[MCOH-EH] Hepatitis B and titers

[JimGarb]

Phil - I have always tried to get documentation of a positive anti-HBS done
following a standard 3 dose Hep B vaccination series that was given in the
past, no matter how many years ago.  If we could get that documentation,
then no anti-HBS testing is done.  And with most hospitals on board with
doing anti-HBS testing 1 to 2 months following the third dose of the series
for some time now, that documentation is often available.  If no prior
response to the vaccine can be documented, then your approach sounds
reasonable given that the vaccine is probably the safest that has ever come
down the pike.  Although we in the past have done the testing before giving
the booster dose.  The balance between getting a booster and a blood test vs
getting a blood test with the chance of avoiding a booster and second blood
test will strike different people differently. 

 

Jim

 

James Garb, MD FACOEM

Medical Director Occupational Health

Cape Cod Healthcare

 

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Adamo, Philip
Sent: Wednesday, September 24, 2014 8:40 AM
To: 'mcoh-eh at 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

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

 

 

 

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