Role Of Clinicians And Health Departments
Clinicians and Health Departments also play a critical role in laboratory reporting of pregnancy status for Hepatitis B-positive women.
- Select a test designated as prenatal or on a prenatal/obstetric panel when ordering an HBsAg screening test for a pregnant woman to help ensure confirmatory testing is performed on all positive HBsAg screens.
- Inform selected laboratory of a womans pregnancy status to ensure confirmatory testing is performed on all positive HBsAg screens.
- Include any and all ICD-10 diagnosis codes indicating current or recent pregnancy when ordering HBsAg tests.
Screening Pregnant Women for Hepatitis B Virus Infection and Screening and Referral Algorithm for Hepatitis B Virus Infection among Pregnant Women
Page one of this tool lists newly offered prenatal hepatitis B surface antigen tests at four major commercial laboratories that indicate pregnancy status on reportable positive HBsAg results. Page two provides a clinical algorithm for screening and referral of pregnant women who are HBsAg-positive. Tool pdf icon
- Be aware of how laboratories reporting to your jurisdiction are reporting pregnancy information .
- Pull these prenatal indicators from both paper-based and electronic laboratory reporting reports.
- Ensure prenatal indicators are shared with your Perinatal Hepatitis B Prevention Program Coordinators.
How Is It Used
The main uses for hepatitis B virus tests include:
Some of the secondary reasons to perform testing include: to screen for hepatitis B infection in at-risk populations or in blood donors, to determine if someone is a carrier, to detect a resolved infection, and to determine if immunity has developed due to vaccination.
Generally, one set of tests is used as an initial panel of tests to detect HBV infection or to determine the cause of acute symptoms while another set of tests may be used after a diagnosis is made to monitor possible progression of the disease, to detect chronic infection, and/or to determine carrier status.
The following table summarizes the set of tests typically used for initial testing:
The following table summarizes tests that may be used as follow-up after initial tests detect an HBV infection:
Who Is At Risk For Hepatitis B
Anyone can contract hepatitis B. However, certain groups are at greater risk. According to the CDC, the following groups are at highest risk for contracting hepatitis B:
- Infants born to infected mothers
- People who inject drugs or share needles
- Sexual partners of people infected with hepatitis B
- Men who have sex with men
- People living in close proximity to a person with hepatitis B
- Health care workers or others exposed to blood in their work environments
- Hemodialysis patients
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Hepatitis Be Antigen Blood Test
This test is used in the diagnosis and monitoring of Hepatitis B infections. The Be Antigen test looks for the presence of a protein found in the blood when the Hep B virus is actively replicating. During these periods, a person is considered to be highly infectious and at a higher risk for spreading the virus to others. Pregnant women have a much greater risk of spreading the virus to their infants during birth when the Hep B virus is replicating. This state usually occurs 3-6 weeks after infection.
Hepatitis B is a viral liver infection which is spread through exposure to infected blood or bodily fluids. It is the most common cause of acute viral Hepatitis. Hepatitis B infections often show no symptoms but when symptoms do occur they are often described as flu-like. Common symptoms include abdominal pain, fever, loss of appetite, nausea, joint pain, fatigue, jaundice, and dark colored urine. Chronic Hep B infections can cause serious health complications like Cirrhosis and Liver Cancer.
Turnaround time for the Hepatitis Be Antigen test is typically 1-2 business days.
Note: Result turn around times are an estimate and are not guaranteed. Our reference lab may need additional time due to weather, holidays, confirmation/repeat testing, or equipment maintenance.
Why Get Tested For Hepatitis B Immunity
Schools, workplaces, or other entities may require proof of immunity to hepatitis B within their requirements. Additionally, if you are unsure if you have previously been vaccinated for, or been infected by, hepatitis B, a screening will allow you to confirm your status.
*It is solely your responsibility to promptly discuss all laboratory test results with a physician. Neither Sonora Quest Laboratories nor its Medical Director will provide interpretation, counseling, consulting, or care recommendations on the basis of any laboratory results provided to you.
