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Hepatitis B Recommendations and Algorithm for Primary Care Providers

The Hepatitis B Foundation published a clinical flowchart with key recommendations to help improve hepatitis B screening, vaccination, and management in the primary care setting. This is the result of an expert panel convened by the Hepatitis B Foundation that included physicians from family medicine, general internal medicine, pediatrics, and obstetrics/gynecology, as well as a nurse practitioner and a physician assistant. Read the full article Chronic hepatitis B infection: A workshop consensus statement and algorithm that was published in the Journal of Family Practice (Sept. 2011;60:E1-E8).

HBF Algorithm


Screening Outline


Screen for HBV

  • Screen all patients who are at increased risk of contracting HBV, especially those from HBV-endemic regions of the world, by testing for hepatitis B surface antigen and antibody (HBsAg and anti-HBs).
  • Screening for HBV is simple, relatively inexpensive, and can dramatically change clinical outcomes related to hepatitis B disease.


  • Vaccinate all infants, children, and adolescents following guidelines outlined by the CDC and American Academy of Pediatrics, as well as adult patients whose screening results are negative for both HBsAg and anti-HBs.

Evaluate and Monitor

  • Patients who are HBsAg-positive are infected with HBV and, while they may appear asymptomatic, they require further evaluation and periodic, life-long monitoring for disease progression.

Consult with a Liver Specialist

  • Elevated ALT and HBV DNA >2,000 IU/mL in patients with chronic HBV infection are suggestive of active liver disease.
  • Primary care providers should promptly consult with a specialist or a provider who has experience treating patients with active hepatitis.
  • A primary care practitioner could then choose to refer these patients to the specialist for continuing care and monitoring, or may prefer to become educated in the management of HBsAg-positive patients.

Screen for HCC

  • In persons with chronic HBV who are at increased risk for hepatocellular carcinoma (HCC), perform periodic screening for HCC according to current AASLD guidelines.


Read the Hepatitis B Foundation’s Recommendations for Pregnant Women

Read the Hepatitis B Foundation’s Recommendations for Children and HBV





Page last modified October 16, 2012

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