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

philip.adamo@umassmemorial.org

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