What do I need to know about testing for hepatitis B?
Key takeaways:
- 0.78% of the Australian population (200,385 people) have chronic hepatitis B.
- Of those, 28% are undiagnosed and at risk of related poor health outcomes including liver cancer, cirrhosis and liver failure.
- Hepatitis B is often asymptomatic and must be diagnosed with a blood test.
- There are some priority populations for testing (listed below).
On this page
Who should I test for hepatitis B?
If a patient has an indication for testing, you are not violating Medicare screening rules by testing them.
- People born in regions with intermediate or high hepatitis B prevalence (Central, North-East and South-East Asia, the Pacific Islands, North and Sub-Saharan Africa, and Southern and Eastern Europe)
- Aboriginal and Torres Strait Islander people
- Partners and household/sexual contacts of people with acute or chronic hepatitis B
- Pregnant people
- Infants and children (> 9 months of age) born to mothers who have hepatitis B
- Patients undergoing chemotherapy or immunosuppressive therapy (who are at risk of reactivation)
- People with clinical presentation of liver disease and/or elevated ALT/AFP of unknown aetiology
- Health professionals who perform exposure prone procedures (EPPs)^
- People with multiple sex partners who have not been previously tested
- People who inject drugs or have done so in the past
- Men who have sex with men
- People who are in custodial settings or have been in the past
- People with HIV or hepatitis C or both
- Patients undergoing dialysis
- Sex workers
- People initiating HIV pre-exposure prophylaxis
“I thought I was pretty fit and healthy until I decided to donate blood and found out I had hepatitis B.” – Community member with lived experience of hepatitis B
“What started as a routine blood test ended up showing hepatitis B living within 4 of our family members without anyone knowing about it or ever hearing about such a disease.” – Community member with lived experience of hepatitis B
Testing should also be offered to anyone who asks, eg as part of an STI screen.
People may not always be aware of their risk. Thorough assessment is encouraged to ensure a diagnosis of hepatitis B is not missed.
If there is documentation that a person is fully vaccinated they do not need to be tested again.
The indication for testing for hepatitis B among Aboriginal peoples highlights the enduring traumatic legacy of colonisation. It recognises the historical disadvantage perpetuated by institutional racism and systemic failures that collectively contribute to health disparities between Aboriginal peoples and non-Indigenous Australians.
^ EPPs are procedures where there is a risk of injury to the healthcare worker that results in exposure of the patient’s open tissues to the blood of the worker. EPPs include those where the worker’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. Source: The Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses.
Quick Links
Decision Making in Hepatitis B | PDF | ASHM
National Hepatitis B Testing Policy – Indications for testing | Website | ASHM
B Positive: Hepatitis B virus testing and interpreting test results | Website | ASHM
Detailed Information
Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia
Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses | | PDF | Communicable Diseases Network Australia | Website | Communicable Diseases Network Australia
For information on hepatitis B epidemiology across risk groups and geographic regions and hepatitis B notifications see:
Viral Hepatitis Mapping Project National Report
| Website & PDF | WHO Collaborating Centre for Viral Hepatitis Epidemiology, The Doherty Institute & ASHM
HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2022 | PDF | UNSW Kirby Institute
What tests should I order when testing for hepatitis B?
HBsAg (hep B surface antigen) = Does the person have hepatitis B?
Anti-HBc (hep B core antibody) = Has the person been exposed in the past?
Anti-HBs (hep B surface antibody) = Is the person immune?
It’s important to specify the 3 tests. Often practice software will generate a request for 'hepatitis B serology', which may result in incomplete serology that doesn’t include all 3 tests.
If acute hepatitis B is suspected from history or examination, you must also order anti-HBc lgM.
All 3 tests are Medicare rebatable simultaneously.
Ensure “? chronic hepatitis B” or similar is written on the request form.
Informed consent should be obtained for hepatitis B testing in a culturally appropriate and safe manner. Use a qualified interpreter if required.
Informed consent for testing means that the person agrees to be tested on the basis that they understand the testing procedures and reasons for testing, and can assess the personal implications of a positive test result, which might include further medical assessment.
In your discussion, you should include information on the reason for the test and the availability of care and treatment.
“My GP showed me my hepatitis B results and it looked so confusing! Thankfully my GP was able to explain what it all meant.” – Community member with lived experience of hepatitis B
“I was told I had hepatitis B but I still don’t understand what all the numbers mean. Googling just makes me more confused. Is there a reliable source of information or community group that can help me?” – Community member with lived experience of hepatitis B
Quick Links
Decision Making in Hepatitis B | PDF | ASHM
B Positive: Hepatitis B virus testing and interpreting test results | Website | ASHM
Detailed Information
How should I interpret hepatitis B serology?
Serology results will determine if someone either:
- has hepatitis B
- is immune to hepatitis B through vaccine or prior infection
- is not immune, ie susceptible to infection.
Further information on providing a diagnosis
Further information on vaccination
Further information on isolated core positive result
Quick Links
Decision Making in Hepatitis B | PDF | ASHM
B Positive: Hepatitis B virus testing and interpreting test results | Website | ASHM
Detailed Information
What information should I provide if results show the person does not have hepatitis B?
- If the result is hepatitis B sAg negative with immunity via vaccination, explain to the patient that they are protected and no further action is required.
- If the result is hepatitis B sAg negative with evidence of prior infection (anti-HBc positive), explain that no action is required now, but there is risk of reactivation in the future with immunosuppressive therapy. See further information here.
- If the result is hepatitis B sAg negative and non-immune (anti-HBs negative), vaccination should be discussed and strongly recommended. See further information here.
A negative result should be clearly documented and conveyed to the person to avoid unnecessary repeat testing or vaccination. A result indicating immunity should be added to the Australian Immunisation Register.
Quick Links
Hepatitis B Testing Policy: Conveying hepatitis B test results | Website | ASHM
B Positive: Hepatitis B virus testing and interpreting test results | Website | Australian Government Department of Health and Aged Care
Detailed Information
B Positive: Hepatitis B virus testing and interpreting test results | Website | ASHM
How should I support my patients with information about hepatitis B testing?
Hepatitis B is a lifelong disease for many patients. It is important to provide support and information about the testing process to:
- minimise the impact of a positive diagnosis on patients and their families
- empower people to feel in control of their health
- reduce patient anxiety
It is important to give your patient information and resources (either printed or digital). See below for a list of relevant community resources.
Further Information
General information on hepatitis B | Website | Health Direct
Hepatitis B Community Forum | Online forum | Hepatitis B Community.org
Hepatitis B Voices Australia | Website
A guide to hepatitis B | PDF | Hepatitis Australia
Hepatitis B testing for adults | Website | Hepatitis Queensland
Hepatitis B: It’s family business (multiple languages available) | Website | Multicultural HIV and Hepatitis Service
This plain English resource is designed to support health workers discussing chronic hepatitis B with patients, including refugee and migrant communities: The Hepatitis B Story (multiple languages available) | Website & PDF | St Vincent’s Hospital Melbourne
Hepatitis B & C (available in Chinese) | Website | Australian Government Department of Health and Aged Care
