Interpretation Of Hepatitis A Serologic Test Results

Submission And Collection Notes

, including immunity and/or diagnostic, are available to assist with completing the Hepatitis Serology boxes in section 3 of the General Test Requisition.

For testing all Hepatitis markers, HIV, HTLV, Syphilis and Rubella, you only are required to submit two FULL red top or serum separator tubes .

Do NOT submit glass tubes.

How It Is Done

The health professional taking a sample of your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure on the site and then put on a bandage.

Clinical Information Discusses Physiology Pathophysiology And General Clinical Aspects As They Relate To A Laboratory Test

Hepatitis A virus is endemic throughout the world, occurring most commonly, however, in areas of poor hygiene and low socioeconomic conditions. The virus is transmitted primarily by the fecal-oral route, and it is spread by close person-to-person contact and by food- and water-borne epidemics. Outbreaks frequently occur in overcrowded situations and in high-density institutions and centers, such as prisons and health care or day care centers. Viral spread by parenteral routes is possible but rare, because infected individuals are viremic for a short period of time . There is little or no evidence of transplacental transmission from mother to fetus or transmission to newborn during delivery.

Serological diagnosis of acute viral hepatitis A depends on the detection of specific anti-HAV IgM. Its presence in the patient’s serum indicates a recent exposure to HAV. HAV-specific IgM antibody level becomes detectable in the blood by 4 weeks after infection, persisting at elevated levels for about 2 months before declining to undetectable levels by 6 months. They rarely persist beyond 12 months after infection.

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What To Think About

• Hepatitis A can be prevented by vaccination. To learn more, see the topic Immunizations.
• You also may be able to prevent a hepatitis A infection even after you have been exposed to the virus if you get a hepatitis A vaccination or a dose of immunoglobulin. To learn more, see the topic Hepatitis A.
• Hepatitis antibodies can take weeks or months to develop, so they might not show up in a test done early in the infection.
• Tests that show how well your liver is working are usually done if your doctor thinks you may have hepatitis. These tests may include measuring bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase.

Serological Testing For Hepatitis A Immunity Is Not Routinely Recommended But May Be Appropriate For Some People

Serological testing for immunity to hepatitis A is not routinely recommended before receiving hepatitis A vaccine.

It is also inappropriate to test people who cannot remember whether they have ever had a hepatitis A vaccine. If a person is recommended for vaccination and has no records of previous vaccination, they should receive a vaccine.

However, certain groups of people should be screened for natural immunity to hepatitis A to avoid unnecessary vaccination:

• people who were born before 1950
• people who spent their early childhood in hepatitis Aendemic areas
• people with an unexplained previous episode of hepatitis or jaundice

People with unexplained jaundice should also be tested for other causes of hepatitis, including hepatitis B.

These people may need to be tested for total hepatitis A antibodies or IgG antibodies against hepatitis A virus. A positive test indicates immunity to hepatitis A. People who are immune do not need hepatitis A vaccination.

To better interpret serological testing results, discuss them with the laboratory that performed the test. Ensure that the laboratory receives the relevant clinical information.

Serological testing to assess immunity after vaccination against hepatitis A is neither necessary nor appropriate. This is because, even in persons who are likely immune, antibody titres are often below the detection limits of the routinely available commercial tests for antibodies against hepatitis A virus.7

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When Should I Get Hepatitis A Testing

Doctors often recommend testing for hepatitis based on a patients medical history, symptoms, and a physical exam.

Most adults with hepatitis A have symptoms that develop around 28 days after infection. Children under six years old rarely have symptoms. Symptoms of hepatitis A include:

• Dark urine
• Diarrhea and stool that is gray- or clay-colored
• Fatigue
• Nausea, vomiting, or loss of appetite
• Yellow eyes and skin, also called jaundice

Doctors may recommend hepatitis A testing in patients with symptoms and a known exposure to HAV or an elevated risk of contracting this disease. Factors that increase the risk of exposure to hepatitis A include:

• Travel, especially to Asia, South America, Central America, Africa, and the Middle East
• Using intravenous drugs and the use of illegal drugs
• Living in a nursing home
• Working in industries involving health care, food, or sewage
• Eating raw shellfish, vegetables, and other foods

In patients who develop symptoms of hepatitis A without a known exposure to the virus, doctors may recommend an acute viral hepatitis panel that looks for hepatitis A, hepatitis B, and hepatitis C in the same blood sample.

Time For Processing Hcv Ab Test Results

The turnaround time for 3rd-generation EIAs is at least 1 day. Many labs do not perform the tests on site and must send specimens to another lab for processing, which may further increase the turnaround time.

