[MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

Welch, Linda E LWelch2 at iuhealth.org
Wed May 9 06:44:58 PDT 2018


Immunization Action Coalition is a great resource. I think page 2, 2nd to last paragraph may answer your question.
http://www.immunize.org/catg.d/p2109.pdf


Respectfully,

Linda
Linda Welch MSN, RN, ACNS-BC
South Central Region Manager
Employee Health Services
IU Health Bloomington
P.O. Box 1149
Bloomington, IN 47402
T: 812.353.5193 P: 812.323.6868 F: 812.353.5465
LWelch2 at iuhealth.org<mailto:LWelch2 at iuhealth.org>
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Tim Crump
Sent: Tuesday, May 08, 2018 4:07 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

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At our institution, we accept documentation of complete Hep B series.  A titer (HepB sAb) alone or with verbal history of immunization is not sufficient.  In Oregon, they can decline the vaccine, but I always discourage.  I much prefer giving Hep B immunizations before an exposure to HBIG after an exposure.

At the time of exposure, we do consider a positive HepB sAb as evidence of immunity at that moment (i.e. HBIG not indicated and follow-up testing not necessary).  Of course the big problem is when a worker with a past positive HepB sAb and verbal hx of immunization has a negative titer at time of a high-risk exposure.  In that instance, I would recommend HBIG, while if immunizations were documented and subsequent titer was positive, we could forgo HBIG even if titer was negative at time of exposure.

Tim Crump, MSN, FNP
Tim Crump, MSN, FNP
Family Nurse Practitioner
Multnomah Pavilion 1 SE, Suite 1110
Occupational Health
Healthcare Human Resources

Oregon Health & Science University
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Therese Bovee-McKelvey
Sent: Tuesday, May 08, 2018 12:22 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

Greetings;

CDC states that healthcare workers must have documentation of 3 valid HepB vaccinations followed by titer to determine immunity.

Clinician Consultation Center states " If exposed person is known to be immune (e.g., they were told they had a positive response to a complete HBV vaccine series, indicated by post-vaccination HBsAb titer ...), they are considered to have lifelong immunity and need no hepatitis B testing or post-exposure treatment.


Many healthcare workers come in with no or partial documentation of completing a HBV vaccine series but most have documentation of a positive HBsAb titer.  Does your facility accept documentation of completed HBV series and/or HBsAb titer to confirm immunity?  Or so you require documentation for both?

If worker (History as above) later has exposure to positive HBV source patient how do you follow-up with them?  Do you follow the Clinician Consultation Center Recommendations for Post-Exposure Prophylaxis After HBV Exposure under the category of "Unvaccinated or Incompletely Vaccinated" and follow-up for 6 months ?  Or would you do another HBsAb titer?


Thanks for any responses, it all helps.

Therese
Therese Bovee McKelvey, MN, RN  Sr. Employee Health Nurse - Employee Health
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