Who this is for
If you are 18 or older and have never been tested, get the triple panel once. That is CDC's position since March 2023, and it applies whether or not you can name a risk factor. CDC also states that anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many people are reluctant to disclose stigmatizing risks.
USPSTF's December 2020 statement is narrower: screen adolescents and adults at increased risk. Its risk groups are people born in countries or regions where HBsAg prevalence is 2% or greater, regardless of vaccination history in the country of origin; US-born people not vaccinated as infants whose parents were born in regions where prevalence is 8% or greater; people who have injected drugs, past or present; men who have sex with men; people with HIV; and sex partners, needle-sharing contacts, and household contacts of people known to be HBsAg positive. CDC's 2023 list adds people who are or were incarcerated, people with a current or past hepatitis C infection, people with a current or past STI or multiple sex partners, people on maintenance dialysis, and people with elevated ALT or AST of unknown origin. If you are in one of USPSTF's six groups, both bodies want you tested. If you are in one of the five CDC added, CDC wants you tested and USPSTF does not name you. Either way, CDC wants you retested periodically for as long as the risk continues.
Most people who carry the virus do not know it. CDC's 2023 report estimates that 580,000 to 2.4 million people in the United States are living with HBV infection and that two thirds of them might be unaware of it. Chronic infection often starts at birth: USPSTF states that people born in regions with prevalence of 2% or greater often become infected at birth and account for up to 95% of newly reported chronic infections in the US.
Screening and vaccination travel together. CDC's report states that 70% of US adults self-reported being unvaccinated as of 2018, and it tells providers to offer vaccination at the same visit as the blood draw, without waiting for results.
Where the recommendations diverge
- USPSTF Not age-bounded Not age-bounded
- CDC 18 and older
- CDC Not age-bounded Not age-bounded
- CDC Not age-bounded Not age-bounded
The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection.
Our note: Interval from the same page's Practice Considerations: "Clinical judgment should be used to determine screening frequency. The USPSTF found no evidence to determine optimal screening intervals." Periodic screening is described as possibly useful for people with negative results, no vaccine series, and continued risk, such as people who continue to inject drugs and men who have sex with men. Ages are left empty because the statement bounds its population by risk, not age. Pregnancy is covered by a separate USPSTF statement (2019, Grade A). Consistent with USPSTF's 2014 recommendation.
New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years.
Our note: From the Summary of CDC's 2023 recommendations report, MMWR Recommendations and Reports 72(1), March 10, 2023. The Recommendations section states the rule as "All adults aged ≥18 years at least once during a lifetime (new recommendation)." No upper age is stated, so stop_age is left empty. People under 18 are excluded from universal screening because of low prevalence and high vaccination in that age group. The report replaced CDC's 2008 risk-based recommendations. CDC's clinician page restates the position and is dated August 14, 2026.
CDC recommends HBV screening for HBsAg for all pregnant women during each pregnancy, preferably in the first trimester, regardless of vaccination status or history of testing.
Our note: From CDC's clinician page, Clinical Testing and Diagnosis for Hepatitis B, dated August 14, 2026, which restates the pregnancy line in Box 1 of the 2023 report. The same page adds that pregnant women with a history of appropriately timed triple panel screening and no new exposure since then only need HBsAg screening. USPSTF covers pregnancy in a separate 2019 statement, so it is not part of the USPSTF row above.
CDC recommends testing susceptible people periodically, regardless of age, with ongoing risk for exposures while risk for exposures persists.
Our note: Same clinician page. The 2023 report states the same rule and defines susceptible people as those never infected (total anti-HBc negative) who either did not complete a vaccine series or are known vaccine nonresponders. On frequency the report states: "Frequency of periodic testing should be a shared decision between the patient and provider and based on individual risk factors, including age and immune status." It adds that additional data on the ideal frequency of periodic testing is needed. No ages, because the rule applies regardless of age.
Why they differ
The gap here is not about age bands. It is about whether screening should depend on risk at all, and it opened in March 2023, when CDC replaced its 2008 risk-based recommendations with one-time screening of every adult. USPSTF has not followed. Its December 2020 statement restates its 2014 position, and as of September 2026 its topic index shows no in-progress update. AASLD's 2018 guidance is also risk-based, and its 2025 successor guideline does not address screening.
