Provider resources
Screening recommendations
Per the CASL/AMMI 2025 HBV Guidelines.
New in 2025: one-time universal screening for all adults ≥ 18 years, regardless of risk factors, using a triple panel — HBsAg, anti-HBs, and anti-HBc.
Who to screen
- All adults ≥ 18 years at least once (universal screening).
- All pregnant individuals, in every pregnancy.
- People born in — or with parents from — intermediate/high-endemicity regions (prevalence ≥ 2%): much of Asia, Africa, the Pacific Islands, parts of the Middle East, Eastern Europe, and South America.
- People who inject drugs, or have ever done so.
- Household, sexual, and needle-sharing contacts of HBsAg-positive individuals.
- People living with HIV or HCV.
- Anyone requiring immunosuppressive or cytotoxic therapy (screen before starting).
- People on hemodialysis; men who have sex with men; individuals with multiple sexual partners; incarcerated individuals.
How to screen — the triple panel
| HBsAg | Anti-HBs | Anti-HBc (total) | Interpretation |
|---|---|---|---|
| – | + | – | Immune — vaccination |
| – | + | + | Immune — resolved past infection |
| – | – | – | Susceptible — offer vaccination |
| + | – | + | Infected (acute or chronic) — confirm & stage |
| – | – | + | Isolated anti-HBc — consider occult HBV; check HBV DNA |
On confirmed HBsAg positivity
- Confirm chronicity (HBsAg positive ≥ 6 months).
- Complete phenotyping: HBeAg/anti-HBe, quantitative HBV DNA, ALT, and quantitative HBsAg.
- Reflex HDV testing (anti-HDV) in all HBsAg-positive individuals — a 2025 recommendation.
- Co-infection panel: anti-HCV, HIV, and hepatitis A immunity.
- Fibrosis staging (FibroScan preferred, or APRI) and baseline abdominal ultrasound.
- Counsel and vaccinate susceptible household and sexual contacts.
Use the decision tool to translate these results into phase, treatment eligibility, and a monitoring plan automatically.