Hepatitis B Antigen Results: What Parents Need to Know

What are the issues related to Hepatitis B surface antigen?

Dear Doctor,
I have been feeling panic and anxiety for the past six months regarding this issue.
I have searched for a lot of information online, but the more I search, the more anxious I become, and I feel very depressed.
Here is a brief description of the situation: My child is a freshman in college (with over 1500 students undergoing health check-ups), and the health check report is as follows: Hepatitis B surface antigen: 0.93 (reference value <1).
Hepatitis B surface antibody: positive.
Hepatitis B e antigen: negative.
GOT and GPT are both normal (according to the hospital report), all showing normal results.
(Before entering high school, all the above tests were negative, and my child received three doses of the vaccine.
A week before the college health check report came out, another dose of the vaccine was administered.) However, after researching online, I found that a Hepatitis B surface antigen level of 0.93 seems to be in a gray area, which makes me very scared.
Therefore, I asked a relative in the northern region to take my child to a highly-rated medical laboratory for retesting.
This laboratory used EIA testing, and the results were as follows: Hepatitis B surface antigen: <0.1 (-) (reference value <1 (-)).
Hepatitis B surface antibody: >1000 (+) (reference value >10 (+)).
Both results showed normal.
The dates of the two tests were approximately 40 days apart.
Later, I called the health check department of hospital to inquire if the antigen value could be falsely elevated.
The hospital stated that, generally, if the antigen is below 1, it is considered negative, and as long as the antibody is positive, there is no problem.
I have several questions for you, Doctor:
1.
What could be the reason for the significant difference in Hepatitis B surface antigen values between the two tests?
2.
Which value should I trust? Should I have it retested again?
3.
Is the report from the highly-rated medical laboratory credible?
4.
Is the antibody concentration of >1000 due to just having received the vaccine? (My child received three doses of the vaccine since birth, and both my husband and I are antigen negative and antibody positive.)
5.
Does having an antibody response after vaccination mean that one can be free from the fear of being a Hepatitis B carrier?
6.
Can the Hepatitis B vaccine prevent all "subtypes" of Hepatitis B?
7.
If the blood sample is stored for too long (my child was among the first group to have blood drawn at the school, with over 1500 freshmen), could there be hemolysis? Would the test values be falsely elevated?
8.
Is blood drawn and processed immediately at the medical laboratory more accurate?
I sincerely request your time to answer these questions.
Thank you very much! I apologize for asking you so many questions; I am really anxious and feel like I am on the verge of depression.
Thank you, thank you!

Lin Mama, 40~49 year old female. Ask Date: 2012/04/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Ms.
Lin.
Basically, the results of the hepatitis B antigen test are not solely about the concentration values, so there is no need to focus too much on the numbers.
As long as the result is <1.0 and there are positive antibodies, it indicates lifelong immunity.
I won't address the other questions individually.
Please don't worry; Changhua Hospital cares about your health.
Dr.
Chen Shidian.

Reply Date: 2012/04/26

More Info

Understanding Hepatitis B Antigen Results: What Parents Need to Know
First and foremost, I want to acknowledge your concerns regarding your child's Hepatitis B test results. It’s completely understandable to feel anxious when it comes to health matters, especially when it involves your child. Let’s break down your questions and clarify the situation regarding Hepatitis B testing.

1. Discrepancy in Hepatitis B Antigen Results: The difference in the Hepatitis B antigen (HBsAg) results from the two different laboratories could be attributed to several factors. Variability in testing methods, calibration of equipment, or even the timing of the tests can lead to different results. The first test showing a value of 0.93 is indeed in a gray area, as it is close to the cutoff of 1.0, which is typically considered negative. The second test, which reported <0.1, clearly indicates a negative result.
2. Which Result to Trust: Given that the second test was conducted at a reputable laboratory and yielded a clear negative result, it is reasonable to trust this finding. If the first test was borderline and the second test is negative, it suggests that your child is not a carrier of Hepatitis B. It may not be necessary to retest unless advised by a healthcare professional based on clinical symptoms or other risk factors.

3. Credibility of the Laboratory: The credibility of the laboratory is crucial. A laboratory accredited by the health department and recognized for its quality standards is generally reliable. If the second test was performed at such a facility, you can have confidence in its accuracy.

4. Antibody Levels Post-Vaccination: The antibody level of >1000 indicates a strong immune response, which is expected after vaccination. Since your child received the Hepatitis B vaccine series, this high level of antibodies suggests effective immunization. It is normal for antibody levels to be high shortly after vaccination.

5. Fear of Being a Carrier: If your child has a positive antibody response and a negative antigen result, it indicates that they are not a carrier of Hepatitis B. The presence of antibodies means that the immune system has responded appropriately to the vaccine, providing protection against the virus.

6. Vaccine Efficacy Against Hepatitis B Subtypes: The Hepatitis B vaccine is effective against all known subtypes of the virus. It is designed to elicit a robust immune response that protects against infection from various strains of Hepatitis B.

7. Sample Handling and Hemolysis: If blood samples are not processed promptly, there is a risk of hemolysis, which can affect test results. However, reputable laboratories typically have protocols in place to minimize this risk. If the first sample was processed quickly and the second one was also handled properly, the results should be reliable.

8. Immediate Processing of Blood Samples: Blood samples that are processed immediately tend to yield more accurate results. Delays can lead to changes in the sample that might affect the test outcomes. Therefore, it is beneficial that the second test was conducted promptly.

In conclusion, based on the information provided, it appears that your child is not a carrier of Hepatitis B and has a strong immune response due to vaccination. It is essential to maintain open communication with your healthcare provider, who can offer personalized advice and reassurance. If anxiety persists, consider discussing these feelings with a mental health professional. Your child's health and your peace of mind are paramount, and seeking support is a positive step.

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