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Guidance

Annexe 2: Text version of hepatitis B testing algorithm

Updated 15 September 2026

© Crown copyright 2026

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This publication is available at https://www.gov.uk/government/publications/improving-testing-rates-for-blood-borne-viruses-in-prisons-and-other-secure-settings/annexe-2-text-version-of-hepatitis-b-testing-algorithm

Note: BBV testing should be recommended to all prisoners, including those already in prison.

Step 1: Determine vaccination status

Identify whether the person is:

  • recorded as having completed the hepatitis B vaccination course
  • recorded as having an incomplete hepatitis B vaccination course
  • vaccination status unknown
  • unvaccinated

If recorded as having completed the vaccination course

  1. Offer a one-off HBsAg test. If the vaccination course is incomplete, give 1 dose of hepatitis B vaccine.
  2. Review the HBsAg result:
    • negative (complete vaccination course if necessary) – person is immune
  3. Provide:
    • reassurance and harm-minimisation
    • completion of the vaccination course if vaccination is incomplete
    • no need to repeat test
    • remember the fourth dose at one year and, ideally, a booster dose at 5 years

If recorded as having an incomplete vaccination course

  1. Offer a one-off HBsAg test and 1 dose of hepatitis B vaccine.
  2. Review the HBsAg result:
    • positive – suspend vaccination and refer for further testing to a specialist service

If vaccination status is unknown

  1. Offer a one-off HBsAg test and 1 dose vaccine.
  2. Review the HBsAg result:
    • positive – suspend vaccination and refer for further testing to a specialist service
    • negative – complete the vaccination course
  3. After completion of the vaccination course:
    • reassurance and harm-minimisation
    • completion of the vaccination course if vaccination is incomplete
    • no need to repeat test
    • remember the fourth dose at one year and, ideally, a booster dose at 5 years

If unvaccinated

  1. Offer a one-off HBsAg test and 1 dose vaccine.
  2. Review the HBsAg result:
    • positive – suspend vaccination and refer for further testing to a specialist service
    • negative – complete the vaccination course
  3. After completion of the vaccination course:
    • reassurance and harm-minimisation
    • completion of the vaccination course if vaccination is incomplete
    • no need to repeat test
    • remember the fourth dose at one year and, ideally, a booster dose at 5 years
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