[MCOH-EH] Covid Vaccines For Healthcare Workers
Upfal, Mark
mupfal at dmc.org
Sun Aug 1 13:36:17 PDT 2021
We’ll put, Melanie!
Mark
*** As of December 18, 2019, I will be fully retired from the DMC. Please use my Wayne State University email for future communications: mupfal at wayne.edu.
Thank you,
Mark Upfal, MD, MPH
On Jul 31, 2021, at 1:03 PM, Swift, Melanie D., M.D., M.P.H. via MCOH-EH <mcoh-eh at mylist.net> wrote:
ACOEM has drafted a statement that is being edited now and will be discussed by the board today. I hope it will contribute our unique perspective and not be a “piling on” or recapitulation of the other statement. There is a fine line to walk here and ACOEM is the perfect organization to champion a compassionate approach.
On the one hand we care deeply about protecting healthcare personnel and we know what they’ve been through on the front lines over the past 15 months. On the other hand, something does need to be done because vaccination rates have plateaued, so we can’t just do more education and voluntary vaccination.
The fact that HCP vaccination rates are not yet over 90% universally represents fears, misinformation, information mistrust, and some (actually valid) confusion about the optimum postinfection vaccination timing/dosage. It’s important to approach all of those concerns compassionately and not to suddenly vilify unvaccinated HCP who we’ve been calling “heroes” since the start of the pandemic. HCP are neither heroes nor villians. They are people, they are our patients. Vaccine mandates are probably necessary in this case, in my opinion, but they can quickly take the tone of a witch hunt – let’s find those unvaccinated HCP and make them take a shot or else just fire them so they and their families can suffer. Then we can feel superior because we got vaccinated and these silly ex-heroes were so afraid of vaccination they were willing to become unemployed and financially insecure. Who needs ‘em, anyway? (whoops, we actually do need them…) And let’s rip those heart rainbows off our windows while we’re at it?
So yes, I do think we’ll need to mandate vaccines, but it’s all to easy to flip the switch to a drastic “take a vaccine or get fired” policy. While this may get some people vaccinated, it won’t change minds or engender trust, and certainly doesn’t make them feel cared for or appreciated. They need individual attention at this point. They’ve heard the facts. They don’t believe them or don’t trust them or don’t understand them, or they believe they have an individual situation that isn’t being addressed. So let’s address them. But that’s a lot of work, firing some of them to set an example and scare the others is much easier. Coupling a mandate with individual medical consultation is really resource intensive. I think they’re worth it.
Completely my personal opinion.
Melanie
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Sumeet Batra via MCOH-EH
Sent: Thursday, July 29, 2021 4:15 PM
To: mcoh-eh at mylist.net
Cc: Sumeet Batra <subatra at ucdavis.edu>
Subject: [EXTERNAL] [MCOH-EH] Covid Vaccines For Healthcare Workers
Agree with the prior comments on this topic. I know this is an MCOH specific mailing list but there are a lot of ACOEM members here so I just wanted to add that it is not too late in my opinion for ACOEM to take a public stand about mandating covid vaccines for certain worker populations, especially outside of healthcare. Many other industries are considering this and our opinion may carry more weight in occupational settings where we’re the main clinical decision makers.
Sumeet Batra MD, MPH
Medical Director of Employee Health Services
UC Davis Health
Phone) 916-734-7513
Fax) 916-734-7510
________________________________
From: MCOH-EH <mcoh-eh-bounces+subatra=ucdavis.edu at mylist.net<mailto:mcoh-eh-bounces+subatra=ucdavis.edu at mylist.net>> on behalf of mcoh-eh-request at mylist.net<mailto:mcoh-eh-request at mylist.net> <mcoh-eh-request at mylist.net<mailto:mcoh-eh-request at mylist.net>>
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To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net> <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: MCOH-EH Digest, Vol 256, Issue 132
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Today's Topics:
1. Re: COVID Vaccine for HCWs (Rolando, Lori)
2. Re: COVID Vaccine for HCWs (Robert K. McLellan)
3. Third doses of Pfizer/Moderna (Radke, Laura L. M.D.)
4. Re: HCP Baseline TB Testing for Onboarding Deferral 4 Weeks
Post completion of 2 dose COVID-19 mRNA vaccine (Wilson, Steve)
----------------------------------------------------------------------
Message: 1
Date: Wed, 28 Jul 2021 15:52:19 +0000
From: "Rolando, Lori" <lori.rolando at vumc.org<mailto:lori.rolando at vumc.org>>
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] COVID Vaccine for HCWs
Message-ID:
<DM6PR12MB55335EE069638F6E6B56E9B1E0EA9 at DM6PR12MB5533.namprd12.prod.outlook.com<mailto:DM6PR12MB55335EE069638F6E6B56E9B1E0EA9 at DM6PR12MB5533.namprd12.prod.outlook.com>>
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I agree as well ... it was a conspicuous absence.
Lori Rolando MD MPH FACOEM
Director, Vanderbilt Occupational Health Clinic
615-936-0955 (p)
615-936-0966 (f)
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Behrman, Amy
Sent: Tuesday, July 27, 2021 1:16 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] COVID Vaccine for HCWs
I totally agree, Mark, on all counts.
