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Quest Diagnostics Hepatitis B Titer

Hepatitis B Vaccine And Surface Antibody Titer Faqs

Boston Hepatitis Free Education and Screening Events – Team HBV and Quest Diagnostics PSA 60 Sec

PLEASE NOTE: This is program specific some programs require 3 Hepatitis B vaccines AND a positive Hepatitis B Surface Antibody titer while others will accept 3 vaccines OR a titer. Please read the information in your CastleBranch account carefully so that you know exactly what you need to meet your programs requirements. If you have any questions, please email and a team member will respond.

How Is It Used

The main uses for hepatitis B virus tests include:

  • To determine whether acute signs and symptoms, such as jaundice, fever and fatigue, are due to hepatitis B infection two tests, hepatitis B surface Ag and hepatitis B core antibody IgM, may be performed as part of an acute viral hepatitis panel along with tests for hepatitis A and hepatitis C to determine which virus may be causing the infection.
  • To diagnose chronic HBV hepatitis
  • To monitor chronic hepatitis B infection and its treatment
  • To detect a previous, resolved hepatitis B infection, in a person who is immune compromised or who has hepatitis C and in whom treatment is planned
  • 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:

    Question 5 How Can Quantitative Hbsag Levels Help Distinguish The Different Phases Of Hbv Infection

    Quantitative HBsAg results, along with selected immunologic and virologic characteristics, may help differentiate infection phases and inform prognosis and therapeutic decision-making. For example, the HBeAg-negative inactive carrier state may be identified by low HBV DNA and low HBsAg in patients with certain genotypes.2 Low serum HBsAg levels measured 1 year after documented HBeAg seroconversion may predict subsequent HBsAg loss in HBV genotype B or C infection.5 It has been documented that a drop in HBsAg levels in patients who are on NA treatment can predict subsequent HBsAg loss. The observed decrease in HBsAg concentration may help predict HBsAg loss and support the decision to discontinue peg-IFN and/or NA therapy.

    Peg-interferon and/or NA treatment may lead to reductions in HBsAg. In general, sustained responders display greater and/or more rapid HBsAg decline than non-responders.1-2,4-6 The quantitative HBsAg level that best predicts sustained virologic response has yet to be well established. However, some experts consider 2 or more measurements of HBsAg below the assayâs lower limit of detection obtained â¥6 months apart to be a potentially useful endpoint for antiviral therapy.9-11

    Recommended Reading: What Are Some Symptoms Of Hepatitis

    Question 9 Which Method Is Used To Determine Quantitative Hbsag Levels

    Quest Diagnostics uses an immunoassay method for quantitative HBsAg testing. The method employs the Ortho Vitros® system to construct a standard curve for the quantitative result calculation. The WHO 3rd International standard reference serum was used to verify the values established for the calibration standard. Results are reported in IU/mL.


  • Wong G, Chan H. Use of quantitative hepatitis B surface antigen with hepatitis B virus DNA in clinical practice. Clin Liver Dis. 2013 2:8-10.
  • Henry Lik-Yuen Chan HL, Thompson A, Martinot-Peignoux M, et al. Hepatitis B surface antigen quantification: why and how to use it in 2011âa core group report. J Hepatol. 2011 55:1121â1131.
  • Edouard Tuaillon , Anne-Marie Mondain, Nicolas Nagot, et al. Comparison of serum HBsAg quantitation by four immunoassays, and relationships of HBsAg level with HBV replication and HBV genotypes. PLoS One. 2012 7:e32143.
  • Andersson KL, Chung RT. Monitoring during and after antiviral therapy for hepatitis B. Hepatology. 2009 49:S166âS173.
  • Tseng T, Liu C, Su T, et al. Serum hepatitis B surface antigen levels predict surface antigen loss in hepatitis B e antigen seroconverters. Gastroenterology. 2011 141:517â525.
  • Kranidiotia H, Manolakopoulosb S, Khakooa SI. Outcome after discontinuation of nucleotide analogues in chronic hepatitis B: relapse rate and associated factors. Ann Gastroenterol. 2015 28:173-181.
  • Seth AK. HBsAg quantification in clinical practice. J Clin Exp Hepatol. 2012 2:75-80.
  • Sequence Following An Initial Negative Hepatitis B Surface Antibody Titer

    Titer Test Near You

    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.
  • Read Also: Hepatitis C Antibody Reactive Meaning

    Question 2 How Is Quantitative Different From Qualitative Hbsag Testing

    Qualitative HBsAg testing is recommended to screen patients at risk for HBV infection and is the test recommended for initial diagnosis. It may also be useful to determine vaccine responses for selected patients. In contrast, quantitative HBsAg testing is not recommended for initial diagnosis, but it is useful for disease and treatment monitoring .

    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.

    Recommended Reading: How Do You Know You Have Hepatitis B

    What Is The Hbeag Test

    The HBeAg test is used to detect the presence of the active hepatitis B virus. If a person is infected with this virus, the level of HBeAg and also HBsAg will be high. The presence of HBeAg in the blood is associated with hepatitis B virus infectivity, the number of infectious virions present in the body, and the presence of HBV core antigen in the infected liver cells.

