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Groups that should be screened for hepatitis B virus

Patient groups	Comments
These individuals should be screened for HBV regardless of their vaccination history*
Individuals born in areas with high (≥8%) or intermediate (≥2%) prevalence rates for HBV, including immigrants and adopted children^¶	Such patients are at high risk for infection.
Pregnant women	Pregnant women should be screened during the first prenatal visit with each pregnancy.^Δ Vaccination during pregnancy is warranted for those with ongoing risk factors for HBV transmission.
Those requiring immunosuppressive therapy	Patients who are HBsAg positive may be at high risk for HBV reactivation, which can be prevented with antiviral therapy. Patients who are HBsAg negative, anti-HBc positive may also be at risk for HBV reactivation if they receive potent immunosuppressive therapy.^◊
Donors of blood, plasma, organs, tissues, or semen	Screening is used to identify those who are at risk of transmitting HBV to others.
Infants born to HBV-infected mothers	Infants born to HBsAg-positive mothers should receive HBIG and hepatitis B vaccine as soon as possible and within 12 hours of birth and then complete the hepatitis B series. Post-vaccination serology should be obtained at 9 to 12 months.^§
These individuals should be screened if they were not vaccinated or were vaccinated but did not have screening prior to vaccination*
US-born persons not vaccinated as infants whose parents were born in regions with high HBV endemicity (≥8%)*^¶	This group is at risk for childhood exposure from their parents who are at high risk for HBV.
Household and sexual contacts of HBsAg-positive persons	Non-immune patients should be immunized. Post-vaccination serology should be performed to ensure immunity.
Persons who have ever injected drugs	Non-immune patients should be immunized.
Persons with multiple sexual partners and/or history of sexually transmitted diseases	Non-immune patients should be immunized.
Men who have sex with men	Non-immune patients should be immunized.
Inmates of correctional facilities	Non-immune patients should be immunized.
Individuals with chronic liver disease (eg, cirrhosis, fatty liver disease, autoimmune liver disease, ALT or AST greater than twice the upper limit of normal)	Non-immune patients should be immunized even if the patient has no other risk factors for HBV transmission; concurrent chronic HBV infection may increase the risk of progressive liver disease.
Individuals with HIV infection	The presence of HBV coinfection informs the choice of antiretroviral regimen. Patients with HIV who are not immune should be vaccinated regardless of risk factors, since HBV infection has an accelerated course in coinfected patients and there are overlapping risk factors.
Individuals infected with HCV	Non-immune patients should be immunized, since acute HBV in patients with chronic HCV can lead to severe hepatitis and there are overlapping risk factors. Patients with chronic HBV are at risk for HBV reactivation with direct-acting antiviral therapy.^¥
Patients with end-stage kidney disease, including those undergoing renal dialysis	Non-immune patients should be immunized. Once vaccinated, serologic testing should be performed annually, and patients should receive booster doses if anti-HBs falls below 10 milli-international units/mL.

Screening for HBV can lead to appropriate medical care for those who have chronic infection or are at risk for reactivation of resolved infection. It can also facilitate vaccination and counseling of uninfected individuals who continue to engage in high-risk behaviors. Prevaccination screening to reduce unnecessary vaccination is also reasonable in health care and public safety workers, patients and residents of facilities for developmentally delayed persons, travelers to countries with intermediate or high prevalence of HBV, and unvaccinated patients >19 years of age with diabetes.

HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; anti-HBc: hepatitis B core antibodies; HBIG: hepatitis B immune globulin; US: United States; ALT: alanine aminotransferase; AST: aspartate transaminase; HIV: human immunodeficiency virus; HCV: hepatitis C virus; anti-HBs: hepatitis B surface antibody.
* If screening is negative, patients should be immunized if they have a risk factor for HBV transmission or are at risk for serious adverse outcomes of HBV infection. In patients with ongoing HBV risk through percutaneous or mucosal exposure, the first dose of the hepatitis B vaccine should be initiated at the time of screening; the need for subsequent doses will depend upon the results. Refer to the UpToDate topics that discuss the epidemiology, transmission, and prevention of hepatitis B virus infection and hepatitis B immunization in adults for additional information about risk factors for HBV infection and HBV immunization.
¶ If HBsAg-positive persons are found in the first generation, subsequent generations should be tested.
Δ Refer to the UpToDate topic that discusses HBV and pregnancy.
◊ Refer to the UpToDate topic that discusses HBV reactivation.
§ Refer to the UpToDate topic that discusses HBV immunization in infants.
¥ Refer to the UpToDate topic that provides an overview of the management of hepatitis C infection.

References:

Abara WE, Qaseem A, Schillie S, et al. Hepatitis B vaccination, screening, and linkage to care: Best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2017; 167:794.
Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep 2008; 57:1.
Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018; 67:1560.

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