[MCOH-EH] MCOH-EH Digest, Vol 254, Issue 128 Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

[Lanzi, Maria]

Thank  you Kathleen!   Really appreciate it the clarification - very helpful

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 at mylist.net> On Behalf Of Harriman, Kathleen at CDPH
Sent: Tuesday, May 07, 2019 6:00 PM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] Re: [MCOH-EH] MCOH-EH Digest, Vol 254, Issue 128 Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

Hi Maria,
You're correct that measles IgG retest results from a state public health lab would not be available within the 72 hour window for MMR PEP, and there is no harm in giving MMR to an immune person without contraindications for the vaccine. However, knowing the true measles immunity status of an exposed HCW is even more important for determining whether that HCW needs work exclusion, or even quarantine. Anytime a measles contact reports a history of measles immunization or disease but is measles IgG negative at a commercial lab, we always retest in the state lab to determine whether other public health interventions are necessary.

The main point I wanted to make is that commercial measles IgG testing can be falsely negative, and a negative result does not necessarily mean that the tested person is susceptible to measles. It's also important to know that people with two documented doses of MMR or who are measles IgG positive have been infected with measles so exposed HCWs who are presumed to be immune to measles should be advised to monitor themselves for measles symptoms, especially prodromal symptoms, and self-isolate immediately if any occur. We have had exposed HCWs who were presumed to be immune to measles develop measles, continue to work while symptomatic, and expose others because they didn't think they could develop measles.  Thanks, Kathy

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


-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces+kathleen.harriman=cdph.ca.gov at mylist.net<mailto:mcoh-eh-bounces+kathleen.harriman=cdph.ca.gov at mylist.net>> On Behalf Of mcoh-eh-request at mylist.net<mailto:mcoh-eh-request at mylist.net>
Sent: Tuesday, May 07, 2019 6:08 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: MCOH-EH Digest, Vol 254, Issue 128

Send MCOH-EH mailing list submissions to
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Today's Topics:

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

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Message: 2
Date: Tue, 7 May 2019 13:07:31 +0000
From: "Lanzi, Maria" <Maria.Lanzi at va.gov<mailto:Maria.Lanzi at va.gov>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] [EXTERNAL] 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<mailto: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<mailto: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.

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<mailto:kathleen.harriman at cdph.ca.gov%3cmailto: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<mailto:Rachel.Leibu at atlantichealth.org%3cmailto:Rachel.Leibu at atlantichealth.org>>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net%3cmailto:mcoh-eh at mylist.net>>>
Cc: "Cuoco, Lisa" <Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org%3cmailto:Lisa.Cuoco at atlantichealth.org>>>
Subject: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

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<mailto:budnicla at njms.rutgers.edu%3cmailto:budnicla at njms.rutgers.edu>>>
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net%3cmailto:mcoh-eh at mylist.net>>>
Cc: "Cuoco, Lisa" <Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org<mailto:Lisa.Cuoco at atlantichealth.org%3cmailto:Lisa.Cuoco at atlantichealth.org>>>
Subject: Re: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

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>


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