Results table and reporting comments for hepatitis B
Updated 25 May 2022
Applies to England
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The table below shows different testing results. For each set of results, clinical comments for reports and recommendations for the laboratory team are outlined below the table.
| Result | HBsAg screen | HBsAg neutralisation or alternative HBsAg assay | Anti-HBc total | Anti-HBc IgM | HBeAg | Anti-HBe |
|---|---|---|---|---|---|---|
| 1 | Not detected | Not required | Not required | Not required | Not required | Not required |
| 2 | Detected | Detected | Not detected | Not detected | Detected | Not detected |
| 3 | Detected | Detected | Detected | Detected (high) | Detected or not detected | Detected or not detected |
| 4 | Detected | Detected | Detected | Detected (low) | Detected | Not detected |
| 5 | Detected | Detected | Detected | Detected (low) | Not detected | Detected |
| 6 | Detected | Detected | Detected | Not detected | Not detected | Detected |
| 7 | Detected | Detected | Detected | Not detected | Detected | Detected |
| 8 | Detected | Detected | Detected | Not detected | Not detected | Not detected |
| 9 | Detected | Detected | Detected | Not detected | Detected | Not detected |
| 10 | Detected | Not detected | Not detected | Not necessary | Not necessary | Not necessary |
| 11 | Detected (repeat sample, follow-up to results in 10) | Not detected | Not detected | Not necessary | Not necessary | Not necessary |
| 12 | Detected | Detected | Not detected | Not detected | Not detected | Not detected |
| 13 | Detected (repeat sample, follow-up to results in 12) Note: HBV DNA result is detected | Detected | Not detected | Not detected | Not detected | Not detected |
| 14 | Detected (Repeat sample, follow up to results in 12) Note: HBV DNA result is not detected | Detected | Not detected | Not detected | Not detected | Not detected |
Result 1
For this result, the clinical comments to report are:
- hepatitis B surface antigen not detected
- no evidence of Hepatitis B infection
When screening tests for all 3 infections are negative/not detected add the following comment:
- negative at the time the screening sample was taken
- please offer testing at any time in pregnancy if the woman has a new exposure risk or develops relevant symptoms
Result 2
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results suggest early acute infection with hepatitis B and high risk of transmission to the baby
- this result has been reported to the local health protection team
- please send an EDTA blood sample for HBV DNA by PCR
- refer immediately for clinical assessment
- baby will require vaccine plus HBIG
Result 3
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results confirm early acute infection with hepatitis B and high risk of transmission to the baby
- this result has been reported to the local health protection team
- refer immediately for clinical assessment
- baby will require vaccine plus HBIG
Result 4
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results consistent with a flare in chronic infection with hepatitis B or a non-specific anti-HBc IgM
- refer immediately for clinical assessment
- baby will require vaccine plus HBIG
Result 5
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results consistent with a flare in chronic infection with hepatitis B or a non-specific anti-HBc IgM
- refer immediately for clinical assessment
- baby will require vaccine
- HBV DNA quantification required: if HBV DNA level is ≥ 1x106 IU/ml at any time in pregnancy baby must also receive HBIG
- if low birth weight of < 1.5 kg baby must also receive HBIG
Result 6
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results consistent with chronic hepatitis B infection
- refer immediately for clinical assessment
- baby will require vaccine
- HBV DNA quantification required: if HBV DNA level is ≥ 1x106 IU/ml at any time in pregnancy baby must also receive HBIG
- if low birth weight of < 1.5 kg baby must also receive HBIG
Result 7
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- HBeAg and anti-HBe are both positive; results consistent with chronic hepatitis B infection
- refer immediately for clinical assessment
- baby will require vaccine and HBIG
Result 8
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- HBeAg and anti-HBe are both negative; results consistent with chronic hepatitis B infection
- refer immediately for clinical assessment
- baby will require vaccine and HBIG
Result 9
For this result, the clinical comments to report are:
- hepatitis B surface antigen detected
- results consistent with chronic hepatitis B infection
- refer immediately for clinical assessment
- baby will require vaccine and HBIG
Result 10
For this result, the clinical comments to report are:
- inconclusive results: positive result in screening assay only, not confirmed in further assay, probable false positive
- to confirm, please repeat 2 weeks from the date of this sample
Result 11
For this result, the clinical comments to report are:
- no evidence of HBV infection and no action required
- the sample gives the same reactivity as the previous one: the absence of serological change and the continued negative results in the confirmatory assay indicate that the result in the screening assay is non-specific
Result 12
For this result, the clinical comments to report are:
- inconclusive results: positive result in screening assay is confirmed in further HBsAg assay but other markers are not detected
- this may be non-specific but may represent early acute HBV infection or recent vaccination
- has the patient received recent HBV vaccination?
- repeat 2 weeks from the date of this sample and also send EDTA sample for HBV DNA
Result 13
Where HBV DNA is detected the clinical comments to report are:
- consistent with early acute HBV infection
- this result has been reported to the local health protection team
- high risk of transmission to the baby
- refer rapidly to appropriate specialist
- baby will require vaccine plus HBIG
Result 14
Where HBV DNA is not detected the clinical comments to report are:
- HBsAg detected but other markers and HBV DNA are not detected
- no evidence of HBV infection and no action required