What to do if hepatitis B or hepatitis C testing is indicated
Test for hepatitis B with:
- HBsAg (hepatitis B surface antigen)
- anti-HBc (hepatitis B core antibody)
- anti-HBs (hepatitis B surface antibody)
> These three tests indicate infection, exposure and immunity, respectively
Copy the text below, then paste into your pathology request for hepatitis B testing:
HBsAg, anti-HBc, anti-HBs
AND/OR
Test for hepatitis C with:
- anti-HCV (hepatitis C antibody)
> Also request HCV RNA PCR be performed if anti-HCV is positive to avoid delays
Copy the text below, then paste into your pathology request for hepatitis C testing:
anti-HCV, if pos do HCV PCR
Testing for both hepatitis B and hepatitis C?
Copy the text below, then paste into your pathology request for hepatitis B and hepatitis C testing:
HBsAg, anti-HBc, anti-HBs, anti-HCV if pos do HCV PCR
More information
National guidance on testing and management is summarised in the following ashm quick reference guides:
Information in the diagnosis, management and referral of viral hepatitis cases can also be found through HealthPathways:
- HealthPathways Gippsland (for clinics in Gippsland PHN)
- HealthPathways Melbourne (for clinics in Eastern Melbourne and North Western Melbourne PHNs)
The HepLOGIC WALRUS risk tool
The information on this page supports the use of the POLAR/WALRUS viral hepatitis risk tool that is being tested in the HepLOGIC pilot and feasibility study. WALRUS provides an alert for hepatitis B virus (HBV) and/or hepatitis C virus (HCV) testing if risk factors are identified in an individual’s electronic medical record who have no record of prior testing.
Hepatitis B indications
Patients who trigger the POLAR/WALRUS hepatitis B testing alert are:
- people whose recorded ethnicity or country of birth corresponds to a high hepatitis B prevalence area
- Aboriginal and Torres Strait Islander people
- people with elevated alanine aminotransferase (ALT > 30 for females or ALT > 45 for males)
- people with elevated aspartate aminotransferase to platelet ratio index (APRI > 1)
- people with evidence of cirrhosis or liver disease, including metabolic associated fatty liver disease (MAFLD)
- people living with hepatitis C or HIV infection
- people a history of injecting or other drug use
AND there is no evidence that they have been offered testing for or have been previously diagnosed with hepatitis B.
Other people who have risk factors for hepatitis B infection but cannot be reliably identified from electronic medical records include: sexual or household contacts and family members of people living with hepatitis B, men who have sex with men, sex workers, and people in custodial settings or undergoing dialysis. Testing is also indicated for pregnant women and some healthcare workers.
The National HBV testing policy or can be referred to for detailed guidance on testing indications.
Hepatitis C indications
Patients who trigger the POLAR/WALRUS hepatitis C testing alert are:
- people whose recorded ethnicity or country of birth corresponds to a high hepatitis C prevalence area
- Aboriginal and Torres Strait Islander people
- people with elevated alanine aminotransferase (ALT > 30 for females or ALT > 45 for males)
- people with elevated aspartate aminotransferase to platelet ratio index (APRI > 1)
- people with evidence of cirrhosis or liver disease, including metabolic associated fatty liver disease (MAFLD)
- people living with hepatitis B or HIV infection
- people a history of injecting or other drug use
AND there is no evidence that they have been offered testing for or have been previously diagnosed with hepatitis C.
Other people who may be at risk of infection with hepatitis C but cannot be reliably identified from electronic medical records include people who: are in custodial settings, have tattoos or body piercings, are sexual partners of a person with HCV infection, received an organ transplant or blood transfusion prior to 1990, were born to mothers with HCV infection, or have had a needle-stick injury. Testing may also be indicated for some healthcare workers.
Repeated hepatitis C testing may be required for people who have an ongoing risk of exposure to hepatitis C, even after treatment.
The National HCV testing policy can be referred to for detailed guidance on testing indications.