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Lab Test: Hepatitis B Surface Antibody Level

    Lab Test
    • Hepatitis B Surface Antibody
    • Detection of hepatitis B surface antibody (anti-HBs) in serum for the evaluation of infection or immunity for hepatitis B infection
    Reference Range
    • Adults and children: 
      • Negative (limits of detection 2-10 IU/L)
      • Positive ≥ 10 IU/L
    Indications & Uses
    • Confirmation of immunity following hepatitis B vaccination - hepatitis B surface antibody (anti-HBs) is the only hepatitis B (HBV) antibody marker present following HBV vaccination.  Titers fall, often rapidly, following the completion of the HBV vaccination series.  The highest anti-HBs titers generally occur 1 month after a booster vaccination, with a sharp decline over the next 12 months and a slow decline thereafter. The generally accepted titer level associated with the minimal level of protection against HBV is 10 International Units/L, although this is debatable.  A titer level between 10 and 100 International Units/L may be an indication for revaccination of immunocompromised patients.  The anti-HBs level may be elevated with 4 days of administration of the booster immunization.
      • A positive anti-HBs titer combined with a negative hepatitis B surface antigen (HBsAg) titer at 12 to 15 months of age indicates effective treatment for infants born to HBsAg-positive mothers and treated with hepatitis B immunoglobulin (HBIG) and HBV vaccination.
    • Suspected hepatitis B exposure from sexual assault - HBV testing should be performed at the time of the initial sexual assault examination to determine the need for HBV immunization.  HBV tests should be repeated in 6 weeks. 
    • Suspected hepatitis B infection - Hepatitis B surface antibody is generated during the resolution phase of acute hepatitis B and is usually a marker for recovery and immunity.  A positive hepatitis B surface antibody may also indicate a chronic HBV infection.  In chronic HBV, the anti-HBs level can remain positive for decades, and some patients may have detectable levels of both HBsAg and anti-HBs.
    Test Tube Needed
    • Marbled serum separator tube (SST)
    • Collect a venous specimen.
    • Elgouhari HM, et al. Hepatitis B: a strategy for evaluation and management. Cleve Clin J Med 2009;76:19-35.
    • Kuo A et al. Chronic hepatitis B infection. Clin Liver Dis 2012;16:347-369.
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.
    • World Health Organization website. Hepatitis B.

MESH Terms & Keywords

  • Hepatitis B, Surface, Antibody