Recommendations for Hepatitis B Virus (HBV) Screening, Testing, and Vaccination

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The table below provides recommendations for screening, testing and vaccination for children and adults based on population groups. Testing should not be a barrier to vaccination of susceptible people, especially in populations that have less engagement with or access to health care. In settings where testing is not feasible or is refused by the patient, the clinician should offer vaccination and at future visits offer testing again. For assistance interpreting hepatitis B screening results, see: Interpretation of Hepatitis B Serologic Test Results.

Infants and Young Adolescents

Older Adolescents and Adults

Infants and Young Adolescents

Population Recommendation
Screening and Testing Vaccination
Recommendations
Infants without known hepatitis B exposure
  • None
  • Routine vaccination of all infants with the hepatitis B vaccine series, with the first dose administered within 24 hours of birth

See Hepatitis B Vaccination of Infants – Adolescents | CDC
Infants born to hepatitis B surface antigen (HBsAg)-positive pregnant people
  • Provide hepatitis B immune globulin (HBIG) and first dose of hepatitis B vaccine within 12 hours of birth, followed by completion of the vaccine series and postvaccination serologic testing

See Hepatitis B Vaccination of Infants – Adolescents | CDC
See: Management of Infants Born to Women with Hepatitis B Virus Infection for Pediatricians (cdc.gov)
Infants born to pregnant people for whom HBsAg testing results during pregnancy are not available but for whom other evidence suggests maternal HBV infection (e.g., HBV DNA, HBeAg-positive, or pregnant person known to be chronically infected with HBV
  • For infants equal to or more than 2,000 grams, provide first dose of hepatitis B vaccine within 12 hours of birth, followed by completion of the vaccine series
  • For infants with birthweight less than 2,000 grams, provide hepatitis B immune globulin (HBIG) and first dose of hepatitis B vaccine within 12 hours of birth, followed by completion of the vaccine series and postvaccination serologic testing

See Hepatitis B Vaccination of Infants – Adolescents | CDC
Adolescents under age 19 years who have not been vaccinated and with no known risk factors
  • None
  • Vaccinate

See Hepatitis B Vaccination of Infants – Adolescents | CDC

Older Adolescents and Adults

Population Recommendation
Screening and Testing Vaccination
Recommendations
Adults with no known risk factors for hepatitis B
  • If never previously screened, test for HBsAg, anti-HBs, and total anti-HBc (triple panel)
  • Vaccinate adults aged 18 – 59 years
People with risk factors, regardless of age, such as: Screening and Testing Vaccination
  • People born in regions of the world with hepatitis B prevalence >2%
  • U.S.-born people not vaccinated as infants whose parents were born in regions with hepatitis B prevalence >8%
  • People with current or past injection drug use
  • People who share needles, or sexual contacts of people with known HBV infection
  • People currently or formerly incarcerated in a jail, prison, or other detention setting
  • People with HIV infection
  • People with current or past hepatitis C virus infection
  • Men who have sex with men
  • People with current or past sexually transmitted infections, or multiple sex partners
  • Current or former household contacts of people with known HBV infection
  • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, or who are predialysis
  • People with elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels of unknown origin
  • If never previously screened, test for HBsAg, anti-HBs, and total anti-HBc (triple panel)
    • Unless less than aged 18 years and completed a vaccine series as an infant
  • If previously screened, but still unvaccinated, offer testing to people who have ongoing risk for exposure

For additional screening considerations for patients on dialysis, see: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (cdc.gov)
  • Vaccinate

For additional considerations for patients on dialysis, see Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (cdc.gov)
Other populations at risk: Screening and Testing Vaccination
  • Residents and staff members of facilities for people with developmental disabilities
  • Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
  • People with diabetes at the discretion of the treating clinician
  • International travelers to countries with high or intermediate levels of endemic hepatitis B virus infection
  • If never previously screened, test for HBsAg, anti-HBs, and total anti-HBc (triple panel)
    • Unless aged <18 years and completed a vaccine series as an infant

For additional screening considerations for patients on dialysis see: Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients (cdc.gov)
  • Vaccinate

For additional vaccination considerations for healthcare personnel see: Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices | MMWR (cdc.gov)

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Adapted from:

Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023. MMWR Recomm Rep 2023;72(No. RR-1):1–25.

Weng MK, Doshani M, Mohammed AK, et al. Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. Morbidity and Mortality Weekly Report 2022;71(13):477-483

Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1):1–31