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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

CSTE Position Statement(s)

  • 23-ID-05


  • Hepatitis B, acute
  • Hepatitis B, chronic


Hepatitis B is a vaccine-preventable liver infection caused by the hepatitis B virus (HBV). Hepatitis B is spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from the gestational parent to baby during pregnancy or at birth. Not all people newly infected with HBV have symptoms, but for those that do, symptoms can include fever, fatigue, poor appetite, stomach pain, nausea, vomiting, abdominal pain, dark urine, clay-colored stools, and jaundice. For some persons, hepatitis B is an acute, or short-term, illness; for others, it can become a long-term, chronic infection.  Chronic hepatitis B can lead to serious health problems, including cirrhosis, liver cancer, and death.

Clinical Criteria

In the absence of a more likely, alternative diagnosis*, acute onset or new detection of at least one of the following:

  • Jaundice,
  • Total bilirubin ≥ 3.0mg/dL, or
  • Elevated serum alanine aminotransferase (ALT) levels > 200 IU/L.

* Alternative diagnoses may include evidence of acute liver disease due to other causes or advanced liver disease due to hepatitis B reactivation (see section VIB), pre-existing chronic HBV infection, other causes including alcohol exposure, other viral hepatitis, hemochromatosis, or conditions known to produce false positives of hepatitis B surface antigen, etc.

Criteria to Distinguish a New Case from an Existing Case

  • A case of HBV infection classified under the Perinatal HBV position statement (16-ID-06) can be additionally enumerated as a confirmed case of chronic HBV infection if a positive HBV viral detection test (HBsAg, HBeAg, or HBV DNA) is obtained after 24 months of age.
  • A confirmed acute case of HBV infection may be additionally enumerated as a new confirmed chronic case of HBV infection if a positive HBV viral detection test is reported 6 months or longer after acute case onset or, if asymptomatic, after the initial positive test result.
  • An acute case of HBV infection should not have been previously enumerated as a case of either acute or chronic HBV infection.
  • A chronic case of HBV infection should not have been previously enumerated as a case of chronic HBV infection.

Subtype(s) Case Definition

Case Classification Comments

Individuals born in the US, under or equal to the age of 24 months, and born to a mother with documented evidence of Hepatitis B should be reported using the Perinatal Hepatitis B Position Statement (16-ID-06), unless there is evidence that exposure occurred via a non-perinatal mechanism (e.g., healthcare acquired).