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HelpTest ID: HBPES Hepatitis B Virus Past Exposure Panel, Serum
Necessary Information
Date of collection is required.
Specimen Required
Patient Preparation: For 24 hours before specimen collection, patient should not take multivitamins or dietary supplements (eg, hair, skin, and nail supplements) containing biotin (vitamin B7).
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube: Serum gel (red-top tubes are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 1.2 mL
Collection Instructions:
1. Centrifuge blood collection tube per manufacturer's instructions (eg, centrifuge and aliquot within 2 hours of collection for BD Vacutainer tubes).
2. Aliquot serum into plastic vial.
Useful For
Screening for past exposure to hepatitis B virus (HBV)
Determining HBV infection and immunity status prior to initiating chemotherapy or other immunosuppressive agents
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HBGSN | HBs Antigen Scrn, S | Yes | Yes |
| HBCSN | HBc Total Ab Scrn, S | Yes | Yes |
| HBBSN | HBs Antibody Scrn, S | Yes | Yes |
Testing Algorithm
If hepatitis B surface antigen (HBsAg) is reactive, then HBsAg confirmation will be performed at an additional charge.
For more information see Hepatitis B: Testing Algorithm for Screening, Diagnosis, and Management
Special Instructions
Method Name
Electrochemiluminescence Immunoassay (ECLIA)
Reporting Name
Hepatitis B Past Exposure, SSpecimen Type
Serum SSTSpecimen Minimum Volume
0.9 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum SST | Frozen (preferred) | 90 days | |
| Refrigerated | 6 days | ||
| Ambient | 7 hours |
Clinical Information
Hepatitis B virus (HBV) is a DNA virus that is endemic throughout the world. HBV is transmitted parenterally or percutaneously from exposure to contaminated blood, blood products, or injection needles, sexually from exposure to body fluids from infected individuals, or perinatally from mother to child during birth delivery by contact with infected mother's blood and vaginal secretions. Transplacental transmission from mother to fetus is uncommon.
HBV persists and causes chronic infection (defined as being positive for hepatitis B virus surface antigen [HBsAg] in serum or plasma for minimum 6 months) in about 10% of individuals who had acute infection during childhood. These individuals may become asymptomatic HBV carriers (ie, inactive chronic hepatitis B), while others may develop chronic liver diseases including cirrhosis and hepatocellular carcinoma. Asymptomatic HBV carriers are at risk (up to 50%) for decompensation of liver function with acute HBV replication (ie, HBV reactivation) during immunosuppression from chemotherapy, immunosuppressive therapy, or organ transplantation.
Individuals who recovered from acute hepatitis B (defined as being negative for HBsAg, positive for HBc total antibodies, negative or positive for HBs antibody) are at lower risk (up to 20%) of HBV reactivation than those with inactive chronic hepatitis B during immunosuppressive therapy or organ transplantation.
For individuals born in regions of the world where HBV prevalence is moderate to high, universal HBV serologic screening before initiation of immunosuppressive therapy is recommended. In the absence of systematic, risk-based testing, universal HBV serologic screening is an option to reduce the risk of missing persons with HBV infection prior to initiation of immunosuppressive treatment.
Interpretation
Hepatitis B virus surface antigen (HBsAg) is the first serologic marker appearing in blood 6 to 8 weeks after exposure to hepatitis B virus (HBV). A confirmed positive HBsAg result is indicative of acute or chronic hepatitis B. In acute cases, HBsAg usually disappears 1 to 2 months after the onset of symptoms. Persistence of HBsAg for more than 6-months duration indicates development of either a chronic carrier state or chronic hepatitis B.
Hepatitis B virus surface antibody (anti-HBs) appears with the resolution of HBV infection and disappearance of HBsAg. A positive result indicates recovery from acute or chronic hepatitis B or acquired immunity from HBV vaccination. This assay does not differentiate between a vaccine-induced immune response and recovery from HBV infection. Per assay manufacturer’s instructions for use, positive results are defined as anti-HBs levels of 11.5 mIU/mL or greater, with adequate immunity to hepatitis B after recovery from past infection or HBV vaccination. Per current Centers for Disease Control and Prevention guidance, individuals with anti-HBs levels of 10 mIU/mL or greater after completing an HBV vaccination series are considered protected from hepatitis B infection.
Negative anti-HBs results, defined as anti-HBs levels of less than 8.5 mIU/mL, indicate a lack of recovery from acute or chronic hepatitis B or inadequate immune response to HBV vaccination.
Indeterminate anti-HBs results, defined as anti-HBs levels in the range of 8.5 to 11.5 mIU/mL, indicate inability to determine if anti-HBs is present at levels consistent with recovery or immunity. Repeat testing in 1 to 3 months is recommended to determine definitive anti-HBs status.
Hepatitis B virus core (HBc) total and IgM antibodies appear shortly after the onset of symptoms of HBV infection and may be the only serologic marker remaining years after exposure to HBV. A positive result indicates exposure to HBV infection. A positive anti-HBs result along with a positive HBc total antibody result is indicative of recovery from HBV infection. A positive anti-HBs result with a negative HBc total antibody result is consistent with immunity to hepatitis B from HBV vaccination.
Summary of interpretation of the various HBV serologic test result profiles is provided in the table below:
|
HBV serologic test results |
Interpretation |
||
|
HBsAg |
HBc total Ab |
HBsAb |
|
|
+ |
+ |
- |
Chronic hepatitis B |
|
- |
+ |
+ |
Past HBV infection |
|
- |
+ |
- |
Past HBV infection or possible false-positive test result |
|
- |
- |
+ |
Immunity from HBV vaccination |
|
- |
- |
- |
No previous exposure to hepatitis B virus (not immune) |
Clinical Reference
1. LeFevre ML, et al: Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014; 161(1):58-66. doi:10.7326/M14-10182
2. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018; 67(4):1560-1599. doi:10.1002/hep.29800
3. Centers for Disease Control and Prevention: Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018; 67(1):1-31. Accessed December 21.Available at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.PDF
4. Centers for Disease Control and Prevention (CDC), Division of Viral Hepatitis: Interpretation of hepatitis B serologic test results. CDC; Accessed December 21, 2023. Available at www.cdc.gov/hepatitis/hbv/interpretationOfHepBSerologicResults.htm
5. Centers for Disease Control and Prevention: Screening and testing for hepatitis B virus infection: CDC Recommendations – United States, Updated August 10,2023. Accessed December 21,2023. Available at www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm?s_cid=rr7201a1_w
Day(s) Performed
Monday through Saturday
Report Available
Same day/1 to 3 daysTest Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
86706
86704
87340
87341 (if appropriate)
G0499 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| HBPES | Hepatitis B Past Exposure, S | 77190-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| HBCSN | HBc Total Ab Scrn, S | 13952-7 |
| HBAGS | HBs Antigen Scrn, S | 5196-1 |
| HBASN | HBs Antibody Scrn, S | 10900-9 |
| HBSQN | HBs Antibody, Quantitative, S | 5193-8 |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| HBGSC | HBs Antigen Screen Confirmation, S | No | No |
mml-hepatitis