Assessing Hepatitis B Immunity

Serologic Testing

The Centers for Disease Control and Prevention recommends testing for anti-HBs using a quantitative method to determine immunity to hepatitis B virus (HBV) infection, with a level ≥10 mIU/mL indicating immunity 1
A quantitative method that allows detection of the protective concentration of anti-HBs (≥10 mIU/mL) should be used, such as enzyme-linked immunosorbent assay (ELISA) 1
Testing should be performed 1-2 months after completion of vaccination series to accurately assess immune response 1
Anti-HBs ≥10 mIU/mL indicates protective immunity against HBV infection, according to the Centers for Disease Control and Prevention 1, 2

Immunocompetent persons with anti-HBs ≥10 mIU/mL after vaccination have long-term protection and do not need further periodic testing, as stated by the Centers for Disease Control and Prevention 1
Anti-HBs <10 mIU/mL after vaccination indicates lack of protective immunity and need for revaccination, according to the Centers for Disease Control and Prevention 1

The American Association for the Study of Liver Diseases recommends a complete serologic panel, including HBsAg, anti-HBs, and total anti-HBc, to define a patient's HBV clinical status and distinguish between immunity from vaccination versus natural infection 3, 4
Anti-HBs positive + anti-HBc negative: Immunity from vaccination, as indicated by the Centers for Disease Control and Prevention 5, 2
Anti-HBs positive + anti-HBc positive: Immunity from resolved natural infection, according to the American Association for the Study of Liver Diseases 5, 3

For hemodialysis patients, the National Kidney Foundation recommends annual testing of anti-HBs due to potential waning immunity 1, 6
Immunocompromised patients (HIV-infected persons, hematopoietic stem-cell transplant recipients, patients on chemotherapy) may need annual testing to assess anti-HBs concentrations, as stated by the Centers for Disease Control and Prevention 1
Healthcare personnel should be tested for anti-HBs 1-2 months after vaccination to ensure protection in case of occupational exposure, according to the Centers for Disease Control and Prevention 1, 7