In this situation, they requested that titers be done before we advised them of our records status or requirements.
Lawrence D Budnick, MD, MPH
Director, Occupational Medicine Service
Associate Professor of Medicine and Preventive Medicine
Rutgers University - New Jersey Medical School
65 Bergen St, GA-167, PO Box 1709, Newark, NJ 07101-1709
tel 973.972.2900
fax 973.972.2904
lawrence.budnick@rutgers.edu
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From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Upfal, Mark
Sent: Thursday, December 11, 2014 2:42 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
I agree that if you meet any of the criteria for proof of immunity (e.g. MMR x 2), you can consider the person immune (even if titer is zero at the time of exposure). If there's inadequate documentation (e.g. only one MMR), then you'd need to rely on the titers.
Mark Upfal, MD, MPH
Corp Medical Director, DMC Occupational Health Services
4201 Saint Antoine, UHC 4G-3
Detroit, MI 48201
(313) 993-0509
__________________________________________
This e-mail message and any attachments may be privileged and confidential and protected information. If you are not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any review, use, disclosure, dissemination, distribution or copying of this communication may be a violation of the law. Please contact the sender immediately by replying to the message and delete it from your computer. Thank You.
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Swift, Melanie
Sent: Thursday, December 11, 2014 2:31 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Does your health dept require titers after exposure if you have full vaccination records?
There are those individuals whose immunity will just not be reflected in an IgG. I had a pediatric resident who spent an hour in the room with an infant with measles, we only had one MMR on record so we gave one post exposure but because of delayed diagnosis we were behind the 8 ball. We simultaneously did an IgG which was negative, so we furloughed her. While she was home she had time to find her old records. She found both pediatric vaccines plus the one she had to get for college, so she had documentation of 3 prior MMRs before the exposure.
Despite her negative IgG and her hour spent cooped up with what turned out to be a highly infectious measles case (wearing NO PPE because at her age she’d NEVER seen measles before) she did not develop the disease.
There are people who will never seroconvert but are immune, and I think if you have good vaccination records you can stop there. (ongoing transmission or a shaky immunization history would be the exception of course.)
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Budnick, Lawrence
Sent: Thursday, December 11, 2014 12:58 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
We require titers for all, esp since few people provide vaccination records. Most of the medical staff are also employees.
This came in handy last year when we had a measles exposure incident. Over 450 employees were potentially exposed, according to our State Dept of Health, and it mandated that only those with documented immunity could work and not be furloughed. Because we already had the tests done, operations were less disrupted than they would have been.
Lawrence D Budnick, MD, MPH
Director, Occupational Medicine Service
Associate Professor of Medicine and Preventive Medicine
Rutgers University - New Jersey Medical School
65 Bergen St, GA-167, PO Box 1709, Newark, NJ 07101-1709
tel 973.972.2900
fax 973.972.2904
lawrence.budnick@rutgers.edu
CONFIDENTIALITY NOTICE: This email communication may contain private, confidential, or legally privileged information intended for the sole use of the designated and/or duly authorized recipient(s). If you are not the intended recipient or have received this email in error, please notify the sender immediately by email and permanently delete all copies of this email including all attachments without reading them. If you are the intended recipient, secure the contents in a manner that conforms to all applicable state and/or federal requirements related to privacy and confidentiality of such information. Thank you.
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Swift, Melanie
Sent: Thursday, December 11, 2014 1:54 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
We finally tied it to credentialing/recredentialing. Took some time to build the case, but once done compliance was virtually 100% after the first 2 year recredentialing cycle.
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu@mylist.net] On Behalf Of Upfal, Mark
Sent: Thursday, December 11, 2014 12:42 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Thanks, Melanie. This is currently a requirement for our employees, but not privileged physicians (unless they are employed by us). I'm trying to advocate for applying the same requirement for all, but need to find out how others do it first. Have a nice holiday!
Mark Upfal, MD, MPH
Corp Medical Director, DMC Occupational Health Services
4201 Saint Antoine, UHC 4G-3
Detroit, MI 48201
(313) 993-0509
__________________________________________
This e-mail message and any attachments may be privileged and confidential and protected information. If you are not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any review, use, disclosure, dissemination, distribution or copying of this communication may be a violation of the law. Please contact the sender immediately by replying to the message and delete it from your computer. Thank You.
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Swift, Melanie
Sent: Thursday, December 11, 2014 1:37 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Yes we require proof of immunity or vaccination. For MMR we provide vaccination, for VZ we provide antibody testing and then vaccination if negative.
If born prior to 1957, considered immune to measles and mumps.
Same for all. (our physicians are employees, though we have a very small number of community physicians with privileges, same requirements apply to them.)
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Upfal, Mark
Sent: Thursday, December 11, 2014 12:02 PM
To: 'MCOH/EH'
Subject: [MCOH-EH] MMR & VZ - proof of immunity
For MMR & VZ, does your organization require proof of immunity for employees and staff? Are the requirements the same or different for new employees vs. newly credentialed physicians on medical staff?
Mark Upfal, MD, MPH
Corp Medical Director, DMC Occupational Health Services
4201 Saint Antoine, UHC 4G-3
Detroit, MI 48201
(313) 993-0509
__________________________________________
This e-mail message and any attachments may be privileged and confidential and protected information. If you are not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any review, use, disclosure, dissemination, distribution or copying of this communication may be a violation of the law. Please contact the sender immediately by replying to the message and delete it from your computer. Thank You.
This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation.
This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation.
This message (including any attachments) is confidential and intended solely for the use of the individual or entity to whom it is addressed, and is protected by law. If you are not the intended recipient, please delete the message (including any attachments) and notify the originator that you received the message in error. Any disclosure, copying, or distribution of this message, or the taking of any action based on it, is strictly prohibited. Any views expressed in this message are those of the individual sender, except where the sender specifies and with authority, states them to be the views of Tenet Healthcare Corporation.