Hepatitis B Titer - More Information

The hepatitis B titer, sometimes known as an HBsAb test and an anti-HBs titer, measures the hepatitis B surface antibody level in the blood to check for immunity to Hepatitis B. Through Accesa Labs, people can place an order for a hepatitis B titer online, get tested at a local lab, and get results electronically, typically in a few business days.

Who Should Get a Hepatitis B Titer?

The hepatitis B titer is ordered by a wide range of people who need documented proof of hepatitis B immunity for compliance, employment, education, or personal health purposes. Common reasons people order this test include:

Healthcare workers and students

Nurses, physicians, medical assistants, dental hygienists, pharmacy technicians, and other healthcare professionals are routinely required to demonstrate hepatitis B immunity as a condition of employment or clinical placement. Healthcare settings carry meaningful exposure risk to hepatitis B through needlestick injuries, contact with blood or body fluids, and patient care activities. Confirmed hepatitis B immunity protects both the healthcare worker and the patients they serve.

Vendor credentialing compliance

Medical device representatives, pharmaceutical sales representatives, and other healthcare contractors who require hospital or clinical facility access must generally maintain current hepatitis B immunity documentation through vendor credentialing platforms such as symplr, RepTrax, and Vendormate. The hepatitis B titer is one of the most commonly required tests on these platforms and is frequently ordered alongside the MMR titer, the QuantiFERON-TB Gold Plus test, and the varicella titer.

People unsure of their immunity status

Routine hepatitis B vaccination has been standard in the United States since the early 1990s. However, not everyone retains detectable hepatitis B antibody levels following vaccination as a small percentage of vaccine recipients do not develop adequate antibody response after the standard hepatitis B vaccination series. A hepatitis B titer is the most reliable way to confirm that a completed vaccine series actually produced protective antibody levels.

International travelers

Hepatitis B vaccination and immunity verification are commonly recommended for international travelers, particularly people visiting sub-Saharan Africa, East Asia, Southeast Asia, and parts of Eastern Europe. Confirming immunity before travel is a practical precaution that reduces uncertainty about hepatitis B risk during travel.

People with occupational exposure risk

In addition to healthcare workers, certain other occupations and activities carry an elevated risk of hepatitis B exposure. First responders, corrections officers and tattoo artists are among those who may benefit from confirming their hepatitis B immunity status.

Hepatitis B Virus & Symptoms

Hepatitis B is a viral infection caused by one of five hepatitis viruses - the Hepatitis B virus (HBV). Hepatitis B infections can be both short-term (acute) and long-term (chronic) and affect an organ in the right upper part of the abdomen known as the liver. Hepatitis B infections are more commonly transmitted by blood and other body fluids during sexual activity, intravenous drug use (IVDA) and inadvertent infected blood or fluid exposure while working in a healthcare environment. Rarely, one can get hepatitis B from getting a tattoo or acupuncture from a contaminated needle and also dialysis for kidney failure.

If one is exposed to and gets a Hepatitis B infection, symptoms can range from nothing to flu-like symptoms like fatigue and headache. Additionally, hepatitis B can result in stomach pain, jaundice (yellow skin) from liver abnormalities, and nausea and vomiting which lasts for 14-21 days. In some cases, symptoms won't begin until six months after the initial exposure.

Because so many people have received the Hepatitis B vaccine as part of their routine vaccines, checking the Hepatitis B titer has become common practice to assess one's immunity to hepatitis B. The hep B titer is technically known as a Hepatitis B surface antibody test, or HBsAb titer test. This hepatitis B vaccine titer is practically used to demonstrate immunity to hepatitis B in people who will be working or studying in healthcare organizations or schools. When ordered in this capacity, the hep b titer is frequently ordered with the MMR titer and varicella titer, all of which are included in the immunization titer panel. Additionally, some people also need to present a negative TB blood test when going through the clearance process for a new school or job. Sometimes, the Hep B surface antibody test is ordered for other reasons. For example, people sometimes get the blood test to check for immunity when engaging in activities that might lead to an inadvertent exposure to Hepatitis B (e.g. traveling, getting a tattoo) instead of getting revaccinated unnecessarily.

