetes in the models, there was a significant difference between subgroups .2). For example, HBV infection was significantly associated with the risk of NAFLD in cohort and cross-sectional studies , but not in case-control studies .2). According to the sensitivity analyses, despite excluded the study using MRS, the results of the relationship between HBV infection and NAFLD remained stable . Additionally, the overall results remained consistent when the pooling model was changed .

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    What Do The Results Mean

    A hepatitis B blood panel consists of three tests that can be done with just one blood sample:

    • Hepatitis B surface antigen . A positive test indicates that youre infected with hepatitis B and that you can spread it to other people. Further tests are needed to see if you have an acute or chronic infection.
    • Hepatitis B core antibody . A positive result can indicate a past or current hepatitis B infection, but doesnt mean youre immune. A positive result needs to be interpreted by a doctor by examining the results of the other two tests.
    • Hepatitis B surface antibody . A positive test indicates that youre protected from hepatitis B either through previous infection or vaccination .

    The combination of these tests can indicate your hepatitis B status and whether you need to be vaccinated. Your test will give a negative or positive result for each category depending on whether your results are above or below the cutoff value.

    Most peoples test results fall into the following categories. But its possible to have a result that doesnt fall into one of these groups. If youre reading your results yourself, be careful not to confuse HBsAb with HBcAb.

    HBsAG

    is associated with hepatitis B immunity after vaccination. But research has found that anti-HBs decline over time.

    A found that more than 95 percent of people had anti-HBs levels greater than 10IU/L two years after vaccination. But this rate decreased to 70 percent after eight years.

    Association Between Hbv Infection And Risk Of Nafld

    Five studies were included to investigate the relationship between HBV infection and the risk of NAFLD .1). Three studies suggested that HBV infection was associated with a decreased risk of NAFLD. Only one study reported a significantly higher risk of NAFLD in HBV-infected patients than in uninfected controls. The remaining studies did not show a significant relationship. The pooled estimate was significant , with significant heterogeneity .

    Forest plot showing the relationship between HBV infection and the risk of NAFLD

    The horizontal axis is the X axis. The points represent the risk estimate of each individual study. Horizontal lines represent 95% confidence intervals diamonds represent the summary risk estimate with 95% confidence interval. HBV, hepatitis B virus. NAFLD, nonalcoholic fatty liver disease. CI, confidence interval. ES, effect size.

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    Hepatitis B Core Antibody Igm Serum

    Suggests clinical disorders or settings where the test may be helpful

    Diagnosis of acute hepatitis B virus infection

    Identifying acute HBV infection in the serologic window period when hepatitis B surface antigen and anti-hepatitis B surface are negative

    Differentiation between acute and chronic or past HBV infections in the presence of positive anti-hepatitis B core

    Testing Algorithm

    A short description of the method used to perform the test

    Chemiluminescence Immunoassay

    NY State Available Indicates the status of NY State approval and if the test is orderable for NY State clients.

    Lists a shorter or abbreviated version of the Published Name for a test

    Lists additional common names for a test, as an aid in searching

    Anti-HBc

    Hepatitis B Core Ab , S

    Hepatitis B Virus

    Anti-Hepatitis Bc

    HBIM

    Testing Algorithm

    Describes the specimen type validated for testing

    Serum SST

    Date of collection is required.

    Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing

    Patient Preparation: For 24 hours before specimen collection do not take multivitamins or dietary supplements containing biotin , which is commonly found in hair, skin, and nail supplements and multivitamins.

    Collection Container/Tube: Serum gel

    1. Centrifuge blood collection tube per collection tube manufacturer’s instructions.

    2. Aliquot serum into plastic tube.

    Special Instructions

    Forms

    0.5 mL

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    Whats The Procedure For A Hepatitis B Titer Test

    A hepatitis titer test requires a healthcare professional to draw a small amount of blood for testing.

    No special preparation is needed beforehand. If needles or the sight of blood make you anxious, you may want to arrange a drive ahead of time in case you feel faint.

    Heres what will typically happen during this test:

  • The person administering the test ties a band around your arm to make your veins easier to find.
  • The person sterilizes the injection site and inserts a small needle into your vein. You may feel a sharp pain, but it should quickly pass.
  • After the needle is removed, the test administrator asks you to apply a gentle pressure with a gauze or a cotton ball.
  • A bandage is applied to the area, and youre free to leave.
  • Home tests that require a fingerpick are also available. The results of your tests are generally available within 3 days.

