BOX 2-4

CDC Chronic Hepatitis B Case Definition

Clinical description

Persons with chronic HBV infection may have no evidence of liver disease or may have a spectrum of disease ranging from chronic hepatitis to cirrhosis or liver cancer. Persons with chronic infection may be asymptomatic.

Laboratory criteria

  • IgM antibodies to anti-HBc negative


  • a positive result on one of the following tests: hepatitis B surface antigen HBsAg, HBeAg, or hepatitis B virus (HBV) DNA,


  • HBsAg positive or HBV DNA positive or HBeAg positive two times at least 6 months apart (Any combination of these tests performed 6 months apart is acceptable.)

Case classification

Confirmed: a case that meets either laboratory criteria for diagnosis Probable: a case with a single HBsAg positive or HBV DNA positive or HBeAg positive lab result when no IgM anti-HBc results are available


Multiple laboratory tests indicative of chronic HBV infection may be performed simultaneously on the same patient specimen as part of a “hepatitis panel.” Testing performed in this manner may lead to seemingly discordant results, e.g., HBsAg-negative and HBV DNA-positive. For the purposes of this case definition, any positive result among the three laboratory tests mentioned above is acceptable, regardless of other testing results. Negative HBeAg results and HBV DNA levels below positive cutoff level do not confirm the absence of HBV infection.

Abbreviations: CDC, Centers for Disease Control and Prevention; anti-HBc, hepatitis B core antigen; HBsAg, hepatitis B surface antigen; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; DNA, deoxyribonucleic acid.

SOURCE: CDC, 2009a.

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