[MCOH-EH] [EXTERNAL] Re: Re: MCOH-EH Digest, Vol 254, Issue 125. Measles Prevention in Non-immune Appropriately Vaccinated

[Swift, Melanie D., M.D.]

If you have a HCW who is exposed to measles and was either presumed immune due to being born before 1957, or you did not have documentation of 2 doses of MMR at hire, you could go ahead and give an MMR (extra doses are not harmful!) and draw your serology at the same time. If your serology is negative and you are in the furlough window, I would still send it to the state lab for more sensitive IgG testing. Even if it does take 3 days, a 3-day furlough is better than the full 2 week furlough!

All this becomes much easier to handle if you enforce 2 MMRs at hire.

Melanie

From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu at mylist.net] On Behalf Of Lanzi, Maria via MCOH-EH
Sent: Tuesday, May 07, 2019 8:08 AM
To: MCOH/EH
Cc: Lanzi, Maria
Subject: [EXTERNAL] Re: [MCOH-EH] Re: MCOH-EH Digest, Vol 254, Issue 125. Measles Prevention in Non-immune Appropriately Vaccinated

Kathleen,

Thank you for that discussion.  The issue for those of us in the field however, is that state testing, in most cases, doesn't come back until after the 3 day window for prophylaxis vaccination in the event of a true negative.   So I would follow Larry Budnick comments as noted below as the "real world" will often impact decision making.

Maria

Maria C. Lanzi, MS, MPH, ANP-BC, COHN-S, CTH
Nurse Practitioner/Program Coordinator
Employee Occupational Health
Corporal Michael J Crescenz Veterans Affairs Medical Center
3900Woodland Avenue
Philadelphia, PA 19104
Work:  215 823 5800 x 2592
Fax:  215 823 5968

From: MCOH-EH <mcoh-eh-bounces+maria.lanzi=va.gov at mylist.net> On Behalf Of Harriman, Kathleen at CDPH
Sent: Monday, May 06, 2019 2:36 PM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] Re: [MCOH-EH] MCOH-EH Digest, Vol 254, Issue 125. Measles Prevention in Non-immune Appropriately Vaccinated

CDC does not recommend serologic testing for measles, mumps or rubella for employees with two documented doses of MMR vaccine (past or present). If such employees are  inadvertently tested and found to be measles IgG negative or equivocal, CDC recommends trusting the vaccine history rather than the serologic results, and considering such employees presumptively immune to measles. See: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm.

What is important to know, and I don't think is well known, is that commercial measles IgG testing is often not sensitive enough to identify people who would mount an adequate immune response to measles if they were exposed.

In California, if a HCW (or any other person) is exposed to measles and it is likely that they have received MMR vaccine but they are measles IgG negative or equivocal at a commercial lab, we ask that the blood specimen be sent for retesting at our state laboratory where it is almost always IgG positive.

If a HCW is actually exposed to measles, we do not consider birth before 1957 adequate proof of immunity, and would want such HCWs tested for measles IgG. Similarly, we would want to retest exposed HCWs with a history of being measles IgG negative or equivocal after a history of two doses of MMR vaccine. If either category of HCW was then tested at a commercial lab and found to be measles IgG negative or equivocal, we would request retesting at our state lab to determine their true measles immune status.

In our experience, falsely measles IgG negative or equivocal results are not uncommon, and we don't want to furlough or quarantine people unnecessarily.

Kathleen Harriman
California Department of Public Health
Richmond CA
kathleen.harriman at cdph.ca.gov<mailto:kathleen.harriman at cdph.ca.gov>

Today's Topics:

1.      Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees (Leibu, Rachel)
2.      Re:  Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees (Lawrence Budnick)

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Message: 1
Date: Mon, 6 May 2019 01:28:20 +0000
From: "Leibu, Rachel" <Rachel.Leibu at atlantichealth.org<mailto:Rachel.Leibu at atlantichealth.org>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: "Cuoco, Lisa" <Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org>>
Subject: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees
Message-ID:BN6PR16MB14264476103AA6C9E49CB476F2300 at BN6PR16MB1426.namprd16.prod.outlook.com<mailto:BN6PR16MB14264476103AA6C9E49CB476F2300 at BN6PR16MB1426.namprd16.prod.outlook.com>

HI Everyone,

With the ever growing measles outbreak, how are you handling those employees who have appropriate proof of vaccination for measles but have a negative measles titer post vaccination.  What are you doing for this cohort of employees both prophylactically and in the event of an actual measles  exposure?

Rachel Leibu, MD, MBA, MS, FACOEM
Medical Director Occupational Medicine Services Atlantic Health System
973-829-4277

Message: 2
Date: Mon, 6 May 2019 12:37:08 +0000
From: Lawrence Budnick <budnicla at njms.rutgers.edu<mailto:budnicla at njms.rutgers.edu>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: "Cuoco, Lisa" <Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org>>
Subject: Re: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees
Message-ID:BN6PR1401MB1969959930C1AEA3A5DE8B50FE300 at BN6PR1401MB1969.namprd14.prod.outlook.com<mailto:BN6PR1401MB1969959930C1AEA3A5DE8B50FE300 at BN6PR1401MB1969.namprd14.prod.outlook.com>

Attached is the guidance document from our state health department. Based on it and measles exposure incidents on our campus in 2013 and 2014, we would give a third dose of vaccine and retiter in 6-8 weeks, to help guide future potential exposures. It is possible that the negative titer the person had was taken long after the 2nd measles vaccination. In addition, as the state guidance notes several times, "Extra doses of MMR are not harmful" as long as there are no contraindications.

Lawrence D. Budnick, MD, MPH
Professor of Medicine
Director, Occupational Medicine Service
Rutgers University - New Jersey Medical School
65 Bergen Street, Suite GA-167, Newark, NJ 07107 tel 973.972.2900 fax 973.972.2904 lawrence.budnick at rutgers.edu<mailto:lawrence.budnick at rutgers.edu<mailto:lawrence.budnick at rutgers.edu%3cmailto:lawrence.budnick at rutgers.edu>>


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