[MCOH-EH] MCOH-EH Digest, Vol 249, Issue 14
Diane Shaw
diane.shaw at tuality.org
Fri Dec 12 15:30:51 PST 2014
We use the guidelines from the Immunization Action Coalition at immunize.org or vaccineinformation.org. Below is the link for their pdf dated 3/14
http://www.immunize.org/catg.d/p2017.pdf
Diane M. Shaw, RN, BSN, CIC
Tuality Healthcare
Employee Health Services
335 S.E. 8th Ave
Hillsboro, OR 97123
Phone: 503.681.1444
Fax: 503.681.4170
Tues.-Fri. 0730-1700 hours
The contents of this transmission may be confidential in nature and should be directed only to the addressee. Do not read, copy, or disseminate this material unless you are the intended recipient. If this transmission has reached you in error, please forward this e-mail to the sender to advise, then destroy the message.
-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of mcoh-eh-request at mylist.net
Sent: Friday, December 12, 2014 8:46 AM
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Subject: MCOH-EH Digest, Vol 249, Issue 14
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Today's Topics:
1. Re: MMR & VZ - proof of immunity (Senior, Cathy (DRMC))
2. Re: MMR & VZ - proof of immunity (Swift, Melanie)
----------------------------------------------------------------------
Message: 1
Date: Fri, 12 Dec 2014 11:37:33 -0500
From: "Senior, Cathy (DRMC)" <CESenior at phhealthcare.org>
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Message-ID: <222DF8583BBC7C4CB20DD7562B9DDD5E0F23675E69 at ex07>
Content-Type: text/plain; charset="us-ascii"
Can you give me a source for the criteria for deciding what titers you need for employees. We do MMR and Varicella but was wondering who the guidelines are determined by example CDC or your Dept of Health. This policy was developed before I came into employee health and was just interested in the original source. Also what about our employees that were employed before we started doing these titers in 2008 all I have on them is Rubella. Did anyone go back and titer all employees?
Cathy Senior RN BSN CDE
Employee Health Director
Penn Highlands DuBois
100 Hospital Avenue
P.O. Box 447
DuBois Pa 15801
Phone 814-375-3392
Fax 814-372-2610
cesenior at phhealthcare.org
www.phhealthcare.org
From: MCOH-EH [mailto:mcoh-eh-bounces at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at rutgers.edu<mailto:budnicla at umdnj.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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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.
This email and any attached files are confidential and intended solely for the intended recipient(s). If you are not the named recipient you should not read, distribute, copy or alter this email. Any views or opinions expressed in this email are those of the author and do not represent those of Penn Highlands Healthcare or its affiliates.. Warning: Although precautions have been taken to make sure no viruses are present in this email, the company cannot accept responsibility for any loss or damage that arise from the use of this email or attachments.
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Message: 2
Date: Fri, 12 Dec 2014 16:45:23 +0000
From: "Swift, Melanie" <melanie.swift at Vanderbilt.Edu>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Message-ID:
<984BE23843F0DE4EBE652D6EE07600BE26D4FEE2 at ITS-HCWNEM104.ds.vanderbilt.edu>
Content-Type: text/plain; charset="us-ascii"
Cathy, the CDC has guidelines at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm
They do not recommend antibody screening measles, mumps or rubella. They recommend vaccination unless vaccine records are obtained. (vaccination also cheaper!)
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Senior, Cathy (DRMC)
Sent: Friday, December 12, 2014 10:38 AM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] MMR & VZ - proof of immunity
Can you give me a source for the criteria for deciding what titers you need for employees. We do MMR and Varicella but was wondering who the guidelines are determined by example CDC or your Dept of Health. This policy was developed before I came into employee health and was just interested in the original source. Also what about our employees that were employed before we started doing these titers in 2008 all I have on them is Rubella. Did anyone go back and titer all employees?
Cathy Senior RN BSN CDE
Employee Health Director
Penn Highlands DuBois
100 Hospital Avenue
P.O. Box 447
DuBois Pa 15801
Phone 814-375-3392
Fax 814-372-2610
cesenior at phhealthcare.org<mailto:cesenior at phhealthcare.org>
www.phhealthcare.org<http://www.phhealthcare.org>
From: MCOH-EH [mailto:mcoh-eh-bounces at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at rutgers.edu<mailto:budnicla at umdnj.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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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 at 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 http://occupationalhealth.vanderbilt.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at 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
www.dmc.org/ohs<http://www.dmc.org/ohs>
__________________________________________
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.
This email and any attached files are confidential and intended solely for the intended recipient(s). If you are not the named recipient you should not read, distribute, copy or alter this email. Any views or opinions expressed in this email are those of the author and do not represent those of Penn Highlands Healthcare or its affiliates.. Warning: Although precautions have been taken to make sure no viruses are present in this email, the company cannot accept responsibility for any loss or damage that arise from the use of this email or attachments.
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