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 Medicare factsheet.

 

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

Haemodialysis patients

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