Rapid tests for hepatitis b

Diagnostic overview

Detection of hepatitis B surface antigen (HbsAg) identifies individuals infected with the hepatitis B virus. Many clinicians find it useful to test for other analytes as well. Quantitative enzyme immunoasssay (EnzymeImmunoAssay or EIA) methods are still considered to be the most sensitive tests and are widely used at well-equipped reference centers or central blood banks. However, lateral flow tests have made great strides in advancing the ease of use of, and access to, high-quality hepatitis B diagnostics over the last few years

Laboratory-Based Tests

Laboratory-based, quantitative EIAs for the following analytes have been used for many years:

  • Hepatitis B surface sntigen (HBsAg)
  • Hepatitis B surface sntibody (HBsAb)
  • Hepatitis B core antigen (HBcAg)
  • Hepatitis B core antibody (HBcAb or anti-HBc)
  • Hepatitis e antigen (HBeAg or HBe)
  • Hepatitis e antibody (HBeAb or anti-HBe)

You can learn more about tests using the above analytes on our "Hepatitis B viral components" page.

Table 1 below shows how test results for various combinations of viral components are interpreted. Examination of this table shows that a positive result for HBsAg is indicative of a hepatitis B infection. While detection of other viral components does not necessarily indicate an active infection, it does provide useful clinical information, particularly immune status.

Table1: Interpretation of the results of various immunoassays for Hepatitis B

Tests

Results

Interpretation

Recommendation

HBsAg

Negative

Not immune/Not Infected- has not been infected, but is still at risk for possible future infection

Get the vaccine.

HBsAb

Negative

HBcAb (IgG)

Negative

HBcAb (IgM)

Negative

HBeAg

Negative

HBeAb

Negative

HBsAg

Negative

Immune/Not Infected - surface antibodies present. The patient Has been vaccinated against hepatitis B infection.

Vaccination is not needed, but surface antibody titers should be checked occasionally to ensure continued immunity

HBsAb

Negative

HBcAb (IgG)

Positive

HBcAb (IgM)

Negative  or Positive

HBeAg

Negative

HBeAb

Negative

HBsAg

Negative

HBsAg

Negative

Immune/Previously Infected- Immune due to prior naturally occurring infection.

Vaccination is no longer needed, as the patient has cleared a prior infection however as with the vaccinated patient, surface antibody titers should be checked occasionally to ensure continued immunity.

HBsAb

Positive

HBcAb (IgG)

Positive

HBcAb (IgM)

Negative

HBeAg

Negative

HBeAb

Negative  or Positive

HBsAg

positive

New infection A positive surface antigen means hepatitis B virus is present and can spread to others. A positive HBeAg further confirms actively replicating virus

Contact a physician that is knowledgeable about hepatitis for further evaluation.

HBsAb

Negative

HBcAb (IgG)

Negative

HBcAb (IgM)

Positive

HBeAg

Negative or Positive

HBeAb

Negative

HBsAg

Positive

Chronic infection A positive surface antigen means hepatitis B virus is present and can spread to others. A positive HBeAg further confirms actively replicating virus. Lack of a HBsAb means the virus is not being cleared, and a positive HBcAb (IgM) shows an infection longer than 6months

Contact a physician that is knowledgeable about hepatitis for further evaluation and to discuss treatment options.

HBsAb

Negative

HBcAb (IgG)

Negative

HBcAb (IgM)

Positive

HBeAg

Negative or Positive

HBeAb

Negative

HBsAg

Negative

Unclear-.   The patient might be recovering from acute HBV infection or has an undetectable level of HBsAg present in the serum and is actually has a chronic infection.
They may also may have had a prior exposure and low antibody titers so low the test is not sensitive enough to detect the low levels of HBsAb. There is also the possibility of  a false positive HBcAb result.

Alternative to serological test should be considered if available (i.e. DNA testing)

The vaccine may or may not be needed. Contact a physician that is knowledgeable about hepatitis for further evaluation.

HBsAb

Negative

HBcAb

Positive

HBeAg

Negative

HBeAb

Negative

Rapid tests

Most rapid tests are intended for qualitative detection of HBsAg and allow for rapid determination of whether a patient has an active hepatitis B infection. The majority of these tests are based on agglutination or lateral flow principles. These tests have been in use for many years and have established track records for performance and quality. The advantage of these tests is that they can be completed in 10 to 20 minutes and performed by nurses or technicians with a minimum of training.

More recently, lateral flow tests have become available which test for all of the main serological markers of hepatitis B (HBsAb, HBsAb, HBcAb, HBeAb, HBeAg). These tests offer the benefit of being able to perform a full serological characterization for hepatitis B (as outlined in table 1). As a result of being newer, there is less information available on the performance of these tests than there is for tests for HBsAg only.

Links to more information