[MCOH-EH] MMR vaccine requirements

[Swift, Melanie]

Agree with Leslie. There are programs that don't have to pay for the lab tests but just have the costs absorbed by the organization; so depending on the math and your actual costs, you might be able to do that as a cost-savings measure.
>From the literature, expect approximately 20% to be negative for mumps IgG; measles and rubella about 5%. For us, it would be worth testing for measles but not for mumps, so cheaper to just vaccinate with MMR for anyone without documented vaccination.

Anecdotally, someone mentioned that adults almost never have vaccine records. Not our experience really - it's amazing how motivated people can be to find their vaccination records, when they know we are going to revaccinate them if they can't find it! ;)

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 Leslie Thompson via MCOH-EH
Sent: Wednesday, February 22, 2017 3:38 PM
To: MCOH/EH
Cc: Leslie Thompson
Subject: Re: [MCOH-EH] MMR vaccine requirements

Right, depends on the organization.  The CDC guidance suggests you can decide based on cost benefit.  We did a cost benefit analysis before switching from vaccine to titer on those without documentation.  In our experience, we see a high percentage of positive titers and the cost is significantly lower than 2 doses of MMR.  Depends on your pricing for titers and vaccine.

Leslie

Leslie Thompson, RN, MSN, COHN-S
Manager, Employee Occupational Health Department
Sharp HealthCare
8695 Spectrum Center Blvd
San Diego, CA  92123
leslie.thompson at sharp.com<mailto:leslie.thompson at sharp.com>



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Tara Dockery
Sent: Wednesday, February 22, 2017 13:28 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] MMR vaccine requirements

That's weird. Usually people don't have documentation and don't remember, so its been our practice to run a titer to see if they have immunity.  But I can imagine every program is different.

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift, Melanie
Sent: Wednesday, February 22, 2017 9:45 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
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<mailto: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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