Interpretation of Hepatitis B Serology Results
A positive total Hepatitis B core antibody (IgG+IgM) with a negative IgM core antibody indicates a past resolved hepatitis B infection with immunity, not a result of hepatitis B vaccination.
Serological Pattern Interpretation
The serological pattern presented (negative Hepatitis B Core Antibody IgM with positive Total Hepatitis B Core Antibody) has a specific interpretation according to CDC guidelines:
| Serological Marker | Result | Interpretation |
|---|---|---|
| HBcAb IgM | Negative | Not an acute infection |
| HBcAb Total (IgG+IgM) | Positive | Prior exposure to hepatitis B virus |
This pattern indicates:
- Past resolved hepatitis B infection
- Not a recent/acute infection (negative IgM)
- The presence of total core antibodies indicates natural infection 1, 2
Why This Is Not From Vaccination
Hepatitis B vaccination produces a different serological pattern:
- Vaccine contains only hepatitis B surface antigen (HBsAg)
- Vaccination leads to production of surface antibodies (anti-HBs) only
- Vaccination does NOT produce core antibodies (anti-HBc) 2
The definitive serological pattern after vaccination is:
- HBsAg: Negative
- Total anti-HBc: Negative
- Anti-HBs: Positive 1
Complete Interpretation
To fully understand your hepatitis B status, additional testing is recommended:
- Hepatitis B Surface Antigen (HBsAg): To confirm you don't have active infection
- Hepatitis B Surface Antibody (anti-HBs): To determine if you have protective immunity
Possible interpretations based on complete testing:
- If HBsAg negative and anti-HBs positive: Resolved infection with immunity
- If HBsAg negative and anti-HBs negative: Past infection with waned antibodies or false positive anti-HBc 2
Clinical Implications
- Immunity Status: You likely have natural immunity from prior infection
- Infectiousness: If HBsAg is negative, you are not currently infected and cannot transmit the virus
- Vaccination: Not needed if you have natural immunity with protective levels of anti-HBs
- Medical Disclosure: Important to inform healthcare providers about your hepatitis B history, especially before immunosuppressive treatments 2
Common Pitfalls to Avoid
Misinterpreting isolated core antibody: An isolated positive total anti-HBc (without other markers) can have multiple interpretations including:
Assuming vaccination status: Core antibodies are never produced by vaccination alone 2
Missing reactivation risk: Patients with resolved hepatitis B can experience reactivation during immunosuppressive therapy 2
Your serological pattern definitively indicates past natural infection with hepatitis B virus, not immunity from vaccination.