Amy J Behrman, MD, FACOEM, FACP
Professor, Perelman School of Medicine
Medical Director, Occupational Medicine
University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
________________________________
From: MCOH-EH <mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net<mailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net<mailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net%3cmailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net>>> on behalf of Mark Upfal <mupfal at wayne.edu<mailto:mupfal at wayne.edu<mailto:mupfal at wayne.edu%3cmailto:mupfal at wayne.edu>>>
Sent: Monday, July 26, 2021 4:07 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net> <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net%3cmailto:mcoh-eh at mylist.net>>>
Subject: [External] [MCOH-EH] COVID Vaccine for HCWs
Colleagues,
You may have seen the recent joint statement on worker COVID vaccination mandates for HCWs. Shouldn't ACOEM have been in the lead on this? Does anyone else find it sad that we're not even following? Where are we on this? We should at least start a conversation...
Mark
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------------------------------
Message: 2
Date: Wed, 28 Jul 2021 17:04:33 +0000
From: "Robert K. McLellan" <Robert.K.McLellan at dartmouth.edu<mailto:Robert.K.McLellan at dartmouth.edu>>
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] COVID Vaccine for HCWs
Message-ID:
<BL1PR03MB6007977B8722B57F605A4D1FB7EA9 at BL1PR03MB6007.namprd03.prod.outlook.com<mailto:BL1PR03MB6007977B8722B57F605A4D1FB7EA9 at BL1PR03MB6007.namprd03.prod.outlook.com>>
Content-Type: text/plain; charset="us-ascii"
Me too. And that maybe we were'n approached because 1. No one in the house of medicine ever thinks of occ med 2. Our past stand with flu vaccine
Bob
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Behrman, Amy
Sent: Tuesday, July 27, 2021 2:16 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] COVID Vaccine for HCWs
I totally agree, Mark, on all counts.
Amy J Behrman, MD, FACOEM, FACP
Professor, Perelman School of Medicine
Medical Director, Occupational Medicine
University of Pennsylvania
3400 Spruce Street
Philadelphia, PA 19104
________________________________
From: MCOH-EH <mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net<mailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net<mailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net%3cmailto:mcoh-eh-bounces+behrman=pennmedicine.upenn.edu at mylist.net>>> on behalf of Mark Upfal <mupfal at wayne.edu<mailto:mupfal at wayne.edu<mailto:mupfal at wayne.edu%3cmailto:mupfal at wayne.edu>>>
Sent: Monday, July 26, 2021 4:07 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net> <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net%3cmailto:mcoh-eh at mylist.net>>>
Subject: [External] [MCOH-EH] COVID Vaccine for HCWs
Colleagues,
You may have seen the recent joint statement on worker COVID vaccination mandates for HCWs. Shouldn't ACOEM have been in the lead on this? Does anyone else find it sad that we're not even following? Where are we on this? We should at least start a conversation...
Mark
---------------------------------------
The MCOH-EH List has always been moderated by members of the ACOEM Medical Center Occupational Health Section. It is currently moderated by Joe Fanucchi MD FACOEM.
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Message: 3
Date: Wed, 28 Jul 2021 19:59:35 +0000
From: "Radke, Laura L. M.D." <laura.radke at froedtert.com<mailto:laura.radke at froedtert.com>>
To: "'mcoh-eh at mylist.net'" <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [MCOH-EH] Third doses of Pfizer/Moderna
Message-ID: <7d770d748f714ef79ccc198400b7badc at froedtert.com<mailto:7d770d748f714ef79ccc198400b7badc at froedtert.com>>
Content-Type: text/plain; charset="us-ascii"
Wondering if any other medical centers are having providers show up with prescriptions from their personal physicians/providers requesting that they be given a third dose of COVID vaccine. This has happened a few times this week at our facilities. If you have experienced this, how have you handled it?
Laura L Radke, MD
Adjunct Assistant Professor of Medicine
Medical Director, F&MCW Occupational Health Services
Phone: 262-253-8197 | Fax: 262-253-5152 Cell Phone: 414-530-0723
E-mail: laura.radke at froedtert.com<mailto:laura.radke at froedtert.com<mailto:laura.radke at froedtert.com%3cmailto:laura.radke at froedtert.com>>
Froedtert & the Medical College of Wisconsin Workforce Health / North Hills Health Center Building B First Floor
W129 N7055 Northfield Dr.
Menomonee Falls, WI 53051
______________________________________________________________________
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Message: 4
Date: Wed, 28 Jul 2021 16:02:59 +0000
From: "Wilson, Steve" <Steve.Wilson at bayareahospital.org<mailto:Steve.Wilson at bayareahospital.org>>
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] HCP Baseline TB Testing for Onboarding Deferral
4 Weeks Post completion of 2 dose COVID-19 mRNA vaccine
Message-ID: <6278b76f4f124369b509fc412ef8d772 at EXCH1.bahad.local<mailto:6278b76f4f124369b509fc412ef8d772 at EXCH1.bahad.local>>
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This is from a Jan 2021 email Oregon Health Authority sent based on CDC guidelines at that time.
Hello,
The Advisory Committee on Immunization Practices (ACIP) recently released a statement which includes information about the timing of COVID vaccine and TB screening tests (TB skin test, Quantiferon or TSPOT).
See: Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States<https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html%3FCDC_AA_refVal%3Dhttps%253A%252F%252Fwww.cdc.gov%252Fvaccines%252Fcovid-19%252Finfo-by-product%252Fpfizer%252Fclinical-considerations.html&data=04%7C01%7Csubatra%40ucdavis.edu%7C64d3a1394f13462d9c5008d952d46c5a%7Ca8046f6466c04f009046c8daf92ff62b%7C0%7C0%7C637631894573988030%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=XKFVkKAls%2FFc1oQS5WHqIrTT573RofwEs0HYFmpCPX0%3D&reserved=0<https://urldefense.proofpoint.com/v2/url?u=https-3A__nam12.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fwww.cdc.gov-252Fvaccines-252Fcovid-2D19-252Finfo-2Dby-2Dproduct-252Fclinical-2Dconsiderations.html-253FCDC-5FAA-5FrefVal-253Dhttps-25253A-25252F-25252Fwww.cdc.gov-25252Fvaccines-25252Fcovid-2D19-25252Finfo-2Dby-2Dproduct-25252Fpfizer-25252Fclinical-2Dconsiderations.html-26amp-3Bdata-3D04-257C01-257Csubatra-2540ucdavis.edu-257C64d3a1394f13462d9c5008d952d46c5a-257Ca8046f6466c04f009046c8daf92ff62b-257C0-257C0-257C637631894573988030-257CUnknown-257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0-253D-257C1000-26amp-3Bsdata-3DXKFVkKAls-252FFc1oQS5WHqIrTT573RofwEs0HYFmpCPX0-253D-26amp-3Breserved-3D0&d=DwMFAg&c=Bi8ZWNNcZUBhi-AHLorvrkVH0ArnzxTAZ7C8kNcJoZo&r=bl97AA4jByLsHh5yQ9x-cQ&m=n-uCP7IHll37F-TX-ZvAU69EUahlVUZiVNcCrAHTRYo&s=zRDCI1HhfppiMdIA7OcwS8YhhERg3KiCPlVnToWrgCA&e=>>.
As found in the above document:
Interpretation of tuberculosis test results in vaccinated persons
Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay (IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA vaccines on either TB test for infection (i.e., TST or IGRA).
For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:
* Perform TB symptom screening on all healthcare personnel or patients.
* If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.
* If utilizing the TST, place prior to COVID-19 vaccination.
* If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose completion.
* All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.
For healthcare personnel who require testing for other reasons:
* Perform TB symptom screening on all healthcare personnel
* Test for infection should be done before or at the same time as the administration of COVID-19 vaccination. If this is not possible, prioritization of test for TB infection needs to be weighed with the importance of receiving COVID-19 vaccination based on potential COVID-19 exposures and TB risk factors.
* Healthcare personnel with high-risk conditions for TB progression should be fully evaluated as soon as possible.
* Healthcare personnel without high-risk conditions for TB progression should proceed with contact tracing (i.e., symptom screening, chest radiograph or other imaging, specimen for microbiologic evaluation) but delay test for TB infection (TST or IGRA) if prioritized for receiving COVID-19 vaccination.
* All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.
Please let me know if you have any questions. Thanks!
Heidi Behm, RN, MPH
Tuberculosis Controller/Nurse Consultant
Public Health Division, Oregon Health Authority
Cell: 503-358-8516
Fax: 971-673-0178
Hopes this helps,
Steve
From: MCOH-EH <mcoh-eh-bounces+steve.wilson=bayareahospital.org at mylist.net<mailto:mcoh-eh-bounces+steve.wilson=bayareahospital.org at mylist.net>> On Behalf Of Fiorella, Kristie
Sent: Wednesday, July 28, 2021 02:05
To: 'mcoh-eh at mylist.net' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [MCOH-EH] HCP Baseline TB Testing for Onboarding Deferral 4 Weeks Post completion of 2 dose COVID-19 mRNA vaccine
CAUTION: This email originated outside of Bay Area Hospital. Do not click links or open attachments unless you recognize the sender and know the content is safe.
Hello~
If you are using IGRA for baseline TB testing, are you deferring at onboarding or entry into your facility until the HCP is 4 weeks post completion of a two dose mRNA?
If you are not delaying, do you feel the COVID-19 mRNA vaccine could have had a potential effect on any HCP IGRA test results during the first 4 weeks after COVID-19 vaccination?
Thank you!
Kristie K. Fiorella, RN, M.S., COHN-S
Manager, Employee Health
700 Children's Drive Room A1026
Columbus, OH 43205-2664
Office Phone: 614-355-4140
Office Fax: 614-355-4142
Clinic Hours: M, W, F: 7:30 A - 4:00 P and T, Th: 8:00 A - 4:30 P
[cid:image001.jpg at 01D7838E.C5C70C30]
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Subject: Digest Footer
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End of MCOH-EH Digest, Vol 256, Issue 132
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