A point-of-care test is also available. The OraQuick® HCV Rapid Antibody Test is an FDA-approved test that can be performed with a fingerstick . It is also a CLIA-waived test and therefore can be used in clinic offices and outreach facilities. Results are reported as reactive or nonreactive within 20 minutes. Just as for the standard HCV Ab test done in the lab, a positive OraQuick® test must be confirmed by an HCV RNA test. The sensitivity and specificity of the test is similar to that of the laboratory-based assays.

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Appropriate Uses Of The Hcv Rna Test

There are 4 major reasons that HCV RNA tests are used:

More rarely, HCV RNA is used when either very acute HCV infection is suspected or a false HCV Ab is suspected.

It would not be appropriate to repeatedly order HCV RNA viral load screening for a patient who is not on or was recently on HCV treatment, or to use the HCV viral load to determine the severity of the patient’s infection or the patient’s risk of developing significant liver disease.

Interpreting Hcv Rna Test Results

It is essential that the provider understands how to interpret HCV RNA test results, especially during the course of HCV treatment.

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Questions For Your Doctor About Test Results

For support in understanding the results of hepatitis A testing, patients should discuss results with their doctor. Questions about test results may include:

• What is my test result?
• Do I have a hepatitis A infection?
• Does the test result suggest that I have immunity to the hepatitis A virus?
• Would I benefit from hepatitis A vaccination?
• Do I need any follow-up tests based on my hepatitis A test results?

Meaning Of Hcv Viral Load

The number of HCV RNA international units per milliliter of blood must be measured before treatment and during the course of treatment, to assess response. Before treatment, however, the HCV viral load is not related to the patient’s liver disease severity or HCV prognosis. This is important for patients and providers to understand.

Note: In hepatitis B, unlike hepatitis C, a higher HBV DNA viral load does correlate with increased disease severity and increased likelihood of outcomes such as hepatocellular carcinoma.

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All Tools & Resources

The ABCs of Hepatitis Fact Sheet

This three page table on Hepatitis A, B, and C provides an overview of statistics, transmission, risk factors, clinical features, screening, testing and vaccination recommendations.Color pdf icon

Hepatitis B Online

Learn how to diagnose, monitor, manage, and prevent hepatitis B virus infection and earn free CE on the University of Washingtons Hepatitis B Online.external icon This site also hosts a new, simplified guidanceexternal icon for primary care providers developed by the multi-disciplinary HBV Primary Care Workgroup.

The Pink Book -Epidemiology & Prevention of Vaccine-Preventable Diseases

Includes a description of the disease, pathogenesis, clinical features, laboratory diagnosis, medical management, epidemiology, risk factors, trends in the United States, vaccine details, vaccination schedule and use, contraindications and precautions to vaccination, adverse reactions following vaccination, vaccine storage and handling, and reference or publications.Hepatitis B Chapter pdf icon

Interpretation of Hepatitis B Serologic Test Results

This one page tool describes the four most common tests used in hepatitis B serologic testing and provides guidance to interpret different patterns of test results.Summary Table: pdf icon

Recommendations for Routine Testing and Vaccination for Chronic Hepatitis B virus Infection

Interpretation of Results of Tests for Hepatitis C Virus Infection and Further Actions

Hepatitis C Online

Test Frequency And Turnaround Time

Hepatitis C Serology testing is performed daily Monday to Friday.

Turnaround time is up to 3 days from receipt by PHO laboratory for Non-reactive antibody results. Reactive and Indeterminate HCV antibody results are available and reported within 6 days.

Repeat testing may be indicated in those with ongoing risk factors for the acquisition of HCV.

Once a patient tests positive for HCV antibodies, other than in cases of maternal antibody transfer, there is no value in repeating the test as they will remain antibody positive for life regardless of whether they have cleared the virus or are chronic carriers.

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Specific Hcv Rna Assays And Range Of Detectable Virus

HCV RNA tests use target amplification techniques. Several assays exist for HCV RNA testing. Methods include polymerase chain reaction , transcription mediated amplification , and branched chain DNA tests. Results are expressed as international units/mL . The different methods and different commercial assays each have a lower limit of quantification and lower limit of detection , therefore a patient’s results could be reported differently depending on the assay used. HCV RNA tests must have an LLOQ of 25 IU/mL or lower when used to assess treatment response with DAAs.

LLOQ = the lowest HCV RNA level that is within the linear and analytically acceptable range of the assay.

LLOD = the lowest level of HCV RNA that is detected 95% of the time.

Interpreting The Hepatitis B Serologic Panel

The hepatitis B blood tests are collectively known as the serologic panel. This set of tests can accurately diagnose current and past hepatitis B infection. Since there are a number of markers and at least six interpretations of the various results, determining their meaning can be challenging. To help clarify, below are the six interpretations organized in a table from these hepatitis B markers.

