Hepatitis B Surface Antibody Positive with Negative Surface Antigen and Core Antibody
This serologic pattern (HBsAg negative, HBsAb positive, HBcAb negative) indicates immunity to hepatitis B virus from successful vaccination, not from natural infection. 1, 2
What This Pattern Means
You have vaccine-derived immunity to hepatitis B. The Centers for Disease Control and Prevention confirms that this specific combination—negative HBsAg, positive HBsAb, and negative HBcAb—is the hallmark serologic pattern of successful hepatitis B vaccination. 1
You are protected against hepatitis B infection. The presence of HBsAb at levels ≥10 mIU/mL indicates protective immunity, and you cannot transmit hepatitis B to others because you have never been infected with the virus. 1, 2
The absence of HBcAb is the key distinguishing feature. Detection of HBsAb without HBcAb specifically distinguishes vaccine-derived immunity from immunity acquired through natural infection (which would show positive HBcAb). 2
Clinical Significance
No active or past infection exists. You have never been infected with hepatitis B virus—the immunity comes solely from vaccination. 1
You are not infectious and pose no transmission risk to others, as confirmed by the negative HBsAg. 1
No further routine testing is typically required in immunocompetent individuals, though annual screening with anti-HBs may be recommended in certain high-risk settings like dialysis units. 3
Special Considerations for Immunosuppression
If you require immunosuppressive therapy (such as chemotherapy, anti-CD20 monoclonal antibodies like rituximab, or high-dose corticosteroids), you should be monitored for potential loss of immunity. 1
The risk of HBV reactivation is minimal in individuals with vaccine-derived immunity because you lack HBcAb, meaning there is no prior natural infection that could reactivate. 1
This is fundamentally different from patients with resolved natural infection (who would be HBsAg negative, HBsAb positive, and HBcAb positive), who carry a 3-45% risk of HBV reactivation with immunosuppressive therapy. 3, 4
Common Pitfalls to Avoid
Do not confuse this pattern with resolved natural infection. Resolved infection would show positive HBcAb in addition to positive HBsAb—the negative HBcAb in your case definitively indicates vaccination rather than past infection. 2
Transient false-positive HBsAg can occur up to 18 days after vaccination (up to 52 days in hemodialysis patients), but this does not apply to your situation since your HBsAg is negative. 2
Passively acquired antibodies from blood product transfusion can rarely cause positive HBsAb without true immunity, but this is uncommon and typically occurs shortly after transfusion. 5