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When To Get Tested
When you have risk factors for HBV infection or when you have signs and symptoms of hepatitis, such as jaundice or unexplained elevated blood levels of alanine aminotransferase , a liver-associated enzyme when you have a condition that requires chemotherapy or drugs that suppress your immune system when you are being treated for HBV or hepatitis C when it is unclear whether you have immunity and your healthcare practitioner is considering giving you the hepatitis B vaccine
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Question 2 What Should Healthcare Providers Do When They Have A Patient With Suspected Measles Infection
Public health authorities are asking healthcare providers to notify them directly if they have a patient with suspected measles.1 This allows for tracking of highly suspect cases and the provision of appropriate public health follow-up. For highly suspect cases, local public health departments will recommend appropriate testing procedures.1
What Is Hepatitis D And How Is It Associated With Hepatitis B
Hepatitis D is another virus that can cause liver infections, but only if hepatitis B is also present. A person may become infected with both viruses at the same time or may first be infected with hepatitis B and then become infected with HDV . In the U.S., the incidence of HDV is low. There is no vaccine for HDV, but since it causes infections only in the presence of HBV, it may be prevented with the HBV vaccine.
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Question 7 Is Hepatitis B Surface Antibody Antibody Always Acquired After A Completed Vaccination Protocol
No. After 3 intramuscular doses of vaccine, > 90% of healthy adults and > 95% of those < 19 years of age develop immunity .1 However, there is an age-specific decline in development of immunity. After age 40 years, about 90% of people become immune, but by age 60 years, only 75% of people become immune.1 Larger vaccine doses or an increased number of doses are required to induce immunity in many hemodialysis patients and in other immunocompromised people.1
This FAQ is provided for informational purposes only and is not intended as medical advice. A clinicians test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.Document FAQS.105 Revision: 0
Question 6 Why Have The Reference Ranges Changed For The Quest Diagnostics Measles Igg Assay
The reference range for the Measles Antibody assay has been lowered to improve sensitivity in accordance with recommendations from the World Health Organization .4 These revised assay cutoffs provide an estimated increase in positivity rate of 5% to 8%. This assay has a sensitivity of 94.7% and a specificityof 97.4%.5
1. For healthcare providers. Centers for Disease Control and Prevention. Reviewed November 5, 2020. Accessed October 22, 2021.
2. World Health Organization. Laboratory testing for determination of population immune status. In: Manual for the Laboratory-based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome. World Health Organization 2018:chap 9. Accessed October 22, 2021.
3. World Health Organization. Molecular epidemiology of measles and rubella. In: Manual for the Laboratory-based Surveillance of Measles, Rubella, and Congenital Rubella Syndrome. World Health Organization 2018:chap 7. Accessed October 22, 2021.
4. WHO International Standard 3rd International Standard for Anti-Measles NIBSC code: 97/648. Instructions for use. National Institute for Biologic Standards and Control 2008. Accessed October 22, 2021.
Version 3 effective 10/25/2021 to present
Version 2 effective 04/22/2020 to 10/25/2021
Version 1 effective 06/04/2016 to 04/22/2020
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When Is It Ordered
Hepatitis B tests may be ordered when someone has signs and symptoms associated with acute hepatitis to determine if they are due to infection with HBV. Some of these include:
- Joint pain
Hepatitis B tests may be done as follow up when routine tests results such as ALT and/or AST are elevated. Sometimes acute forms of hepatitis may be detected this way since they may cause only mild symptoms that can be confused with the flu. Chronic hepatitis more often has no symptoms and is more commonly detected when routine test results are abnormal.
A test for hepatitis B surface antigen may be used for screening when someone falls into one of the high-risk categories for chronic hepatitis B. Joint guidelines from the Centers for Disease Control and Prevention and American College of Physicians were published in December 2017 and recommend the following groups be tested for HBsAg:
When hepatitis B tests are used to monitor people with chronic hepatitis B infections, they may be performed on a regular basis. Hepatitis B surface antigen and hepatitis B e antigen , often along with HBV DNA, are usually measured about every 6 months to a year since, in some people, HBeAg will go away on their own. In those who are being treated for chronic HBV, HBeAg and HBV DNA tests can be used to determine whether the treatment is successful.
