How is hepatitis B immunity confirmed through testing?

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Last updated: June 23, 2025 • View editorial policy

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From the Guidelines

Hepatitis B immunity is confirmed through blood tests that measure specific antibodies in the bloodstream, with a level of anti-HBs greater than or equal to 10 mIU/mL indicating immunity and protection against hepatitis B infection. The most definitive test is the hepatitis B surface antibody (anti-HBs) test, which detects antibodies produced in response to the hepatitis B surface antigen 1. This immunity can develop either from successful vaccination or from recovery after a natural infection. For those who have recovered from a natural infection, the hepatitis B core antibody (anti-HBc) will also be positive, while vaccinated individuals will only have the anti-HBs antibody present. Sometimes healthcare providers may also test for hepatitis B surface antigen (HBsAg) to ensure there is no active infection.

Key Points to Consider

  • Postvaccination serologic testing should consist of testing for anti-HBs and HBsAg, and should be performed 1–2 months after administration of the final dose of the vaccine series 1.
  • Persons found to have anti-HBs concentrations of ≥10 mIU/mL after the primary vaccine series are considered to be immune, and do not need further periodic testing to assess anti-HBs levels unless they are immunocompromised 1.
  • Immunocompromised persons might need annual testing to assess anti-HBs concentrations, and those who do not have a protective concentration of anti-HBs after revaccination should be tested for HBsAg 1.
  • The interpretation of serologic test results for hepatitis B infection is crucial, and the presence of anti-HBs is generally indicative of immunity to HBV infection, while the presence of HBsAg indicates active infection 1.

Testing and Interpretation

  • The anti-HBs test is the most definitive test for confirming hepatitis B immunity, and a level of anti-HBs greater than or equal to 10 mIU/mL indicates immunity and protection against hepatitis B infection 1.
  • The hepatitis B core antibody (anti-HBc) test can also be used to diagnose hepatitis B infection, and is typically positive in individuals who have recovered from a natural infection 1.
  • The HBsAg test is used to diagnose active hepatitis B infection, and is typically positive in individuals who are infected with the virus 1.

Recommendations

  • All individuals who have completed the hepatitis B vaccine series should undergo postvaccination serologic testing to confirm immunity, and those who do not have a protective concentration of anti-HBs should be revaccinated or tested for HBsAg 1.
  • Healthcare providers and public safety workers at risk for blood or body fluid exposure should undergo regular testing to assess anti-HBs concentrations, and those who are immunocompromised should undergo annual testing 1.

From the FDA Drug Label

Antibody titers ≥10 mIU/mL against HBsAg are recognized as conferring protection against hepatitis B. Seroconversion is defined as antibody titers ≥1 mIU/mL.

Hepatitis B immunity is confirmed through testing by measuring antibody titers against HBsAg.

  • A titer of ≥10 mIU/mL is considered protective against hepatitis B.
  • Seroconversion is defined as an antibody titer of ≥1 mIU/mL. 2

From the Research

Hepatitis B Immunity Testing

Hepatitis B immunity can be confirmed through testing by checking for the presence of antibodies against the hepatitis B virus. The following tests are used to confirm immunity:

  • Hepatitis B surface antigen (HBsAg) test: This test checks for the presence of the hepatitis B virus in the blood.
  • Hepatitis B surface antibody (anti-HBs) test: This test checks for the presence of antibodies against the hepatitis B virus.
  • Hepatitis B core antibody (anti-HBc) test: This test checks for the presence of antibodies against the core antigen of the hepatitis B virus.

Interpretation of Test Results

The interpretation of test results is as follows:

  • Presence of anti-HBs: Indicates immunity to hepatitis B, either through vaccination or past infection.
  • Presence of anti-HBc: Indicates past infection with hepatitis B.
  • Presence of HBsAg: Indicates current infection with hepatitis B. According to 3, hepatitis B vaccination is recommended for health care workers, but there is a nonresponse rate of 5% to 32% and an unknown duration of immunity. The study recommends postvaccination testing within 1 to 2 months to document immunity, periodic anti-HBs monitoring, and booster vaccination to maintain protective titer levels.

Screening for Hepatitis B Antibodies

Screening for hepatitis B antibodies is recommended for patients with chronic liver disease, as acute hepatitis B can lead to more severe hepatic injury and a higher fatality rate in these patients. According to 4, testing for HBsAg and anti-HBs is considered the most efficient and reasonably cost-effective method to screen for hepatitis B serologic markers.

Efficacy of Hepatitis B Vaccine

The efficacy of hepatitis B vaccine in haemodialysis patients has been evaluated in a study 5. The study found that 87% of patients developed anti-HBs levels above 10 IU/l after primary vaccination, and an antibody titre above 100 IU/l following primary vaccination is necessary to maintain that level of antibody 1 year later.

Limitations of Hepatitis B Immunity Testing

There are limitations to hepatitis B immunity testing, as passively acquired antibody to hepatitis B surface antigen can be a pitfall in evaluating immunity to hepatitis B viral infections 6. Additionally, the absence of anti-hepatitis B surface antibody after vaccination does not necessarily mean absence of immune response, as T helper response and memory cells may also be induced by the vaccine 7.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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