[MCOH-EH] - diphtheria toxin work and vaccinations

[Swift, Melanie]

For those interested, here is our protocol for researchers working with high dose diphtheria toxin, with some background information that may help. This was quite a challenge to unravel so if you happen to have people working with high dose toxin this may save you time. People who never handle more than 10% of the human LD50 just need routine Td/Tdap boosters - the main concern is that it comes in concentrate and someone has to dilute it. We also have some protocols that call for injection of very concentrated toxin.

I've also attached the CDC's protocol for antitoxin administration. Diphtheria antitoxin is no longer made in the US and supplies are scarce. Access to antitoxin in the US is directed by the CDC's diphtheria officer (!) who determines when and where antitoxin may be deployed. It's administered under an Investigational New Drug protocol. Note that there is a high risk of reactions to the antitoxin (it's horse serum-based) and you have to do allergy testing right before administration. You'd be on the phone with the CDC by then. Contact information is included in our protocol.

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 Swift, Melanie
Sent: Monday, August 03, 2015 4:15 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] - diphtheria toxin work and vaccinations

YES. Michelle I'd be glad to discuss offline. We have people working with high dose concentrated toxin, which has enough toxin for 70 lethal human doses in 0.1ml. I've spent some quality time researching this and speaking to experts at, CDC, NIH and the FDA.
Our high dose handlers get baseline and annual titers - this is a send-out lab and protection for normal bacteria exposure is not adequate level for exposure to preformed toxin. We boost based on titer.
Low dose handlers just need booster q 10y.
Would be happy to share what we've learned.
Sent from my iPhone

On Aug 3, 2015, at 1:32 PM, Gochnour, Michelle K. <michelle.gochnour at seattlechildrens.org<mailto:michelle.gochnour at seattlechildrens.org>> wrote:
If you have workers using diphtheria toxin, how frequently do you provide vaccination booster?  Do you titer as well to ensure levels of antibody (IgG)?  I have a researcher suggesting he should have more frequent boosters than 10 years (as needed for tetanus).  Thoughts?

Michelle
Michelle Kom Gochnour, MN, RN, COHN-S
Senior Occupational Health Consultant | Occupational Health Services
Seattle Children's Hospital


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