You are here

Hepatitis B A010

Last amended 
10 January 2017

In this section

Current RMA Instruments
Reasonable Hypothesis SOP
13 of 2017
Balance of Probabilities SOP
14 of 2017
Changes from previous Instruments

SOP Bulletin194.pdf

ICD Coding
  • ICD-9-CM Codes: 070.2, 070.3
  • ICD-10-AM Codes: B16, B18.0, B18.1
Brief description

Hepatitis B is a viral infection of the liver.  Since 1992 all Australian Defence Force personnel are screened on enlistment for Hepatitis B virus (HBV) infection and vaccinated if not already immune.  The SOP covers only symptomatic acute infection, and chronic (symptomatic or asymptomatic) infection of at least six months duration.  The SOP does not cover people with acute Hepatitis B who have a subclinical infection and who do not go on to develop chronic infection.  The SOP does cover people with chronic but inactive infection ("carriers").

Confirming the diagnosis

Diagnosis is usually based on laboratory testing for serology or nucleic acid markers.  Newer methods such as polymerase chain reaction testing for nucleic acid markers are becoming more widely available.  Diagnosis of acute HBV infection requires a clinical illness consistent with acute infection, in conjuction with positive laboratory testing.  Positive serology for acute infection comprises:

  • HBsAg  positive
  • Anti-HBc  positive
  • IgM anti-HBc  positive
  • Anti- HBs  negative

Diagnosis of chronic infection requires confirmation by repeated laboratory testing over a minimum six month period.  Positive serology for chronic infection comprises:

  • HBsAg  positive
  • Anti-HBc  positive
  • IgM anti-HBc  negative
  • Anti- HBs  negative

Additional diagnoses covered by SOP

  • Hepatitis B "carrier state"
Conditions that may be covered by SOP
  • Serum hepatitis – (an out-dated term) serology required to confirm
Conditions not covered by SOP
  • Hepatitis A*
  • Hepatitis C*
  • Hepatitis D*
  • Hepatitis E*

* Another SOP applies

Clinical onset

For acute symptomatic HBV infection, clinical onset will be when the symptoms of the clinical illness, subsequently confirmed to be acute HBV infection, first manifest.  For chronic HBV infection (in the absence of acute clinical infection) clinical onset will be when infection with HBV was first diagnosed by laboratory testing.

Clinical worsening

Worsening of HBV infection will mainly be a consderation in cases of chronic infection and is most likely to be evidenced by reactivation of previously inactive disease.  Appropriate therapy for HBV infection depends on the individual circumstances and disease manifestations.  Anti-viral therapy can be effective in controlling the disease and reducing adverse outcomes.