[MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

[Tim Crump]

I am on the side of recommending that workers repeat the Hep B immu series if they have a verbal history of Hep B vaccination (but no documentation) and a positive titer.  When discussing with the worker, I walk them through the hypothetical situation of a high-risk exposure to Hepatitis B, and their Hep B titer at that time is negative.  If their Hep B immu status was documented, I could safely disregard the current negative titer and assume immunity from their previous positive titer.  But without that documentation, I would need to play it safe and recommend Hepatitis B Immune Globulin.  Of course the worker can decline to repeat the series and they can decline the immune globulin if the situation arises, but often when workers think of it through the lens of a high-risk exposure, the repeating the series for documentation can make more sense.  Best, Tim

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
3181 SW Sam Jackson Park Rd
Mail code: UHN 89
Portland, OR 97239-3098
Department Phone: 503-494-5271
Office Phone: 503-346-1152
Fax: 503-494-4457
Email: crumpt at ohsu.edu<mailto:crumpt at ohsu.edu>

Mon-Fri, 7:30-4:00

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Stuart Sandler via MCOH-EH
Sent: Tuesday, July 10, 2018 3:50 PM
To: esweet at dhs.lacounty.gov; mcoh-eh at mylist.net
Cc: fldocstu at aol.com
Subject: Re: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

Erika,

I understand the highlighted paragraph in the statement -  it is obvious that if you have a documented series of vaccines with a subsequent titer positive, the series worked.  If the titer is negative, then repeat the series and, if the titer is negative still, they are considered non-converters and need B Immunoglobulin with any future exposures.

Maybe I wasn't clear initially.    I am wondering  why the need for physical documentation of the vaccines if the titers are positives. Some responses have said that if there is a positive titer, but the employee cannot produce physical proof of vaccine (on paper), they don't accept the titer and want to repeat the vaccine series.  To me, that doesn't make sense, so I wanted to know why.  If the employee verbalizes a history of vaccine series but can't produce proof, if they were in the military and don't remember what they received but received a barrage of vaccines, or if they received vaccines with a different employer, but they are not sure of what - the employer was in the health care or similar field where Hep B vaccines are the norm -  would you not accept that as a reasonable probability of vaccination if you also have a positive titer?  We do that with positive MMR and Varicella titers.

Stuart A. Sandler, DO

-----Original Message-----
From: Erika Sweet <esweet at dhs.lacounty.gov<mailto:esweet at dhs.lacounty.gov>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: fldocstu <fldocstu at aol.com<mailto:fldocstu at aol.com>>
Sent: Tue, Jul 10, 2018 5:52 pm
Subject: RE: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers
See attached CDC FAQ on Hep B and the Healthcare Worker.

Erika Sweet, RN, MSN, NP, COHN-S
Director of Employee Health Services
Los Angeles County Department of Health Services
Office (310) 222.2364



From: MCOH-EH [mailto:mcoh-eh-bounces+esweet=dhs.lacounty.gov at mylist.net<mailto:mcoh-eh-bounces+esweet=dhs.lacounty.gov at mylist.net?>] On Behalf Of Stuart Sandler via MCOH-EH
Sent: Tuesday, July 10, 2018 5:33 AM
To: mcoh-eh at mylist.net<mailto:eh at mylist.net>
Cc: fldocstu at aol.com<mailto:fldocstu at aol.com>
Subject: Re: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

List,

I may be missing something, so ask for enlightenment.  If someone comes in knowing that they had the 3 series of HepB vaccine and you receive a positive HepBSAb titer on your pre-hire testing, why would you give a repeat series if the person cannot produce written documentation of the vaccines?  I received my vaccines many years ago and the institution is no longer available to ask for records, nor did we think of that at the time.  Would not the positive titer itself suffice for proof of immunity?  I have not been asked in the past by any employer or hospital for proof of vaccine, just proof of immunity.


And what do you do with a person who doesn't remember if they had ever been vaccinated (happens more times than I can count), yet has a sufficient HepBSAb titer?  It doesn't mean that they never received the series.  Then, too, what do you do if the person received two vaccines only, but has a significantly positive titer?  Why would you give them the third, especially if it had been a while since the first two? For example, I became significantly symptomatic after my second vaccine (OK, it WAS in the stone ages at the early start of vaccinations and they weren't as refined as they are curently), so a titer was done prior to getting the third.  I had a high Ab titer, so it was decided that I had been properly immunized and that the risks of having the third were outweighed by the possible of a worsened reaction.  BTW, I had a documented 0 titer prior to the vaccine series.

Just curious.

Stuart A. Sandler, DO


-----Original Message-----

Today's Topics:

1. Re: #ExtMail# Incompletely Vaccinated HepB & Immunity Titers
AND ? requiring Hepatitis B vaccination for employees?
(Schweitzer, Kit)


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Message: 1
Date: Mon, 9 Jul 2018 22:32:14 +0000
From: "Schweitzer, Kit" <KSchweitzer at peacehealth.org<mailto:KSchweitzer at peacehealth.org>>
To: "MCOH/EH" <mcoh-eh at mylist.net<mailto:eh at mylist.net>>
Subject: Re: [MCOH-EH] #ExtMail# Incompletely Vaccinated HepB &
Immunity Titers AND ? requiring Hepatitis B vaccination for employees?
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We require documentation of 3 Hep B vaccs AND positive titer to ensure life long immunity as recommended by CDC. We start the series over if they don't have documentation and only a titer. If documentation and no titer, we draw a titer.
Thank you.

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