    Should I Get The Hbv Vaccine

    Boston Hepatitis Free Education and Screening Events – Team HBV and Quest Diagnostics PSA 60 Sec

    The Centers for Disease Control and Prevention recommends that adults in high-risk groups get vaccinated. Some of these groups include people:

    • In close contact with someone who has hepatitis B
    • Who undergo dialysis
    • With chronic liver or kidney disease
    • With HIV or who seek treatment for other sexually transmitted diseases or drug treatment
    • Who travel to countries where hepatitis B is common
    • Who are healthcare workers with potential exposure to HBV

    Unless there is something in your medical history to the contrary, it is prudent to get the series of vaccinations. Babies, children and adolescents are routinely given the series of shots if you have already been vaccinated, you probably are protected for many years, perhaps for life, and will not usually need to get the vaccine again.

    Don’t Miss: Hepatitis B And C Can Be Spread By

    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


  • Centers for Disease Control and Prevention. Hepatitis B. . Accessed May 30, 2013.
  • Ganem D, Prince AM. Hepatitis B virus infectionnatural history and clinical consequences. N Engl J Med. 2004 350:1118-1129.
  • 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

    Quest, Quest Diagnostics, the associated logo, Nichols Institute, and all associated Quest Diagnostics marks are the registered trademarks of Quest Diagnostics. All third-party marks®’ and ‘are the property of their respective owners. © 2000- 2021 Quest Diagnostics Incorporated. All rights reserved.Image content features models and is intended for illustrative purposes only.

    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

    Read Also: How Do I Know If I Have Hepatitis B

    Find A Quest Lab Near Me

    Who needs a titer?

    Students in many healthcare programs and clinicians and reps often need to show proof their vaccines have effectively worked and they have immunity to the diseases they may be exposed to in student clinicals or work settings. We are a local business having been in Stafford since 2006 and have provided vaccines, TB testing, Drug testing and titer testing to thousands of individuals in that time. We are recognized by many vendor credentialing services like Castle Branch, Vendormate, Intellicentrics, symplr, Vendormate, Parallon, RepTrax and more.

    There are many titers but, we perform Quantitative titers that display numerical values which is what the schools and employment places require. The results measure the presence and amount of antibodies in blood.

    Most healthcare programs, colleges and universities require students to provide proof that they are up to date on their vaccinations before they can enroll. You may not be able to show proof due to unfortunate events like floods, fires, lost records, etc. So, then a titer is a low cost way and faster alternative to re-immunizing all over again and provides record of immunity.

    If you never had the vaccine to prevent the disease nor had the disease itself you should not waste money on a titer for that disease but, vaccinate.

    When do I get my results?

    What do titers cost?

    We accept payments via Paypal .

    Do I have to pay more at the lab?No. The lab will simply draw your blood.

    How do I get started?

    Question 2 What Is The Hepatitis B Surface Antibody

    Custom Lab Testing Near You

    The hepatitis B surface antibody is the antibody that is produced in response to hepatitis B surface antigen , a protein present on the surface of the hepatitis B virus. Anti-HBs appears after convalescence from acute infection and lasts for many years. It can also be produced in response to hepatitis B vaccination.

    Other hepatitis B antibodies are not produced in response to vaccination. This is because these antigens are not in the vaccine.

    Also Check: What Form Of Hepatitis Is Sexually Transmitted

    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

    What Are The Different Types Of Hepatitis B

    In most of the adult cases of hepatitis B , the virus is completely cleared from the body upon treatment. However, the remaining 5% can go on to develop chronic forms of the disease. It has been observed that within 6 months of the treatment, most people not only clear the virus but also become immune to the same. In general, there are 3 distinct types of hepatitis B infections seen:Healthy Chronic Carriers These people carry the virus but dont develop any symptoms. They are not infectious to others but have a higher risk of developing hepatic conditions such as cirrhosis. However, if the immune system in such individuals gets suppressed owing to an infection or treatment via immunosuppressant drugs, there are chances that they may develop hepatitis B infection. Chronic Infectious Carriers They are the contagious carriers of the disease as they have virus replicating in their systems. They show signs of hepatitis such as damaged liver that progresses into liver cirrhosis. Only 5% of the cases can show remission of the virus.Chronic Mutant The chronic mutant form is a result of a mutated strain of the virus that causes permanent alteration to the hepatitis B viruss genetic makeup. Those with it have the risk of being infectious to others and it is observed to be more resistant to treatment than other forms of hepatitis B.

    Recommended Reading: What Is Autoimmune Hepatitis C

    What Does The Test Result Mean

    The tests for hepatitis B may be ordered individually but are often ordered in some combination, depending on the reason for testing. Results of the tests are typically evaluated together. Sometimes the meaning of one result depends on the result of another test. However, not all tests are performed for all people.

    The table below summarizes possible interpretations of some common patterns of results.

    Initial Tests
    None detected or detected at very low level Chronic infection but low risk of liver damage carrier state

    *Note: There are some types of HBV that do not make e-antigen. In areas where these strains of HBV are common , testing for HBeAg is not very useful. In these cases, a negative HbeAg result does not necessarily mean that the person is not infectious it may be that the person is infected with a strain that does not make the e-antigen.

    Monitoring treatment of chronic infection: If the results from initial and follow-up testing indicate that a person has chronic hepatitis B, then the individual may be treated with medication and the effectiveness of that treatment may be monitored using the tests for HBe and HBs antigen and antibody and HBV DNA:

    Hepatitis B Blood Tests

    Team HBV At Harvard PSA With Screening Donated By Quest Diagnostics

    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.
  • Recommended Reading: What Is Hepatic Steatosis Mean

    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:

    • Fever
    • Joint pain
    • Jaundice

    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.

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