Hepatitis B#

Hepatitis B is a viral infection of the liver caused by the hepatitis B virus (HBV). The infection can be acute (short-term, usually clearing within 6 months) or chronic (persisting more than 6 months and lasting a lifetime).

Many people with Hep B never feel sick - especially those who acquired it at birth or in early childhood, which is the most common pattern globally. Even without symptoms, chronic Hep B can quietly damage the liver over decades, raising the risk of cirrhosis (liver scarring) and liver cancer.

The good news: most people are already protected if they completed routine childhood vaccination, and chronic Hep B is manageable with regular monitoring and, when needed, antiviral medication.

Hep B is transmitted through blood, semen, vaginal fluids, and other body fluids of an infected person. Common routes:

• Childbirth (parent to baby) - the most common route worldwide; vaccination of newborns reduces this dramatically.
• Unprotected sex with an infected partner.
• Sharing needles, syringes, or other injection equipment.
• Sharing personal items that may carry trace blood (razors, toothbrushes, glucometers).
• Tattoo, piercing, or medical procedures with unsterilized equipment.
• Occupational exposure (healthcare workers, first responders).
• Blood transfusions in countries or eras without modern blood screening (in Canada, before 1970 is the historical cut-off).

Hep B is not transmitted through casual contact - hugging, sharing food or drinks, kissing on the cheek, coughing, sneezing, or breastfeeding (the virus is not transmitted through breast milk).

Most people with Hep B have no symptoms, especially with chronic infection. When symptoms occur (more often with acute infection), they can include:

• Fatigue and feeling unwell.
• Loss of appetite and nausea.
• Abdominal pain (especially in the upper right side, where the liver sits).
• Jaundice (yellow tint to the skin and whites of the eyes).
• Dark urine and pale, clay-coloured stools.
• Joint aches and low-grade fever.

Symptoms - if they occur - typically appear 1-4 months after exposure and last several weeks. Most adults clear acute Hep B on their own; about 5% of adult infections become chronic. The chronic-infection rate is much higher when acquired at birth or in early childhood (up to 90% become chronic).

The Hep B vaccine is one of the most effective vaccines available - more than 95% of people who complete the series develop protective antibodies that typically last for life. Vaccination is the main reason Hep B rates have dropped substantially in countries with universal childhood programs.

If you completed the standard Canadian childhood Hep B series, you do not need a booster in adulthood under most circumstances. Adults who missed the series can catch up at any age - see the vaccination section below.

No. We don't add Hepatitis B to standard STI screening by default. Per Canadian guidelines, we add HBV testing only when you are unvaccinated and have one or more of these risk factors:

• Exposure to someone with Hepatitis B through blood or body fluids.
• High-risk sexual activity (unprotected sex with multiple partners).
• Substance use with shared equipment.
• Use of shared or contaminated materials (e.g., tools used for personal-service procedures that can break the skin, like tattoo or piercing equipment).
• Use of shared or contaminated medical devices (e.g., shared glucometers).
• Occupational exposure to blood or body fluids.
• Travel to or residence in an endemic region.
• Received blood transfusions or medical procedures in Canada before 1970.
• History of incarceration.
• History of HIV or Hepatitis C.
• Born in a country with high HBV prevalence.

Mention any of these in your intake's medical-history section and the clinician will add HBV testing where appropriate.

Screening is not routinely recommended if:

• You're vaccinated and don't carry a special-risk indication (see next accordion).
• You have a known history of Hepatitis B infection - screening doesn't add useful information; ongoing care is with an infectious disease or hepatology specialist.

Sometimes - yes. Even vaccinated patients are screened if they have a special-risk status:

• From areas with intermediate (2%) or higher HBV prevalence.
• Currently pregnant.
• Require immunosuppressive therapy (medications that weaken the immune system).
• Donating blood, plasma, semen, organs, or tissue.
• Born to a parent with Hepatitis B.

There's no fixed recommended frequency. For unvaccinated patients with ongoing risk-factor exposure, screening every 1-2 years is reasonable. For vaccinated patients without special-risk indications, repeat screening is generally not needed.

Hep B blood testing typically includes:

• HBsAg (Hepatitis B surface antigen) - detects active infection. A positive result means you currently have Hep B.
• Anti-HBs (Hepatitis B surface antibody) - detects immunity. A positive result means you're protected (from past vaccination or past resolved infection).
• Anti-HBc (Hepatitis B core antibody) - detects past exposure. A positive result means you've been exposed at some point (could be resolved or chronic).

The combination of these three tests gives a complete picture: protected, currently infected, previously infected and resolved, never exposed, or vaccinated.

TeleTest can prescribe two vaccine options. Both protect against Hepatitis B; the difference is whether Hepatitis A protection is also included.

1. Standalone Hepatitis B vaccine - protects against Hepatitis B only.

• Standard adult schedule: 3 doses at 0, 1, and 6 months.
• An accelerated 2-dose schedule (for adults aged 18+) exists with a specific brand; the clinician will discuss what's appropriate.
• Approximate cost: $40-$70 per dose at most Canadian pharmacies (~$120-$210 for the full series). Private insurance may cover the cost.
• Best choice if: you only need Hep B protection (you've already had Hep A vaccine or had Hep A infection, or your travel/exposure pattern doesn't warrant Hep A).

