Which patients to screen for hepatitis B
It is critical to opportunistically test patients who are at higher risk of having chronic hepatitis B.
When patients with chronic hepatitis B present with symptoms or signs, they may already have severe liver disease, and it may be too late for therapeutic intervention.
Opportunistic testing for a person determined by their doctor to be at risk of hepatitis B is allowable under the Medicare Benefits Schedule. For more information about the use of Medicare Benefits Schedule items in diagnosing and managing hepatitis B infection, see ASHM's Hepatitis B and Primary Care Providers resource.
Most people with chronic HBV infection in Australia were infected early in life, and were either born overseas in an endemic country, or are Indigenous Australians. These two priority populations probably represent more than two thirds of all chronic hepatitis B in Australia.
Patient groups who should be offered routine testing for HBV infection:
People born in regions of intermediate and high prevalence of chronic HBV infection (>2%) – see map below
People born in Australia before 2000 whose parents were born in regions with high prevalence of chronic HBV infection
Aboriginal and Torres Strait Islander Australians
Infants born to women with chronic HBV infection (test at least 3 months after last dose of hepatitis B vaccine)
Household, sexual, or needle-sharing contacts of people infected with HBV
People who have ever injected drugs
Men who have sex with men
People living with HIV/AIDS or with chronic hepatitis C infection
People who have been in prison
People with unexplained elevation in ALT or AST
People requiring immunosuppressive therapy e.g. chemotherapy or for autoimmune diseases or transplantation
Blood and tissue donors
Sources of blood/body fluid for exposures that might require PEP
All pregnant women (not higher risk, but universal antenatal screening important to prevent vertical transmission)
For more information about who should be tested for hepatitis B, see the National Hepatitis B Testing Policy.
Any patient from one of these groups who remains susceptible to HBV infection should be offered vaccination.
This is provided free in many states and territories, however eligibility varies according to jurisdiction - see the Notification and immuisation page for more information on eligibility and ordering the vaccine.
Global prevalence of chronic hepatitis B, 2012
Adapted from: Weinbaum CM et al. 2008