[MCOH-EH] MMR vaccine requirements

[Nancy Rodway]

i Just want to add to that because, in my experience, it is RARE to have an adult with appropriate vaccination records (one immunization of rubella, two immunizations for varicella, measles, mumps.   In that case, i have a choice (see below) of options  to ensure immunity.  One IS to get serologic evidence of antibody status (in other words, draw the labs)   In my experience, it is more straightforward to do this (and less risky) rather than deal with the immunization of women of child-bearing age with a vaccination that is contraindicated in pregnancy.  So, i draw titers if the new hire does not bring vaccination records or laboratory proof of immunity (any lab proof of immunity in the past is acceptable).  Then I immunize as appropriate with the few that do not have evidence of immunity.


Nancy Rodway MD MPH FACOEM




>From the MMR article:

All persons who work in health-care facilities should have presumptive evidence of immunity to measles. This information should be documented and readily available at the work location. Recently vaccinated HCP do not require any restriction in their work activities.

Presumptive evidence of immunity to measles for persons who work in health-care facilities includes any of the following:

  *   written documentation of vaccination with 2 doses of live measles or MMR vaccine administered at least 28 days apart,†  (MY ADDITION: YOU ONLY NEED ONE IMMUNIZATION FOR RUBELLA, TWO FOR MEASLES, MUMPS AND VARICELLA)
  *   laboratory evidence of immunity,§
  *   laboratory confirmation of disease, or
  *   birth before 1957.¶

Prevaccination Testing

Prevaccination antibody screening before MMR vaccination for an employee who does not have adequate presumptive evidence of immunity is not necessary unless the medical facility considers it cost effective (134,170--172) although no recent studies have been conducted. For HCP who have 2 documented doses of MMR vaccine or other acceptable evidence of immunity to measles, serologic testing for immunity is not recommended. In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. Because rapid vaccination is necessary to halt disease transmission, during outbreaks of measles, serologic screening before vaccination is not recommended.




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________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Swift, Melanie <melanie.swift at Vanderbilt.Edu>
Sent: Wednesday, February 22, 2017 12:45 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] MMR vaccine requirements


Hi Cathy,



The CDC does not recommend that you run titers for these diseases in the absence of vaccination records. If someone does not have a record of vaccination, the appropriate thing to do is vaccinate them. Antibody testing is not very informative or helpful for MMR. No, you should not check titers after vaccinating. One in 5 appropriately vaccinated individuals will have a negative IgG for mumps!



We do accept a positive antibody test if someone presents us with one, and we have checked IgG on someone who has a contraindication to vaccination, just to guide an accommodation decision.



Guidance may be found at Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 2011;60(RR07);1-45.<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm>



Attached is a statement we provide to people whose school, or next employer, is asking them to have labs drawn despite appropriate vaccination.



Melanie



Melanie Swift, MD

Associate Professor of Clinical Medicine

Director, Vanderbilt Occupational Health Clinic

Vanderbilt University Medical Center



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Reichen, Catherine
Sent: Wednesday, February 22, 2017 11:36 AM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] MMR vaccine requirements



Can anyone help me out?  If a new hire does not have vaccine records to prove MMR vaccination – we run titers.  If the titer for rubeola shows no immunity but rubella shows immunity – should the employee receive one or two MMR’s?  Do you run repeat titers after a period of time?  Do you allow them to start working with only one vaccine? Can you also provide a resource of how to determine this requirement?  Thank you in advance!



Cathy


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