2. Combined Hepatitis A & B vaccine (Twinrix) - protects against both Hepatitis A and Hepatitis B in a single injection.

• Standard adult schedule: 3 doses at 0, 1, and 6 months.
• An accelerated schedule (0, 7, 21 days + 12-month booster) is available for travel preparation when there isn't time for the standard schedule.
• Approximate cost: $80-$110 per dose (~$240-$330 for the full series).
• Best choice if: you also need or want Hepatitis A protection - common scenarios include international travel (Hep A is common in many regions), men who have sex with men, people who inject drugs, food-service workers, and anyone wanting "two-for-one" protection without separate injections.

See the Twinrix vaccination page for more details on the combined vaccine.

If you were born in Canada in the 1990s or later, you were likely offered the routine Hep B vaccine series in childhood. If you completed the series:

• You're typically protected for life - no booster is needed for most healthy adults.
• You don't need testing to confirm immunity unless you have a special-risk indication (see the screening section above).

If you're unsure whether you completed the series, options include:

• Checking your immunization records (your provincial vaccine registry, family doctor's records, or school health records).
• Anti-HBs antibody testing to confirm immunity - useful before starting healthcare work, immunosuppressive therapy, or pregnancy. Not routinely needed for healthy adults.

If your records are unavailable and antibody testing is negative, a catch-up series (3 doses) is reasonable. Re-vaccination is safe even if you were partially vaccinated as a child.

1. Order the Vaccination panel on teletest.ca. Choose Hepatitis B alone or the combined Hep A/B option.
2. Complete the intake. A clinician reviews your history (travel plans, prior vaccinations, occupational and lifestyle context) and confirms which vaccine is appropriate.
3. The prescription is sent to your preferred pharmacy. Most patients receive the first dose the same day - in Ontario and BC, pharmacists are authorized to administer Hep B and combined Hep A/B vaccines directly.
4. Return for subsequent doses at 1 month and 6 months (or your clinician's recommended schedule if accelerated).

For most healthy adults, no. A completed Hep B series typically provides lifelong protection. Boosters are generally only recommended for:

• Immunocompromised patients (e.g., on dialysis, transplant recipients) - they may need periodic antibody testing and boosters.
• Healthcare workers with documented occupational exposure and inadequate antibody response.
• Patients with confirmed non-response to the original series.

For travel, current Canadian guidance does not recommend routine booster doses if you completed the original series.

• Childhood vaccination through provincial school programs is fully covered.
• Adult catch-up vaccination is generally not covered by provincial health plans except for specific eligible groups (some examples: men who have sex with men, people who inject drugs, household contacts of someone with Hep B, healthcare students - varies by province).
• Private insurance often covers the vaccine cost in adults - check your plan.
• Out-of-pocket ranges roughly $40-$70 per dose for the standalone Hep B vaccine and $80-$110 per dose for the combined Hep A/B vaccine. Your pharmacy can confirm exact pricing.

A positive Hep B test means you have current or past Hep B exposure - the specific tests that are positive will tell the clinician which:

• HBsAg positive = current active infection (acute or chronic). Requires follow-up.
• Anti-HBc positive, HBsAg negative = past exposure that has resolved (your body cleared it). No active infection.
• Anti-HBs positive only = immunity from vaccination or past resolved infection - no infection, you're protected.

A positive HBsAg result triggers a follow-up message in your patient portal. The clinician will:

• Refer you to an infectious disease specialist or hepatology clinic for confirmatory testing, further bloodwork (HBV DNA viral load, ALT, etc.), and ongoing care.
• Discuss what the result means in your specific situation.

Chronic Hep B is manageable. Many people with chronic Hep B live full, healthy lives with appropriate monitoring and, when indicated, antiviral medication. Untreated chronic Hep B is the concern - which is why diagnosis and specialist follow-up matter.

TeleTest does not contact partners directly. Partner notification is your responsibility, but it matters:

• Sexual partners and household contacts should be tested and, if not already immune, vaccinated to prevent transmission. The Hep B vaccine is highly effective at preventing infection in non-immune contacts.
• Public health may follow up - Hep B is a reportable infection in all Canadian provinces. The lab notifies public health of positive results; public health may contact you for partner notification and counselling. They reach out confidentially first.

• All pregnant patients in Canada are screened for Hep B as part of routine prenatal bloodwork - this is universal, not optional.
• If you test positive during pregnancy, your prenatal team will coordinate care with an obstetrician familiar with Hep B and an infectious disease/hepatology specialist.
• The baby will receive Hep B immunoglobulin and vaccination at birth - this is highly effective at preventing transmission. With this approach, transmission rates drop from up to 90% (untreated) to less than 5%.
• Breastfeeding is safe even if you have Hep B - the virus is not transmitted through breast milk.

Yes - Hep B blood testing through the provincial public-health laboratory is covered by your provincial health plan when ordered by a clinician for an eligible resident. The lab fee is not billed to you.

TeleTest's consultation fee is paid out-of-pocket - this covers the asynchronous clinician review that authorizes the requisition. The blood test itself remains covered.

If you're not an eligible resident (no provincial health card or out-of-province), additional uninsured lab fees may apply.