- USPSTF (2020) gives a Grade B to screening adolescents and adults at increased risk, using an HBsAg test with a confirmatory test for reactive results. Pregnancy is handled by a separate USPSTF statement.
- CDC (2023) screens all adults 18 and older at least once during a lifetime with the triple panel, screens every pregnancy, tests susceptible people periodically while risk persists, and tests anyone who asks. It attaches no grade.
- AASLD (2018) screens the risk groups in its Table 3 using HBsAg and anti-HBs, including all pregnant women and people who need immunosuppressive therapy. Its table has no universal-adult line, and it attaches no grade: the guidance was developed by consensus of an expert panel without a formal systematic review. Its position is quoted here rather than carried as a row in the ledger above, which lists USPSTF and CDC.
USPSTF's reasoning is arithmetic about prevalence. Its page states: "The estimated prevalence of HBV infection in the general US population is 0.3% to 0.5%, which makes it reasonable to screen adolescents and adults born in countries or regions with an HBsAg prevalence of 2% or greater", and it extends the same 2% threshold to the clinical and behavioral groups it lists. Its evidence review found that screening based on broad criteria "identified nearly all cases of HBV infection, with numbers needed to screen ranging from 32 to 148", and it notes that "There are currently no randomized clinical trials comparing screening with no screening to provide direct evidence of the benefit of screening."
CDC's reasoning is about who risk-based screening misses. Its 2023 report states: "Risk-based testing alone has not identified most persons living with chronic HBV infection and is considered inefficient for providers to implement." It states that "Universal screening of adults is cost-effective compared with risk-based screening and averts liver disease and death", and describes the new approach as "a simpler and less stigmatizing implementation strategy than previous risk-based HBV screening recommendations". CDC is candid about the evidence: its work group "did not identify any studies directly comparing the effects of universal screening versus risk-based screening", and weighed cost-effectiveness, indirect evidence, practicality, public health benefit and subject matter expertise instead. The report's own surveillance data show the problem with asking about risk: of the 2,009 acute hepatitis B case reports from 2019 that included any risk information, 47% had no risk identified.
CDC also states how to handle the conflict. In the section comparing its position with USPSTF and AASLD, it closes with one rule: "Providers should follow the most conservative approach when recommendations differ." For an adult who has never been tested, the more conservative approach is the one that tests you: the one-time triple panel.
AASLD sits closer to USPSTF than to CDC, and CDC says so: "AASLD also recommends screening persons at increased risk for infection; however, this guidance primarily is based on previous CDC recommendations." The two risk lists differ at the edges. AASLD's Table 3 includes unvaccinated people with diabetes aged 19 through 59, travelers to countries with intermediate or high prevalence, residents and staff of facilities for developmentally disabled persons, and health care and public safety workers with occupational blood exposure; CDC's report names the first three as groups it covers through universal adult screening rather than periodic testing. CDC's list in turn added incarceration, a current or past hepatitis C infection, and STIs or multiple sex partners in 2023. AASLD's newer guideline, the AASLD/IDSA 2025 practice guideline on treatment of chronic hepatitis B, addresses prevention, liver cancer surveillance and treatment and does not revisit screening, so the 2018 guidance remains AASLD's screening statement.
The bodies also differ on which test to run: USPSTF names HBsAg with a confirmatory test, AASLD names HBsAg and anti-HBs, and CDC names all three markers. AASLD's own text allows anti-HBc as an alternative first test, as long as anyone positive is then tested for HBsAg and anti-HBs.
What the test involves
One blood draw. Under CDC's recommendation the laboratory runs three tests on it. HBsAg is a protein on the surface of the virus, and CDC states that its presence indicates the person is infectious, except when it is transiently positive within 30 days after a dose of vaccine. Total anti-HBc appears with infection and persists for life, so it marks previous or ongoing infection; people whose immunity comes from a vaccine do not develop it. Anti-HBs is the antibody vaccination produces, and CDC states that a level of 10 mIU/mL or higher is a known correlate of protection only when testing follows a complete vaccine series.
Under USPSTF the laboratory runs an HBsAg test approved by the US Food and Drug Administration and follows a reactive result with a confirmatory test. USPSTF adds that serologic panels run with or after HBsAg screening allow for diagnosis and determine further management.
