After a Possible Exposure: Testing Patients for Hepatitis B and C

When patients may have been exposed to a bloodborne virus — through an infection-control lapse in a clinic, for instance — health departments have to notify them and offer testing. CDC's guidance sets out which tests to use for hepatitis B and C, and one rule that is easy to miss: a single negative result soon after exposure is not the end of it.

Screening recommendations depend on the risk of transmission, and the right tests vary with how recent and how likely the exposure was. CDC staff are available to consult on testing for any particular notification.

Hepatitis B

Consider three serologic tests, which together establish a person's infection and immunity status:

• hepatitis B surface antigen (HBsAg);
• antibody to the surface antigen (anti-HBs);
• total antibody to the core antigen (total anti-HBc).

Since March 2023, CDC has also recommended one-time hepatitis B screening for all adults with this triple panel.

Hepatitis C

Start with an HCV antibody test that reflexes to a nucleic acid test (NAT) for HCV RNA if the antibody is positive. CDC recommends collecting everything needed for the diagnosis in a single visit.

Retest after six months

For both hepatitis B and C, a recent infection may take six months or more to show up on blood tests. To find every infection, retest once six months have passed since the last exposure.

Notifying patients

• CDC's Patient Notification Toolkit helps health departments notify patients after a possible infection-control lapse.
• The Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-Resistant Pathogens (CORHA) publishes guidance on notification during a suspected healthcare-associated outbreak.

CDC's viral hepatitis outbreak team can be consulted at any point in the process.

Sources

Based on "Viral Hepatitis: Notification After Exposure," Centers for Disease Control and Prevention, Health Care Outbreak Toolkit; a work of the United States government in the public domain.