8/1/23, 11:22 AM Interpretation of Hepatitis B Serologic Test Results | CDC

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Interpretation of Hepatitis B Serologic Test Results

Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies.
Different serologic “markers” or combinations of markers are used to identify different phases of HBV infection and to
determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or
vaccination, or is susceptible to infection.

Hepatitis B surface antigen (HBsAg):

A protein on the surface of hepatitis B virus that can be detected in high levels in serum during acute or chronic
hepatitis B virus infection. The presence of HBsAg indicates that the person is infectious, except when it might be
transiently positive within 30 days after a dose of hepatitis B vaccine (HepB). The body normally produces antibodies
to HBsAg as part of the normal immune response to infection. HBsAg is the antigen used to make HepB vaccine.
Hepatitis B surface antibody (anti-HBs):
The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection.
Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. Among vaccine
responders who completed a vaccine series, anti-HBs levels can decline over time, however the majority are still
immune and will mount a response when exposed to HBV.
Total antibody to hepatitis B core antigen (anti-HBc):
Appears at the onset of symptoms in acute hepatitis B, is a measure of both IgM and IgG, and persists for life. The
presence of total anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.
People who have immunity to hepatitis B from a vaccine do not develop anti-HBc.
IgM antibody to hepatitis B core antigen (IgM anti-HBc):
Positivity indicates recent infection with hepatitis B virus (<6 mos). Its presence indicates acute infection. IgM anti-HBc
should be ordered only when acute HBV infection is a concern.

Test and Result Interpretation Action

HBsAg—Positive Acute infection Link to hepatitis B care

Total anti-HBc — Positive
IgM anti-HBc — Positive
Anti-HBs — Negative

HBsAg — Positive Chronic Infection Link to hepatitis B care

Total anti-HBc — Positive
IgM anti-HBc — Negative1
Anti-HBs — Negative

HBsAg — Negative Resolved Infection Counsel about HBV infection reactivation risk
Total anti-HBc — Positive
Anti-HBs — Positive

HBsAg — Negative Immune from receipt of prior vaccination If no documentation of full vaccination, then
Total anti-HBc — Negative (if documented complete series) complete vaccine series per ACIP
Anti-HBs — Positive2 recommendations.

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8/1/23, 11:22 AM Interpretation of Hepatitis B Serologic Test Results | CDC

Test and Result Interpretation Action

HBsAg — Negative Only core antibody is positive. See possible interpretations and corresponding actions:
Total anti-HBc — Positive
Anti-HBs — Negative Resolved infection where anti-HBs levels Counsel about HBV infection reactivation risk
have waned

Occult Infection Link to hepatitis B care

Passive transfer of anti-HBc to an infant No action

born to an HBsAg-positive gestational
parent

A false positive, thus patient is Offer HepB vaccine per Advisory Committee on
susceptible Immunization Practices (ACIP)

A mutant HBsAg strain that is not Link to hepatitis B care

detectable by laboratory assay

HBsAg — Negative Susceptible, never infected (if no Offer HepB vaccine per ACIP recommendations
Total anti-HBc — Negative documentation of HepB vaccine series
Anti-HBs — Negative3 completion)

1
IgM anti-HBc also might be positive in persons with chronic infection during severe HBV infection flares or reactivation.

2
Immune if anti-HBs concentration is >10 mIU/mL after vaccine series completion.

3
Anti-HBs concentrations might wane over time among vaccine responders. People with a documented, complete HepB vaccine series typically do not need to be revaccinated,
except for special populations like patients on hemodialysis or health care personnel.

Last Reviewed: January 13, 2023

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