There are three broad categories for determining who should be tested for HBV: People from countries with high rates of HBV (“endemic” is the term used to describe this), people in certain medical situations or conditions, and people with certain risk factors. If someone was born in certain regions of the world, including but not limited to Asia, Southeast Asia, sub-Saharan Africa, and certain parts of the Mediterranean and South America, they should be screened. This is especially important for immigrants, refugees, asylum seekers, and children adopted from abroad. Similarly, if a child is born to a mother from one of these regions, they should be tested, too. In addition to screening based on country of origin, there are certain medical conditions or situations (such as hemodialysis patients or all pregnant women), as well as groups with certain risk factors.

Who should get screened:

Anyone from endemic regions of the world

  • Anyone born in a country with HBV rates greater than 2%
  • Anyone born in the U.S. who did not receive a vaccination and whose parents were born in a country with HBV rates greater than 8%

Anyone with certain medical situations or conditions

  • All pregnant women
  • Babies born to HBV-infected mothers
  • Hemodialysis patients
  • Anyone needing immunosuppressive therapy (such as chemotherapy or those receiving organ transplants)
  • Anyone with HCV before undergoing DAA therapy
  • Donors of blood, plasma, organs, tissues, or semen (before donation)
  • Anyone with an unexplained elevated ALT/AST liver test


  • Anyone who injects drugs
  • Men who have sex with men
  • Anyone living with HIV
  • Household members, needle-sharing (including injection equipment), or sex partners of anyone who has HBV
  • Anyone who is the source of blood or body fluids resulting in a potential HBV exposure (such as an occupational needlestick, or blood splash, or sexual assault) where post-exposure prophylaxis may be necessary

These activities have been associated with the risk of transmission:

  • Mother-to-child transmission during pregnancy and labor
  • Condomless sex with an infected partner
  • Sharing syringes and other drug-injection equipment (cookers, cotton, water, etc)
  • Sharing household items such as razors or toothbrushes with an infected person
  • Other blood-to-blood contact
  • Occupational exposure from needlesticks or other risks of blood-to-blood contact

Other than transmission via blood, sex, or mother-to-child, HBV is very hard to get. It is not transmitted from casual contact, including the following:

  • Sharing eating utensils
  • Sharing drinking glasses
  • Hugging or kissing
  • Exposure to other body fluids such as sweat or tears

Hepatitis B is not transmitted through food (that’s hep A), but can be transmitted from an HBV-infected mother to baby through pre-chewed food.