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How To Get Tested

Hepatitis A testing uses a sample of blood to test for antibodies against the hepatitis A virus. When prescribed by a doctor, a blood sample may be collected in a hospital or other medical setting and sent to a laboratory for analysis.

Blood is usually drawn from a vein in the patients arm or the back of the hand.

What Does The Test Measure

To determine if viral hepatitis is caused by the hepatitis A virus, hepatitis A testing looks for certain antibodies. Antibodies are substances made by the immune system in response to infection with a virus such as hepatitis A.

Hepatitis A testing looks for two types of antibodies. Antibodies are part of the bodys protective response to a viral infection, and hepatitis A virus antibodies may be measured by a few different tests:

• Hepatitis A immunoglobulin M antibody test: When a person is first infected with hepatitis A, the body produces IgM anti-HAV antibodies. These antibodies are usually detectable from two weeks after symptoms begin to around six months later.
• Hepatitis A immunoglobulin G antibody test: The IgG anti-HAV antibody test detects IgG antibodies that develop later in the course of the disease. IgG antibodies are detectable in the body for life, providing protection against a future hepatitis A virus infection. The IgG anti-HAV test is used to detect past HAV infections and may occasionally be used to determine if an individual has developed immunity from a previous infection or vaccination.
• Total hepatitis A antibody test: The total HAV antibody test detects both IgM and IgG antibodies and thus is used to identify both current and past infections.

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Hepatitis A Infection Is Typically Diagnosed Through Blood Tests

The various human hepatitis viruses cause very similar symptoms. Therefore, neither the individual nor the healthcare provider can tell by symptoms or signs if a given individual is suffering from hepatitis A unless laboratory tests are performed.

Fortunately, blood tests are widely available to accurately diagnose hepatitis A, including tests for antibodies, or the affected persons immune response to hepatitis A proteins. This immune response is conclusively demonstrated by the presence of Immunoglobulin M antibodies, indicating acute disease, and immunoglobulin G , indicating a past infection or vaccination. The IgG antibodies are present for life, indicating immunity.

HAV RNA is present in blood and feces soon after infection , until 1 to 2 weeks after the onset of symptoms. Longer shedding in feces can occur in children and those infected with HIV. HAV is also shed in saliva and urine, but no assays are available to detect this.

Following is some guidance for the interpretation of the test results:

Previous Chapter

Understanding Your Test Results

Understanding your hepatitis B blood tests can be confusing. It is important to talk to your health care provider so you understand your test results and your hepatitis B status. Are you infected? Protected? Or at risk? The Hepatitis B Panel of blood tests includes 3 tests and all three results must be known in order to confirm your status.

Below is a chart with the most common explanation of the test results, but unusual test results can occur. Please note that this chart is not intended as medical advice, so be sure to talk to your health care provider for a full explanation and obtain a printed copy of your test results. In some cases, a person could be referred to a liver specialist for further evaluation.

More Detailed Information About Hepatitis B Blood Tests

An acute hepatitis B infection follows a relatively long incubation period – from 60 to 150 days with an average of 90 days. It can take up to six months, however, for a person to get rid of the hepatitis B virus. And it can take up to six months for a hepatitis B blood test to show whether as person has recovered from an acute infection or has become chronically infected .

The following graphic from the U.S. Centers for Disease Control and Prevention represents the typical course of an acute hepatitis B infection from first exposure to recovery.

According to the CDC, a hepatitis B blood test result varies depending on whether the infection is a new acute infection or a chronic infection.

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Why It Is Done

Hepatitis virus testing is done to:

• Identify the type of hepatitis virus causing the infection.
• Screen people who have a higher chance of getting or spreading hepatitis A. This includes doctors, dentists, and nurses.
• Screen blood donors and donor organs. This is done to help prevent the spread of hepatitis A.
• Find out if a person has antibodies after getting a hepatitis A vaccination. Having antibodies means the vaccine worked.
• Find out if hepatitis A is the cause of abnormal liver function tests.

How Much Does The Test Cost

When ordered by a doctor, testing for hepatitis A may be paid for by a patients health insurance coverage. Health plans vary, so its important for patients with health insurance to talk to an administrator about the cost of testing, including any copays or deductibles that may be required.

If a patient doesnt have health insurance coverage that covers hepatitis A testing, it may be helpful to discuss the cost of testing with a doctor. The total cost can include the office visit, the blood draw, and technician fees in addition to the cost of laboratory testing.

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Preparation Prior To Transport

Label the specimen container with the patients full name, date of collection and one other unique identifier such as the patients date of birth or Health Card Number. Failure to provide this information may result in rejection or testing delay.

Centrifuge if using SST. Place specimen in biohazard bag and seal. Specimens should be stored at 2-8°C following collection.