Table of Contents
Content Information
A. Purpose of Surveillance and Reporting
- To identify sources/sites of transmission and to prevent spread from such sources.
- To ensure identification of infected pregnant women and prevent perinatal transmission.
The following table contains selected hepatitis B serologic markers (what’s looked for in blood samples) and their definitions. These results help determine which phase of infection, resolution or immunity a person is in. These are results relevant to the reporting requirements.
| Interpretation of the Hepatitis B Panel | ||
|---|---|---|
| Tests | Results | Interpretation |
| HBsAg anti-HBc anti-HBs | negative negative negative | Susceptible |
| HBsAg anti-HBc anti-HBs | negative positive positive | Immune due to natural infection |
| HBsAg anti-HBc anti-HBs | negative negative positive | Immune due to hepatitis B vaccination** |
| HBsAg anti-HBc IgM anti-HBc anti-HBs | positive positive positive negative | Acutely infected |
| HBsAg anti-HBc IgM anti-HBc anti-HBs | positive positive negative negative | Chronically infected |
| HBsAg anti-HBc anti-HBs | negative positive negative | Four interpretations possible * |
* Four Interpretations
** Antibody response (anti-HBs) can be measured quantitatively or qualitatively. A protective antibody response is reported quantitatively as 10 or more milliinternational units (>=10mIU/mL) or qualitatively as positive. Post-vaccination testing should be completed 1-2 months after the third vaccine dose for results to be meaningful. Definitions
Additional Tests
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B. Laboratory and Healthcare Provider Reporting Requirements
Iowa Administrative Code 641-1.3(139) stipulates that the laboratory and the healthcare provider must report. The preferred method of reporting is by utilizing the Iowa Disease Surveillance System (IDSS). However, if IDSS is not available, the reporting number for IDPH Center for Acute Disease Epidemiology (CADE) is (800) 362-2736; fax number (515) 281-5698, mailing address:
Iowa Department of Public Health, CADE
Lucas State Office Building, 5th Floor
321 E. 12th St.
Des Moines, IA 50319-0075
Note: Healthcare providers, hospitals and laboratories are reminded to report all cases of HBsAg-positive pregnant women.
C. Local Public Health Agency Follow-up Responsibilities
Case Investigation
- Confirm the diagnosis. Contact the patient’s health care provider to verify the test result and interpretation. Also verify that the patient has been informed of his or her diagnosis. If a provider cannot be reached within 72 hours of the initial attempt to contact the provider, proceed with the investigation. Be sure to inform the patient that you were unable to contact his/her provider and that additional follow-up with that provider may be needed to confirm the diagnosis and/or discuss treatment options.
- See the “Interpretation of the Hepatitis Panel” above for test result interpretation.
- Acute cases of hepatitis B must have symptoms of hepatitis B to be counted as an acute case according to CDC case definitions (see Additional Information). If symptoms are not present then the case should still be investigated and reported to CADE.
- Symptomatic reported cases without profile results may be considered confirmed cases when found to be epidemiologically related to an HBsAg-positive case within the previous 6 months of their onset (e.g., jaundiced IV drug user who relates sharing a needle with a case reported 3 months ago).
- See the “Interpretation of the Hepatitis Panel” above for test result interpretation.
- Complete a Hepatitis B case investigation (in IDSS) for all suspected or confirmed cases of hepatitis B.
- Make appropriate recommendations for prevention of transmission and identify contacts at risk. Efforts should be made to locate contacts and inform them of their exposure, making certain to maintain client confidentiality. Locating contacts who are at high risk of infection or who may have significant consequences (e.g., a sexual contact that is pregnant) is especially important. Language-specific materials can be found at www.cdc.gov/hepatitis/Resources/PatientEdMaterials.htm
- Make necessary interventions to stop transmission to others (e.g., blood banks must be notified if the case donated or received blood or blood products within the past 6 months, physicians of pregnant clients should be contacted to ensure proper follow-up of the newborn, etc.). If it appears that an outbreak may be occurring (i.e., two or more current cases with suspected common source), contact the Center for Acute Disease Epidemiology (CADE) at 800-362-2736.
- Many risk factors are common to hepatitis B and HIV, therefore clients who may also be at risk of HIV infection (e.g., IV drug users), should be tested for HIV. A list of current confidential HIV test sites is available through the HIV/AIDS/Hepatitis Program at (515) 281-6801.