What Is Hepatitis B
Hepatitis B is a liver infection that is spread through contact with blood or other bodily fluids. It is most commonly spread through sexual contact, shared drug needles, from an infected mother to her child in the womb, or direct contact with the blood of an infected person. Some cases of hepatitis B are acute and do not require medical treatment. However, some people may develop chronic hepatitis B which may require lifelong treatment. According to the CDC, there were 3,218 reported cases of acute hepatitis B in the United States in 2016. However, given that symptoms are not always present, the CDC estimates that total number of acute hepatitis B cases in that year to be closer to 20,900. The number of people in the United States with chronic hepatitis is estimated to be 850,000, but the CDC believes this number may actually be as high as 2.2 million.
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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
Question 3 How Are Laboratory Tests Used To Support A Measles Diagnosis
Detection of measles-specific IgM antibody in serum and measles RNA by real-time polymerase chain reaction in a respiratory specimen are the most common methods for confirming measles infection. Measles RNA by RT-PCR is the preferred method for confirming an acute case.1
A positive RT-PCR test confirms the measles diagnosis.1,3 While detection of IgM antibody can be diagnostic, false-positive results may occur, especially in low-prevalence populations.1 Conversion of a negative IgM result to a positive result or a 4-fold or greater increase in measles IgM titer between acute and convalescent serum specimens is diagnostic.1 False-negative IgM results can also occur if the serum sample is obtained < 3 days after rash presentation, . Additionally, IgG seroconversion can also help diagnose recent measles infection in the absence of recent measles vaccination. Laboratory confirmation is essential for all sporadic measles cases and all outbreaks.1
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What Are The Symptoms Of Hepatitis B
Not all individuals infected with acute hepatitis B will experience symptoms. In fact, the CDC estimates that only about 30-50% of infected people age 5 and older will have symptoms. When symptoms are present, they will develop about 3 months after exposure and will include the following:
- Joint pain
Individuals with chronic hepatitis B will generally not have any symptoms. When symptoms are present, they are generally very similar to the symptoms of acute hepatitis B. Given the serious nature of hepatitis B and the effects it can have on your liver and overall health, it is important to talk to your doctor about hepatitis B if you believe you may have been exposed to the disease.
What Is Being Tested
Hepatitis B is an infection of the liver caused by the hepatitis B virus . Hepatitis B blood tests detect viral proteins , the antibodies that are produced in response to an infection, or detect or evaluate the genetic material of the virus. The pattern of test results can identify a person who has a current active infection, was exposed to HBV in the past, or has immunity as a result of vaccination.
For details on the various tests, see the table under Common Questions: How is it used?
Hepatitis is a condition characterized by inflammation and, sometimes, enlargement of the liver. It has various causes, one of which is infection by a virus. HBV is one of five “hepatitis viruses” identified so far that are known to mainly infect the liver. The other four are hepatitis A, hepatitis C, hepatitis D, and hepatitis E.
HBV is spread through contact with blood or other body fluids from an infected person. Exposure can occur, for example, through sharing of needles for IV drug use or through unprotected sex. People who live in or travel to areas of the world where hepatitis B is prevalent are at a greater risk. Mothers who are infected can pass the infection to their babies, usually during or after birth. The virus is not spread through casual contact such as holding hands, coughing or sneezing. However, the virus can survive outside the body for up to seven days, including in dried blood, and can be passed by sharing items such as razors or toothbrushes with an infected person.
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How Can I Help Stop The Spread Of Hepatitis B Virus From Mother To Child
The Problem: Although an estimated 95% of pregnant women receive prenatal hepatitis B surface antigen testing, fewer than half of the expected births to HBsAg-positive women are identified. Laboratory reports are required to include gender and age/date of birth, but pregnancy status is not typically reported to health departments.
The Solution: All laboratories providing HBsAg-testing services should be encouraged to capture pregnancy status for women tested for HBsAg to aid in identification of HBV-infected pregnant women.
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?
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