How do I order a Hepatitis B (HB) titer?

How to Order a Hepatitis B Titer

To order a Hepatitis B titer, request a quantitative Hepatitis B surface antibody (anti-HBs) test, which should be performed 1-2 months after completing the vaccination series to determine immunity status. 1

Understanding Hepatitis B Titers

A Hepatitis B titer measures the level of antibodies against the Hepatitis B surface antigen (anti-HBs) in the blood. This test is used to:

• Determine if a person has developed immunity after vaccination
• Assess the need for revaccination or booster doses
• Evaluate immunity status before potential exposure (especially for healthcare workers)

Specific Test to Order

When ordering a Hepatitis B titer, specify:

• Quantitative Hepatitis B surface antibody (anti-HBs)
• Request results in mIU/mL (international units)

When to Order Hepatitis B Titers

Hepatitis B titers should be ordered in the following situations:

• 1-2 months after completing the Hepatitis B vaccination series 1
• For healthcare personnel (HCP) upon hire or matriculation 1
• For specific high-risk populations:
  • Hemodialysis patients (annually) 1
  • Immunocompromised persons 1
  • After exposure to HBV-positive blood or body fluids 1

Interpreting Results

• Anti-HBs ≥10 mIU/mL: Considered protective (immune) 1
• Anti-HBs <10 mIU/mL: Not protective (non-immune) 1

Follow-up Actions Based on Results

For immunocompetent persons:

• Anti-HBs ≥10 mIU/mL: No further testing or vaccination needed 1, 2
• Anti-HBs <10 mIU/mL after primary series: Revaccination recommended 1

For healthcare workers:

• Anti-HBs <10 mIU/mL: Administer one additional dose of HepB vaccine, followed by anti-HBs testing 1-2 months later 1
• If anti-HBs remains <10 mIU/mL: Complete a second series (total of 6 doses), followed by repeat testing 1

For hemodialysis patients:

• Annual anti-HBs testing recommended 1
• Booster dose when anti-HBs levels decline to <10 mIU/mL 1, 2

For immunocompromised persons:

• Consider annual anti-HBs testing and booster doses 1, 2

Important Considerations

• Different assays may have different cutoff values, so refer to the specific test's package insert for accurate interpretation 1
• For post-exposure testing, timing is critical - testing should be performed 1-2 months after vaccination 1
• For healthcare workers who received HBIG (Hepatitis B Immune Globulin), anti-HBs testing should be delayed until HBIG is no longer detectable (approximately 6 months) 1

Common Pitfalls to Avoid

• Ordering the wrong test: Don't confuse anti-HBs (surface antibody) with HBsAg (surface antigen) or anti-HBc (core antibody)
• Testing too early: Testing before 1-2 months after vaccination may not accurately reflect immunity
• Unnecessary testing: Routine periodic testing is not recommended for immunocompetent persons who have documented immunity 1, 2, 3
• Misinterpreting declining antibody levels: In immunocompetent individuals, protection persists even when antibody levels fall below 10 mIU/mL due to immunologic memory 2, 3

By following these guidelines, you can appropriately order and interpret Hepatitis B titers to ensure proper immunity assessment and management.