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Hepatitis B Titer - Testing Process

The hepatitis B titer can be performed at most lab locations around the country. This blood test requires fairly standard lab equipment which every lab has available. On the day of your HBsAb test, you will get a small amount of blood drawn. No fasting is required before the hep B titer and your results will come back relatively quickly. Given that the hepatitis B vaccine series is thought to provide lifetime immunity as measurable via antibody levels, it makes sense to start with a hepatitis B titer before getting revaccinated to confirm your immunity status. Most people will have received the hepatitis B vaccine series if they received routine vaccines while growing up even if they cannot find their HBV immunization records.

Interpreting hepatitis B titer lab results is not overly complex. In reviewing the sample hepatitis B lab report above, one can see the hepatitis B surface antibody level reported under the results column in mIU/mL units. Quant indicates that this hep B titer will report an actual quantitative, or numerical, result as opposed to a qualitative Hep B titer which just reports a positive (reactive) or negative (nonreactive) result. Quantitative hepatitis B IgG titer levels are considered the gold standard for proving hepatitis B immunity.

On the hep B lab sample result above, one can see the text that says that, based on the antibody level, the patient has immunity to hepatitis B virus. As a result, this person will not need to be revaccinated with the hepatitis B virus series. In contrast, if the lab result reported that the patient is not immune to hepatitis B, then revaccination with the hepatitis B vaccine series would be recommended.

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Routine immunization with the hepatitis B vaccine is the reason that the hepatitis B titer is even utilized as a measure of hep B immunity. The hepatitis B vaccine was developed in the 1960s and approved in the 1980s. The HBV vaccine has become a regular part of routine childhood and adult vaccinations. The full HBV immunization series typically consists of 3 separate doses and the first dose is often given one day after birth. Injected into the muscle, the Hepatitis B vaccine is not a live vaccine. In most people, after getting the HBV vaccine series, the immune system learns what a hepatitis B infection looks like and can generate special proteins called antibodies that will protect the body if a Hep B infection attempts to invade the body in the future.

This hepatitis B surface antibody test is a useful test for anyone who is looking to find out if they are considered immune to hepatitis B or not. For most people, hep B titer testing will eliminate the need for revaccination when hep B immunity is needed for school, work or personal reasons.

Hepatitis B Titer vs. Hepatitis B Surface Antigen Test

Patients sometimes confuse the hepatitis B titer (surface antibody test) with the hepatitis B surface antigen test. These two tests measure different things and serve different purposes:

The hepatitis B titer (HBsAb test) measures hepatitis B surface antibodies which are proteins the immune system produces in response to vaccination or prior infection. A positive result means the immune system has developed protection against hepatitis B. This is the test used to confirm immunity for healthcare compliance, school enrollment, and vendor credentialing purposes. This lab test is not useful for checking for an actual hepatitis B infection as the hepatitis B surface antibodies check for immunity, not an infection.

The hepatitis B surface antigen test (HBsAg test) detects the presence of the hepatitis B virus itself in the blood. A positive result means the person is currently infected with hepatitis B. This test is used to diagnose active hepatitis B infection or identify chronic carriers and not to assess immunity. The hepatitis B surface antigen test is available separately through Accesa Labs for patients who need to check for active infection rather than immunity.

In a person who has been successfully vaccinated or has recovered from hepatitis B, the HBsAb titer result will typically be positive (immune) while the HBsAg test will be negative (no active infection). Both tests can be ordered simultaneously if comprehensive hepatitis B status assessment is needed.

Hepatitis B Vaccine Series and Booster Protocol

The standard hepatitis B vaccine series consists of three doses given at months 0, 1, and 6. The first dose is typically given at birth as part of routine newborn care in the United States. After completing the full series, most people develop detectable protective antibody levels. However, a small percentage of vaccine recipients do not respond adequately to the standard series. The length with which hepatitis B titers persist after longer periods of time seems to depend on the strength of the initial titer response. Hepatitis B titer levels may also naturally wane with time and will vary from person to person.

People who test below the immunity threshold after completing a hepatitis B vaccine series typically complete another hepatitis B vaccine series and then retest. Some providers may recommend a single booster dose followed by retesting before proceeding to a full repeat series. A medical provider or occupational health office can advise on the most appropriate approach.

Patients who have received fewer than three doses of the hepatitis B vaccine should consider completing the full vaccine series before relying on a hepatitis B titer to document immunity. Testing immunity before completing the full series may yield a falsely negative or low result that does not reflect the immune response a complete series would produce.

Hepatitis B Titer - Additional Information

CDC Hep B Testing