Timing matters if you are being vaccinated at the same visit. CDC recommends collecting blood before vaccination because transient HBsAg positivity has been reported for up to 18 days after a dose, and states that providers do not need to wait for results to give the first or next dose.
If the result is abnormal
CDC's 2023 report maps each result pattern to an action. Acute or chronic infection: link to hepatitis B care. Resolved infection: counsel about the risk of reactivation, which matters if you are ever immunosuppressed. Immune: reassure if the vaccine series was completed, or complete it. Susceptible: offer the vaccine. An isolated core antibody result is handled according to its cause.
A positive HBsAg means infection, and AASLD's 2018 guidance defines chronic infection as HBsAg present for at least 6 months. The initial evaluation CDC lists for anyone who is HBsAg positive includes a complete blood count, a comprehensive metabolic panel with AST and ALT, HBeAg and anti-HBe, HBV DNA (the viral load), tests for hepatitis C, hepatitis D and HIV, hepatitis A immunity, an abdominal ultrasound, and elastography or a serum fibrosis assessment. Treatment for acute infection is not typically indicated except in severe disease.
Not everyone with chronic infection is treated. USPSTF states that between 20% and 40% of patients with chronic HBV infection will require treatment, and AASLD describes chronic hepatitis B as a dynamic disease in which serial ALT and HBV DNA levels guide the decision to start. People not on treatment are assessed regularly; AASLD sets ALT checks at 3- to 6-month intervals for HBeAg-positive patients with persistently normal ALT. Anyone with cirrhosis warrants liver cancer surveillance by ultrasound every 6 months.
Two more steps follow a positive result. Household, sexual and needle-sharing contacts should be notified, tested and, if susceptible, vaccinated. And cases are reported to the state or local health jurisdiction. CDC states that people should not be excluded from health care work, school, child care or other settings because of HBV infection. AASLD adds hepatitis A vaccination if not already immune, and abstinence or only limited use of alcohol.
More on this screening
Frequently asked questions
I was vaccinated. Do I still need to be screened?
Under CDC, yes, once: the triple panel identifies vaccinated people as well as infected ones, and CDC chose an all-adults rule because it was more feasible to implement than one carved into specific age groups. Under USPSTF the answer depends on risk, and vaccination does not remove you from its risk groups: its recommendation applies to adolescents and adults at increased risk "including those who were vaccinated before being screened for HBV infection", and its birthplace rule applies regardless of vaccination history in the country of origin. People under 18 are the group CDC left out of universal screening, citing low prevalence and high vaccination in that age group.
I have no risk factors. Do I need this?
CDC says yes, once, and its 2023 report explains why asking about risk is unreliable: of the 2019 acute hepatitis B case reports that included any risk information, 47% had no risk identified, and many people are reluctant to disclose stigmatizing risks. USPSTF says no unless you fall into one of its increased-risk groups. If you want the test, CDC states that anyone who requests HBV testing should receive it, regardless of disclosure of risk.
My HBsAg test was positive. What does that mean?
You have a hepatitis B infection, acute or chronic; AASLD defines chronic as HBsAg present for at least 6 months. The next step is a medical evaluation with a primary care clinician or a liver specialist, including viral load, liver enzymes and a fibrosis assessment. There is no cure, but CDC states that early diagnosis and treatment of chronic infection reduces the risk for cirrhosis, liver cancer, and death, and USPSTF puts the share of chronic infections that require treatment at 20% to 40%.
My core antibody is positive but HBsAg is negative. Am I infected?
Most often this is a past infection that resolved. CDC states that total anti-HBc indicates previous or ongoing infection and persists for life, and that people whose immunity comes from a vaccine do not develop it. The action CDC attaches to a resolved infection is counseling about reactivation risk, which is relevant if you are ever immunosuppressed. An isolated core antibody, with neither HBsAg nor anti-HBs, is handled according to its cause.
How often should I be retested?
Once is the recommendation for most adults under CDC. For people who are susceptible (never infected, and either not fully vaccinated or known vaccine nonresponders) and have ongoing risk, CDC says periodic testing while the risk persists, with the frequency "a shared decision between the patient and provider and based on individual risk factors, including age and immune status." USPSTF says clinical judgment should set the frequency for people with continued risk and that it found no evidence to determine optimal screening intervals. AASLD's 2018 guidance states no re-screening interval.