[MCOH-EH] Genome Equivalents as a measure of viral load

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

Yes, but it is extraordinarily rare to have someone who actually performs Category 3 SHEA (category 1 OSHA) "exposure-prone" procedures AND who cannot get their viral load below the recommended permissible levels with treatment. Bear in mind that drawing blood, giving shots, suturing, skin procedures, and other types of routine care and procedures do not fall into that category.

These cases should all undergo review by an expert panel including ID, OH, legal, etc, and yes, Occupational Health would be the appropriate employer entity to ensure the monitoring is done and to secure those confidential medical records.

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
Associate Medical Director, Occupational Health Service
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>


From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu at mylist.net] On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Tuesday, November 12, 2019 3:15 PM
To: MCOH-EH; Occ-Env-Med-L at listserv.unc.edu
Cc: Thanassi, Wendy; Tacoronti, Rudolph V.
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load

Wait- wow- really? Do you actually restrict practice? Does anyone require these twice-yearly test results be given to OH?

Wendy
Chief, OH
PAVAHCS

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Lanzi, Maria via MCOH-EH
Sent: Tuesday, November 12, 2019 8:33 AM
To: MCOH-EH <mcoh-eh at mylist.net>; Occ-Env-Med-L at listserv.unc.edu
Cc: Lanzi, Maria <Maria.Lanzi at va.gov>
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load

Thanks Melanie!



From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Swift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Tuesday, November 12, 2019 11:26 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>; Occ-Env-Med-L at listserv.unc.edu<mailto:Occ-Env-Med-L at listserv.unc.edu>
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie at mayo.edu<mailto:Swift.Melanie at mayo.edu>>
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load

Conversion differs slightly for each virus. I got this from something published (or presented, can't recall) by Mark Holodniy, MD, FACP, CIC, Professor of Medicine, Stanford University School of Medicine and Palo Alto VA. Viral load results may be expressed in copies/ml or genome equivalents (GE)/ml rather than international units (IU.) But, IU conversion factors are:
For HIV, 1 IU = 1.74 copies.
For HBV, 1 IU = 5.6 copies.
For HCV, 1 IU = 3.8 copies.

Following are recommended viral loads for infected HCW performing invasive procedures under SHEA guidelines compared to CDC:

SHEA recommendations:
Clinical Activities

Recommendation

Permissible Viral Load

"Category 1 or 2"
de minimis, or theoretical but unlikely risk

No practice restriction
Receive follow-up by personal physician
Adhere to optimal infection control procedures
Double glove for Category 2 procedures

N/A

"Category 3"
Definite Risk Procedure

Viral load check twice yearly
Restricted from high risk procedures if viral load above permissible level
Receive follow-up by personal physician
Adhere to optimal infection control procedures
Double glove for high risk procedures

HBV <10,000 GE/mL
(about 2000 IU/ml)
HCV <10,000 GE/mL
(about 2500 IU/ml)
HIV <500 GE/mL
(about 300 IU/ml)


CDC Recommendations (Hepatitis B only)
Clinical Activities

Recommendation

Permissible Viral Load

"Category 2" Low or No Risk Procedure

No panel oversight needed
Receive follow-up by personal physician

N/A

"Category 1" Definite Risk Procedure

Viral load check twice yearly
Restricted from high risk procedures if viral load above permissible level
Receive follow-up by personal physician
Adhere to optimal infection control procedures

HBV < 5,000 GE/mL (about 1,000 IU/ml)




Hope this helps,
Melanie

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Galaid Edward I
Sent: Tuesday, November 12, 2019 10:19 AM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>; Occ-Env-Med-L at listserv.unc.edu<mailto:Occ-Env-Med-L at listserv.unc.edu>
Subject: [EXTERNAL] [MCOH-EH] Genome Equivalents as a measure of viral load

This is pertaining to the unit of measure that is used in the SHEA HCP with HBV/HCV/HIV infection document (https://www.shea-online.org/images/guidelines/BBPathogen_GL.pdf) to quantify viral load.

My Lab Director and his colleagues have not been able to come up with a conversion factor to express viral load as copies/mL or IU's.

Appreciate any info on how you're handling this.   This is not a new issue.  I am just stumped.

And maybe the SHEA document from 2010 is due for an update.

Thanks

Ed Galaid


Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Roper St. Francis Physician Partners Occupational Medicine
Charleston, SC
Member, ACOEM Task Group,  Guidance for the Medical Evaluation of Law Enforcement Officers
(O) 843-402-5053



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