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Life sciences · Journal article
BMC Infectious Diseases · November 5, 2026
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Despite the success of various elimination strategies in reducing hepatitis B virus (HBV) prevalence, it remains a substantial public health safety concern drawing considerable attention in China and globally. Testing of HBV serological markers helps evaluate infection status and humoral protective immunity. This study aims to describe HBV serological marker positivity among a large hospital-based test-record cohort in Hangzhou, to generate updated local real-world laboratory-derived descriptive data on HBV serology to support local hepatitis B prevention and control programmes. We conducted a retrospective single-center, cross-sectional analysis of 184896 initial HBV-related test specimens (age 0–102 years) from Hangzhou Ninth Hospital, covering March 2020 to December 2025. These specimens included tests for five HBV serological markers: HBsAg, anti-HBs, HBeAg, anti-HBe, and anti-HBc. HBV serological markers were quantified using chemiluminescence immunoassays (CLIA). After filtering identical duplicate results from the same patient, 151089 test records corresponding to 120345 unique individuals were included. Analyses were stratified by age and sex. Categorical variables were compared using appropriate statistical tests. Among the 116333 valid specimens for HBsAg testing, the overall hepatitis B surface antigen (HBsAg) positivity was 9.73% (11316/116333). HBsAg positivity varied across age strata, peaking at 15.98% in the 41-50-year age group and reaching the lowest value of 0.65% in the 0-10-year age group. Sex-related differences were observed: HBsAg positivity was higher among male test records than female ones (10.82% vs. 8.50%). Among 138682 specimens evaluable for hepatitis B surface antibody (anti-HBs), 47.68% (66118/138682) showed seroprotective anti-HBs levels. anti-HBs seropositivity was highest (71.00%) in 0-10-year age children, followed by a marked drop to 35.32% in 11-20-year age group, and stabilized at suboptimal levels (45.44%–49.16%) across older age groups (21 years and above). Sex-related differences in anti-HBs positivity were detected. While males exhibited a higher overall response rate than females (48.28% vs. 46.90%; P < 0.001), the (normal+high)/low response level is higher in females. The hepatitis B e antigen (HBeAg) positivity increased progressively with age, reaching a peak of 2.87% in the 31-40-year age group, then decreased with age. Hepatitis B e antibody (anti-HBe) and hepatitis B core antibody (anti-HBc) positivity showed similar trends. A total of 27 different HBV serological patterns were identified among specimens with complete five-marker panel results; the five-marker-negative profile was the most frequent pattern, and serological pattern distributions differed by age and sex. This hospital-based dataset demonstrates age- and sex-associated variation in HBVserological marker positivity among tested individuals in Hangzhou. These findings reflect serological profiles among hospital-attending patients and cannot be directly extrapolated to the general population. Further population-based and prospective studies are required to support local HBV prevention and control strategies toward WHO 2030 elimination goals. Not applicable.