Hepatitis B Surface Antibody (anti-HBs) is the protective antibody your immune system makes after successful vaccination against Hepatitis B or after natural recovery from a past Hepatitis B infection.
The “QN” (quantitative) result tells you how much antibody is present, in mIU/mL (milli-international units per milliliter), which helps determine whether you are likely immune.
Why it matters
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A sufficient anti-HBs level strongly suggests protection against future Hepatitis B infection.
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It helps confirm a successful vaccine response (especially important for healthcare workers, people on dialysis, the immunocompromised, and infants born to HBsAg-positive mothers).
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It can guide next steps if your level is low or if you never responded to vaccination.
Typical reference points (how labs often report it)
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≥10 mIU/mL: Generally considered protective/immune.
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<10 mIU/mL: Non-immune or uncertain protection; may reflect no prior vaccination, incomplete series, waning measurable antibodies, or a vaccine non-response.
Note: Some labs set slightly different cutoffs (e.g., 12 mIU/mL). Your report’s reference range takes precedence.
How to read your result
If your anti-HBs is elevated/positive (e.g., ≥10 mIU/mL)
What it means
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You are likely immune to Hepatitis B.
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This usually follows a full vaccine series or recovery from past infection.
Common reasons
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Completed vaccination with a normal immune response.
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Past infection that has resolved (in this case, anti-HBs is present and HBsAg is negative; anti-HBc total is usually positive from the past exposure).
What to consider next
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For most healthy adults, no booster is needed once immunity is documented.
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Occupational or high-risk settings may require proof of immunity; some programs prefer repeat testing at defined intervals.
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If you’re on hemodialysis or immunocompromised, your clinician may monitor levels periodically and consider additional doses if the level falls below 10 mIU/mL.
If your anti-HBs is low/negative (e.g., <10 mIU/mL)
What it means
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You’re not clearly immune based on this test alone.
Common reasons
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Never vaccinated, or vaccine series not completed.
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Antibody levels declined over time (this can happen even if you formed immune memory).
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Primary non-response to vaccination (more common in smokers, people with obesity, diabetes, chronic kidney disease, HIV, older age, or those on certain medications).
What to consider next
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If never vaccinated or series incomplete: start or complete a Hepatitis B vaccine series (traditional 3-dose or newer 2-dose schedules exist).
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If previously vaccinated but now <10 mIU/mL: many clinicians give one booster dose and re-check anti-HBs 1–2 months later. If still <10, a full repeat series is often considered.
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If you have higher-risk conditions (e.g., hemodialysis, immunosuppression), your care team may monitor anti-HBs more closely and maintain levels ≥10 mIU/mL with additional doses as needed.
Important: A negative anti-HBs does not diagnose active infection. If exposure or infection is a concern, your clinician may order HBsAg (surface antigen) and anti-HBc (core antibody) to complete the picture.
Understanding the Hepatitis B panel at a glance
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HBsAg (surface antigen): Present in active infection.
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Anti-HBc total (core antibody): Indicates past or current infection (not vaccine-induced).
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Anti-HBs (this test): Indicates immunity (post-vaccine or post-recovery).
Common patterns
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Immune from vaccination: HBsAg negative, anti-HBc negative, anti-HBs positive.
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Immune from past infection: HBsAg negative, anti-HBc positive, anti-HBs positive.
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Susceptible (not immune): HBsAg negative, anti-HBc negative, anti-HBs negative.
Timing tips
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After finishing a vaccine series, check anti-HBs 1–2 months later to document response.
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Measuring too soon after a single dose may underestimate your true response.
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After natural infection, anti-HBs appears as you recover and HBsAg clears.
Factors that can affect results
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Immune status: Immunosuppressive therapy, HIV, chronic kidney disease (dialysis) can lower vaccine responses.
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Age, smoking, obesity, diabetes: Associated with reduced vaccine response.
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Vaccine schedule/product: Different schedules (2-dose vs 3-dose) and formulations exist; adherence matters.
