Hepatitis B Decision Tool – Initial Screening

Gastroenterology & Hepatology, Infectious Disease
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Hepatitis B Decision Tool - Initial Screening[html]
Summary: A Hepatitis B decision tool for interpretation of initial screening tests.
See soapnote's Hepatitis B <a href="../../infectious/hepatitis-b-screening/">Screening Decision Tool</a> and <a href="../../infectious/hepatitis-b-chronic/">Chronic Decision Tool</a>.
[/html][select name="Q1" value="negative|positive"] <-- HBsAg - Hepatitis B surface antigen
[select name="Q2" value="negative|positive"] <-- HBcAb - Hepatitis B core antibody
[select name="Q3" value="negative|positive"] <-- HBsAb - Hepatitis B surface antibody
[conditional field="Q1|Q2|Q3" condition="(Q1).is('negative')&&(Q2).is('negative')&&(Q3).is('negative')"]Susceptible to HBV infection
Interpretation - Susceptible to Hepatitis B infection.
Recommendation - Vaccination. [/conditional][conditional field="Q1|Q2|Q3" condition="(Q1).is('negative')&&(Q2).is('positive')&&(Q3).is('negative')"]Immune to HBV infection (vaccinated)
Interpretation - Immune to Hepatitis B infection due to vaccination.
Recommendation - No intervention required. [/conditional][conditional field="Q1|Q2|Q3" condition="(Q1).is('negative')&&(Q2).is('positive')&&(Q3).is('positive')"]Immune to HBV infection (resolved natural infection)
Interpretation - Immune to Hepatitis B infection due to natural infection.
Recommendation - No intervention required. [/conditional][conditional field="Q1|Q2|Q3" condition="(Q1).is('positive')&&(Q2).is('negative')&&(Q3).is('positive')"]Acute or chronic HBV infection
Interpretation - Acute or chronic Hepatitis B infection.
Recommendation -
Obtain Hepatitis B IgM to clarify whether acute (positive IgM) or chronic (negative IgM). [/conditional][conditional field="Q1|Q2" condition="(Q1).is('positive')&&(Q2).is('positive')"]This isn't an ordinary finding. Hepatitis B surface antigen and Hepatitis B surface antibody shouldn't both be positive. [/conditional][conditional field="Q1|Q2|Q3" condition="(Q1).is('negative')&&(Q2).is('negative')&&(Q3).is('positive')"]Interpretation unclear
Interpretation - Unclear; four possibilities:
1. Resolved infection (most common)
2. False-positive anti-HBc, thus susceptible
3. "Low level" chronic infection
4. Resolving acute infection
Recommendation -
To evaluate for possible low level chronic hepatitis infection, obtain quantitative Hepatitis B DNA level, serum ALT, and Hepatis B e antigen and antibody.
To detect possible acute infection in window phase, obtain Hepatitis B core antibody IgM level (positive in acute disease).[/conditional][conditional field="Q1|Q2|Q3" condition="(Q1).is('positive')&&(Q2).is('negative')&&(Q3).is('negative')"]Unusual and transient finding.
Interpretation - Unclear; two possibilities:
1. Early acute infection
2. Transient finding up to 18 days after vaccination
Recommendation - Clinical judgement can guide further investigation, such as short interval retesting.[/conditional][html]
You may wish to proceed to evaluation and treatment of Chronic Hepatitis B. This is located at <a href="../../infectious/hepatitis-b-chronic/">soapnote.org/infectious/hepatitis-b-chronic/</a>.[/html]
[html]<hr>[/html][checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).is('')"][html]
reference: AFP article on diagnosis and treatment of hepatitis B: <a href="http://www.aafp.org/afp/2010/0415/p965.html">Wilkins (2010) Am Fam Phys 81: 965-72</a>; CDC <a href="http://www.cdc.gov/hepatitis/HBV/index.htm">Hepatitis B page</a> and <a href="http://www.cdc.gov/hepatitis/HBV/PDFs/SerologicChartv8.pdf">serology chart</a>; American Association for Study of Liver Diseases (AASLD) <a href="http://www.aasld.org/practiceguidelines/Pages/default.aspx">Hepatitis B Guidelines</a>.[/html][/conditional]
Hepatitis B Decision Tool - Initial Screening
Summary: A Hepatitis B decision tool for interpretation of initial screening tests.
See soapnote's Hepatitis B Screening Decision Tool and Chronic Decision Tool.
<-- HBsAg - Hepatitis B surface antigen
<-- HBcAb - Hepatitis B core antibody
<-- HBsAb - Hepatitis B surface antibody

You may wish to proceed to evaluation and treatment of Chronic Hepatitis B. This is located at soapnote.org/infectious/hepatitis-b-chronic/.


display/hide references
Result - Copy and paste this output:

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