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Anti-Hepatitis B Surface antibodies (Anti-HBs titre)

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Anti-HBs antibodies are protective antibodies produced by the immune system in response to: Hepatitis B vaccination or Recovery from a past Hepatitis B virus (HBV) infection

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Anti-Hepatitis B Surface Antibodies (Anti-HBs Titre) - Comprehensive Guide

  • Why is it done?
    • Test Purpose: Measures the level of antibodies produced against hepatitis B surface antigen (HBsAg), indicating immunity to hepatitis B virus
    • Assessment of Immunity: Evaluates protective antibody levels following hepatitis B vaccination or natural infection recovery
    • Post-Vaccination Monitoring: Performed 1-2 months after completing hepatitis B vaccine series to confirm adequate immune response
    • Occupational Risk Assessment: Required for healthcare workers, first responders, and those with high exposure risk to hepatitis B
    • Determination of Prior Infection: Helps differentiate between current/recent infection and resolved infection with immunity
    • Pre-exposure Prophylaxis Eligibility: Identifies individuals who need vaccination or booster doses before potential exposure
    • Post-Infection Recovery Confirmation: Confirms clearance of hepatitis B virus and development of natural protective immunity after acute infection
  • Normal Range
    • Units of Measurement: mIU/mL (milliInternational Units per milliliter)
    • Negative/No Immunity: < 10 mIU/mL (considered non-protective; indicates lack of immunity)
    • Borderline/Equivocal: 10-100 mIU/mL (requires clinical interpretation and possible repeat testing or booster vaccination)
    • Positive/Protective Immunity: ≥ 10 mIU/mL (considered protective; indicates adequate immunity against hepatitis B)
    • Strong Positive/Excellent Immunity: > 100 mIU/mL (indicates robust, long-lasting protection; most desirable range)
    • Note on Reference Ranges: Reference ranges may vary slightly between laboratories; specific ranges should be confirmed with the testing facility
  • Interpretation
    • < 10 mIU/mL (Negative/Non-Protective): No detectable antibodies against hepatitis B surface antigen; indicates no immunity from vaccination or prior infection; individual is susceptible to hepatitis B virus and requires vaccination or booster dose
    • 10-100 mIU/mL (Borderline/Equivocal): Detectable but low-level antibodies; response to vaccination may be considered suboptimal; some protection may exist but waning immunity is a concern; booster vaccination may be recommended, particularly for high-risk individuals; retest may be warranted in 1-3 months
    • ≥ 10 mIU/mL (Positive/Protective): Adequate protective antibodies present; indicates immunity from successful vaccination or cleared prior infection; individual has protective immunity and is not at risk for hepatitis B infection; continued periodic monitoring may be warranted depending on risk factors
    • > 100 mIU/mL (Strong Positive): High-level protective antibodies indicating excellent immune response to vaccination or resolved infection with strong natural immunity; offers long-lasting protection; most favorable outcome
    • Factors Affecting Results: Age (diminished response in elderly); immunosuppression (HIV/AIDS, medications); non-responders to vaccine; incomplete vaccination series; time elapsed since vaccination (waning immunity over years); chronic liver disease; diabetes; smoking
    • Non-Responders: Approximately 5-10% of vaccinated individuals fail to develop protective antibodies; may require revaccination, higher vaccine doses, or alternative formulations
    • Waning Immunity Pattern: Antibody levels typically peak 1-2 months post-vaccination, then gradually decline over 5-10 years; periodic monitoring may be indicated for high-risk populations
    • Clinical Significance: Anti-HBs titre reflects immune status but does not indicate whether immunity derives from vaccination or natural infection; used as endpoint of successful vaccination and to guide booster recommendations
  • Associated Organs
    • Primary Organ Affected: Liver (hepatocytes); hepatitis B virus directly infects and replicates within liver cells
    • Associated Conditions with Low/Absent Anti-HBs: Increased risk of acute hepatitis B infection; chronic hepatitis B virus infection if exposed; fulminant hepatic failure in susceptible individuals
