It is unfortunate that even though there
were new 2013 CDC recommendations, there are still so many individual decisions
that need to be made with regard to Hep B for healthcare workers. Nothing is
ever totally clear-cut, but there are still so many questions.
We still struggle with many new hires not
having documentation of their Hep B vaccines given in the past. Previously, we
would titer new hires
if the employee “was sure”
they completed the series in the past. In most cases now, based on the newest
recommendations, we repeat the series or get a declination rather than titer if
there is no documentation of the three vaccines.
Employee Health Coordinator
Phone 570-621-4351
Fax 570-621-4257
bkantner@schuylkillhealth.com
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
Hahnemann Campus
Phone: 508-334-6179
FAX: 508-334-6433
cell 508-713-3993
philip.adamo@umassmemorial.org
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