Interpretation of postvaccination serologic testing for infants born to HBsAg-positive women*

HBsAg	Anti-HBs	Interpretation	Action
Positive	≥10 mIU/mL	Infected with HBV	Refer for appropriate follow-up including medical evaluation for chronic liver disease.
Positive	<10 mIU/mL
Positive	Not reported
Negative	≥10 mIU/mL	Protected against HBV	NA
Negative	<10 mIU/mL	Susceptible to HBV	Provide an additional dose of HepB vaccine and obtain HBsAg and anti-HBs one to two months later.^¶ If anti-HBs remains <10 mIU/mL, administer two additional doses of HepB vaccine (at least eight weeks apart) to complete the second series and obtain HBsAg and anti-HBs one to two months later.
Negative	Not reported	Indeterminate	Repeat serologic testing.
Not reported	≥10 mIU/mL
Not reported	<10 mIU/mL
Not reported	Not reported

HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; anti-HBs: antibody to HBsAg; mIU: milli-international units; NA: not applicable; HepB: hepatitis B vaccine.
* Postvaccination serology (HBsAg and anti-HBs) should be obtained after completion of the HepB vaccine series, usually at 9 to 12 months of age or one to two months after the last dose of HepB vaccine if immunization is delayed.
¶ This is the preferred regimen. As an alternative, depending upon clinical circumstances or family preference, infants may be revaccinated with a second complete three-dose series (at 0, 1 to 2, and 6 months), followed by serologic testing (HBsAg and anti-HBs) one to two months after the final dose. Refer to UpToDate content on HBV immunization in infants for additional information.

Adapted from: Centers for Disease Control and Prevention (CDC). Postvaccination serologic testing results for infants aged ≤24 months exposed to hepatitis B virus at birth: United States, 2008-2011. MMWR Morb Mortal Wkly Rep 2012; 61:768 with additional data from 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; 67:1.

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Interpretation of postvaccination serologic testing for infants born to HBsAg-positive women*