    Question 1 What Is The Clinical Indication For Hepatitis B Surface Antibody Quantitation

    Hepatitis B surface antibody quantitation is used to determine hepatitis B immune status, ie, to determine if the patient has developed immunity against the hepatitis B virus. Such immunity may develop following exposure to the hepatitis B virus or its vaccine.

    Patients at higher risk of exposure to the virus include:

    • Infants born to infected mothers
    • Sex partners of infected persons
    • People with more than 1 sex partner in the last 6 months
    • People with a history of sexually transmitted infection
    • Men who have sex with men
    • Injection drug users
    • Household contacts of an infected person
    • Healthcare and safety workers who have contact with blood and body fluids
    • People who have lived or traveled in an area in which hepatitis B is common
    • People who live or work in a prison

    Testing is not recommended routinely following vaccination. It is advised only for people whose subsequent clinical management depends on knowledge of their immune status. These people include:

    • Chronic hemodialysis patients
    • Immunocompromised people, including those with HIV infection, hematopoietic stem-cell transplant recipients, and people receiving chemotherapy
    • Infants born to women who test positive for the hepatitis B surface antigen
    • Sex partners of people who test positive for the hepatitis B surface antigen
    • Healthcare and public safety workers who have contact with blood or body fluids

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    Hepatitis B Surface Antibody Qualitative

    Presence of antibody to hepatitis B surface antigen is used to determine immune status to HBV or disease progression in individuals infected with HBV. Anti-HBs levels can be measured to determine if vaccination is needed, or following a vaccination regimen, to determine if protective immunity has been achieved.

    – Anti-HBs usually can be detected several weeks to several months after HBsAg is no longer found, and it may persist for many years or for life after acute infection has been resolved.

    – It may disappear in some patients, with only antibody to core remaining.

    – People with this antibody are not overtly infectious.

    – Presence of the antibody without the presence of the antigen is evidence for immunity from reinfection, with virus of the same subtype.

    What is the Hepatitis B virus?

    Hepatitis B virus infection, also known as serum hepatitis, is endemic throughout the world. The infection is spread primarily through blood transfusion or percutaneous contact with infected blood products, such as sharing of needles among injection drug users. The virus is also found in virtually every type of human body fluid and has been known to be spread through oral and genital contact. HBV can be transmitted from mother to child during delivery through contact with blood and vaginal secretions, but it is not commonly transmitted via the transplacental route.

    The incubation period for HBV infection averages 60 to 90 days .

    What are common symptoms?

    How Much Does A Hepatitis B Titer Test Cost

    Hepatitis B Springboard

    The cost of a hepatitis B test varies based on where you get the test. Prices range from roughly $24 to $110.

    Your insurance may cover some or all of the cost. Under the Affordable Care Act, all new health plans must cover preventative services including hepatitis B vaccination and testing without a deductible or copay.

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    Question 3 How Is The Quantitative Hepatitis B Surface Antibody Test Performed

    An immunometric technique is used. The anti-HBs binds to HBsAg ad and ay subtypes, which are coated on the test wells. Binding of a horseradish peroxidase-labeled HBsAg conjugate to the anti-HBs completes the sandwich formation. Unbound materials are then washed away. In the next step, the horseradish peroxidase catalyzes oxidation of a luminogenic substrate, producing light. Light signals are detected and quantified. Intensity of the light is proportional to the amount of anti-HBs present in the patient sample. The result is standardized to an international unit system and reported as milliinternational units per milliliter .

    Hbv Dna Hbv Genotype And Hbv Drug Resistance Assays

    Specimen: Serum or plasma

    Container: Red-top tube, yellow-top tube , gel-barrier tube, plasma preparation tube, or lavender tube

    Collection method: Routine venipuncture

    The specimen should be transfused to separate plasma/serum from cells within 6 hours and kept frozen when testing cannot be done promptly.

    The tests use PCR amplification, DNA probe hybridization, and sequencing method.

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    Hep B Titer Test Required By Most Schools And Employers

    This assay is used to determine immune status for Hepatitis B.

    Hepatitis B Surface Antibody : The surface antibody is formed in response to the hepatitis B virus. Your body can make this antibody if you have been vaccinated, or if you have recovered from a hepatitis B infection. If this test is positive, then your immune system has successfully developed a protective antibody against the hepatitis B virus. This will provide long-term protection against future hepatitis B infection. Someone who is surface antibody positive is not infected, and cannot pass the virus on to others.

    This is a Quantitative test required by many schools and medical programs. Levels of anti-HBs will be provided.

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