    • Hepatitis B Infection Complications: Acute hepatitis with jaundice and elevated liver enzymes; chronic hepatitis with progressive liver fibrosis; cirrhosis; hepatocellular carcinoma; acute liver failure; portal hypertension; hepatic encephalopathy
    • Extrahepatic Manifestations: Immune complex vasculitis; glomerulonephritis; arthralgia; serum sickness-like syndrome; cryoglobulinemia; polyarteritis nodosa
    • High-Risk Populations for Severe Outcomes: Healthcare workers without immunity; people with HIV/AIDS; dialysis patients; immunosuppressed transplant recipients; pregnant women without immunity; infants born to HBsAg-positive mothers; household contacts of chronic HBV patients
    • Impact of Chronic HBV on Other Organs: Secondary effects on kidney (glomerulonephritis), heart (pericarditis risk), pancreas (pancreatitis risk), spleen (splenomegaly from portal hypertension)
    • Immune System Considerations: Test reflects B cell and T cell mediated immune response; impaired immune function (immunosuppression, aging, HIV) reduces anti-HBs response; vaccine response correlates with overall immune system competency
  • Follow-up Tests
    • If Anti-HBs < 10 mIU/mL: Hepatitis B surface antigen (HBsAg) to rule out chronic infection; Anti-HBc (core antibody) to determine prior exposure history; Consider booster vaccination or complete series if never vaccinated; Re-test 1-2 months post-booster
    • If Anti-HBs 10-100 mIU/mL: Repeat testing in 1-3 months to assess for rising or stable levels; Consider booster vaccination if declining trend; HBsAg and Anti-HBc if acute infection suspected; Risk assessment for need for enhanced prophylaxis
    • If Anti-HBs ≥ 10 mIU/mL: No immediate follow-up required if high-risk individual maintains protective levels; Periodic monitoring every 5-10 years for healthcare workers or others with ongoing exposure risk; HBsAg if acute infection symptoms develop
    • Complementary Hepatitis B Tests: HBsAg (hepatitis B surface antigen) - detects active infection or carrier state; Anti-HBc (hepatitis B core antibody) - indicates past or present infection; HBeAg/Anti-HBe - assesses viral replication status; HBV DNA PCR - quantifies viral load in chronic infection
    • Liver Function Assessment: Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), alkaline phosphatase, bilirubin, albumin - for baseline if exposure history unknown or to evaluate for liver disease
    • Fibrosis and Cirrhosis Assessment: FibroTest, transient elastography, or liver biopsy if chronic HBV infection confirmed for staging disease progression
    • Immunocompromised Patients: CD4 count in HIV-positive individuals; immunoglobulin levels; consideration for enhanced HBV screening protocols; more frequent monitoring intervals
    • Post-Exposure Prophylaxis (PEP): Hepatitis B Immune Globulin (HBIG) may be given if exposure occurs in non-immune individuals; HBsAg and anti-HBs testing at intervals (6 weeks, 3-4 months, 6 months) post-PEP
    • Monitoring Frequency: Initial anti-HBs testing 1-2 months post-vaccination series; repeat testing if levels decline or exposure risk remains high; typically every 5-10 years for stable, protected individuals
  • Fasting Required?
    • Fasting Status: NO - Fasting is not required for anti-HBs titre testing
    • Specimen Collection: Blood sample via venipuncture; can be performed at any time of day; no special timing required
    • Food/Beverage Restrictions: No restrictions - normal diet and hydration are acceptable
    • Medications to Avoid: No medications need to be avoided; continue all regular medications as prescribed. (Note: Immunosuppressive medications may affect result interpretation but should not be discontinued)
    • Timing Considerations: For post-vaccination testing: wait 1-2 months after completing vaccine series for optimal antibody development; avoid testing immediately after vaccination
    • Patient Preparation: Minimal preparation needed; wear comfortable clothing with accessible upper arms for venipuncture; stay hydrated; inform healthcare provider of recent vaccinations, medications, or immunosuppression
    • Special Circumstances: Pregnant women can undergo testing; immunocompromised patients should maintain routine testing schedules; post-exposure prophylaxis recipients follow specific testing protocols determined by healthcare providers

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