Frequently asked questions
Do protective levels ever “wear off”?
Measured anti-HBs can decline over time, but most healthy people retain immune memory. Even if the number drops below 10 mIU/mL years later, you may still be protected. Certain high-risk groups are managed more proactively with periodic testing/boosters.
If I’m already immune, do I need boosters?
Healthy adults with documented anti-HBs ≥10 mIU/mL generally do not need routine boosters. High-risk or immunocompromised individuals may follow specific monitoring/booster plans.
Can I be infected and still have anti-HBs?
During acute recovery, anti-HBs emerges as HBsAg disappears. Persistently positive HBsAg with anti-HBs is unusual—if there’s any confusion, your clinician will review the full panel and clinical context.
Practical next steps (based on your result)
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≥10 mIU/mL: Keep documentation as proof of immunity for school, work, or travel. No routine boosters for most healthy adults.
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<10 mIU/mL: Talk to your clinician about:
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Completing or repeating a vaccine series, or
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A challenge/booster dose followed by re-testing in 1–2 months, especially if you’re in a higher-risk setting.
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Test details
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Analyte: Hepatitis B surface antibody (anti-HBs)
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Method: Immunoassay (varies by lab)
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Units: mIU/mL
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Specimen: Serum
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Typical cutoff for immunity: ≥10 mIU/mL (lab-specific)
Important disclaimers
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Interpretation should consider your full Hepatitis B panel, vaccination history, risk factors, and medical history.
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This information is for education and does not replace medical advice. Consult your clinician for personal recommendations, especially if you are pregnant, immunocompromised, on dialysis, or have a potential exposure.
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What does it mean if your Hepatitis B Surface Ab Immunity, Qn result is too low?
A low Hepatitis B surface antibody level—typically <10 mIU/mL—suggests you are not clearly immune to Hepatitis B. This doesn’t diagnose an active infection; it indicates that your measurable protection is inadequate or uncertain.
Why your level may be low
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No vaccination or incomplete series
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Antibodies have waned over time (levels can drop even if some immune memory remains)
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Vaccine non-response: more likely with older age, smoking, obesity, diabetes, chronic kidney disease/dialysis, HIV, certain medications, or immunosuppression
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Testing too early after the first dose (before full series completion)
What to do next
1) If never vaccinated or series incomplete
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Start or complete a Hepatitis B vaccine series (2-dose or 3-dose options exist).
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Check anti-HBs 1–2 months after the final dose to confirm response.
2) If previously vaccinated but now low (<10 mIU/mL)
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Many clinicians give a single booster (“challenge”) dose, then re-test anti-HBs in 1–2 months.
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If still <10 mIU/mL, a repeat full series may be recommended.
3) If you’re higher risk (healthcare worker, on hemodialysis, immunocompromised, diabetes, chronic liver disease, household/sexual contact of a person with Hep B):
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Your care team may monitor levels periodically and maintain ≥10 mIU/mL with additional doses as needed.
What this result does not tell you
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It does not confirm active infection. If exposure or symptoms are a concern, your clinician may add:
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HBsAg (surface antigen): checks for current infection
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Anti-HBc (core antibody): indicates past or current infection
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When to re-test
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After vaccination or booster: Recheck 1–2 months later.
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Ongoing risk or immunosuppression: Your clinician may set a regular monitoring schedule.
Practical checklist
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Review your vaccine history and complete any missing doses.
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Ask about the best vaccine schedule for you (2-dose vs 3-dose, timing).
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Plan a follow-up anti-HBs test to verify protection.
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If you work in healthcare or have high exposure risk, keep documentation of your immune status.
Related tests to consider
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HBsAg (rules out active infection)
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Anti-HBc total (evidence of past exposure)
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ALT/AST if infection is suspected or for baseline liver health
Key takeaways
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Low anti-HBs (<10 mIU/mL) = not clearly immune.
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Most people can reach protective levels with completion of vaccination or a booster + re-test.
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High-risk or immunocompromised individuals may need closer monitoring and targeted booster strategies.
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