Can I Use a Hepatitis B Titer Test Instead of the Hepatitis B Vaccine for Immigration?
Quick Answer
Yes. A positive hepatitis B surface antibody (anti-HBs) titer test demonstrating immunity is accepted as proof of hepatitis B immunity for immigration purposes. If your titer is positive, you do not need the hepatitis B vaccine. If negative, you will need the vaccine series.
Hepatitis B Titer Testing for Immigration
For immigration purposes, laboratory evidence of hepatitis B immunity is accepted as an alternative to documented vaccination. The relevant test is the hepatitis B surface antibody (anti-HBs) titer, which measures the level of protective antibodies against hepatitis B virus. A positive anti-HBs result indicates immunity, either from prior vaccination or prior infection followed by recovery.
What Anti-HBs Level Is Required
The standard threshold for hepatitis B immunity is an anti-HBs level of 10 mIU/mL or greater. This is the widely accepted cutoff used by laboratories and public health authorities. A result at or above this threshold is considered positive (immune). A result below 10 mIU/mL is considered negative (non-immune), and you will need to receive the hepatitis B vaccine series.
What Happens If Your Titer Is Negative
If your anti-HBs titer is negative (below 10 mIU/mL), you will need to receive the hepatitis B vaccine series. The standard series consists of 3 doses: dose 1 at the initial appointment, dose 2 at least 4 weeks later, and dose 3 at least 8 weeks after dose 2. Alternatively, Heplisav-B (a 2-dose series for adults 18 and older) can shorten the timeline significantly. Form I-693 cannot be finalized until the series is complete.
Prior Hepatitis B Infection vs. Vaccination
A positive anti-HBs titer can result from either prior vaccination or prior hepatitis B infection followed by recovery. If your titer is positive due to prior infection, you are still considered immune for immigration purposes. However, the civil surgeon may also test for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) to determine your hepatitis B status. A positive HBsAg result indicates current hepatitis B infection, which has separate immigration implications.
Titer Testing Is Included in the Flat Fee
At our office, hepatitis B titer testing is included in the flat fee for the immigration medical exam. There are no additional charges for the blood draw or laboratory processing. If your titer is negative and you need the vaccine series, all doses are also included in the flat fee.
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