Phil – I have always tried to get documentation of a positive anti-HBS done following a standard 3 dose Hep B vaccination series that was given in the past, no matter how many years ago. If we could get that documentation, then no anti-HBS testing is done. And with most hospitals on board with doing anti-HBS testing 1 to 2 months following the third dose of the series for some time now, that documentation is often available. If no prior response to the vaccine can be documented, then your approach sounds reasonable given that the vaccine is probably the safest that has ever come down the pike. Although we in the past have done the testing before giving the booster dose. The balance between getting a booster and a blood test vs getting a blood test with the chance of avoiding a booster and second blood test will strike different people differently.
Jim
James Garb, MD FACOEM
Medical Director Occupational Health
Cape Cod Healthcare
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Adamo, Philip
Sent: Wednesday, September 24, 2014 8:40 AM
To: 'mcoh-eh@mylist.net'
Subject: Re: [MCOH-EH] Hepatitis B and titers
Good morning all:
I am interested in how your institution handles Hep B titers at pre-placement
The 2013 CDC recommendations state:
“All HCP recently vaccinated or recently completing HepB vaccination who are at risk for occupational blood or body fluid exposure should undergo anti-HBs testing. Anti-HBs testing should be performed 1–2 months after administration of the last dose of the vaccine series when possible. HCP with documentation of a complete 3-dose HepB vaccine series but no documentation of anti-HBs 10 mIU/mL who are at risk for occupational blood or body fluid exposure might undergo anti-HBs testing upon hire or matriculation. Testing should use a quantitative method that allows detection of the protective concentration of anti-HBs (10 mIU/mL) (e.g., enzyme-linked immunosorbent assay [ELISA]).”
The word “might” is not good especially when mid level providers work off protocols. This is also different then what figure 6 implies.We also know and the literature supports that the measurement of immunity wanes over time. My recall is that after 7 years it is difficult to measure the immunity greater than 10. There is also literature that those who receive the vaccine in infancy have undetected immunity in adulthood; however, they are immune to Hep b.
Based on this information, I have in previous hospitals set a standard of giving a booster for those with documented 3 doses and more than 7 years and then checking the immunity with a titer rather than checking a titer, getting an non immune response, administering a booster and checking again. Any thoughts on this?
Thanks,
Phil
Philip Adamo, M.D., MPH, FACOEM
Associate Vice President and
Medical Director, Employee Health &
Occupational Injury Care and Wellness
UMass Memorial Medical Center
Hahnemann Campus Suite 201
291 Lincoln Street
Worcester, MA 01605
Phone: 508-334-6179
FAX: 508-334-6433
cell 508-713-3993
"THE GREAT USE OF LIFE is to spend it for something that will outlast it."
William James
The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer.