[MCOH-EH] Hepatitis B and titers

[Hudson, T. Warner]

Phil- your approach makes sense. We check titers and if negative give booster and then recheck the titer.

Sent from my BlackBerry 10 smartphone.
From: Adamo, Philip
Sent: Wednesday, September 24, 2014 5:39 AM
To: 'mcoh-eh at mylist.net'
Reply To: MCOH/EH
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
philip.adamo at umassmemorial.org

"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.


________________________________

IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
-------------- next part --------------
An embedded and charset-unspecified text was scrubbed...
Name: ATT001.txt
URL: <http://mylist.net/archives/mcoh-eh/attachments/20140924/a8985dab/attachment-0001.txt>