[MCOH-EH] postvaccination serologic testing

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

Hi Maria,

This is a common misconception that postvaccination antibodies are helpful, but actually they are not.  For measles, mumps, rubella or varicella, development of a positive IgG after vaccination does not always indicate full protection, and conversely a negative post-vaccination IgG is not an indication of non-response. If you happen to draw one on someone who has good documentation of completed vaccination, and it returns negative, you ignore it. Unlike hepatitis B, with MMRV there is no indication to provide additional doses until someone "converts" and you don't label them a "nonresponder." In the event of an exposure, consider everyone with good documentation of being appropriately vaccinated to have evidence of immunity. (Note that if there is an ongoing community or facility outbreak, especially of mumps, public health authorities might recommend a 3rd MMR for everyone with 2 prior doses.)

See attached ACIP recommendations - drawing your attention to page 13 for this comment on measles:
"For HCP who have 2 documented doses of MMR vaccine or other acceptable evidence of immunity to measles, serologic testing for immunity is not recommended. In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing."

You will see the same guidance for mumps, rubella, and varicella on pages 16, 19 and 24, respectively.

For a more eloquent explanation of this, I highly recommend a recent OccPod (Episode 56) interviewing Dr. Amy Behrman! https://podcasts.apple.com/us/podcast/occpod-episode-56-covid-19-updates-and-measles-outbreaks/id1551349925?i=1000648282743

Hope this helps,

Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Lanzi, Maria via MCOH-EH
Sent: Wednesday, March 27, 2024 10:20 AM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Lanzi, Maria <Maria.Lanzi at va.gov>
Subject: [EXTERNAL] Re: [MCOH-EH] Re: TB testing (TST): tuberculin skin testing

Just curious... how do you know which employees mounted an immune response and which didn't - since no vaccine is 100% effective.
Would you consider an employee, whose titer you didn't know, immune in the event of an outbreak?
How would you know who to quarantine and who not?

Thanks,
Maria

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Stephanie Perkins
Sent: Monday, March 25, 2024 11:43 AM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

We don't draw titers for MMR/VZV and Hep B automatically. If someone comes in with the Hep B series already completed the Hep B titer is offered, but not required. The MMR/VZV titers aren't drawn in employee health anymore. We used to, but it wasn't cost effective, and CDC says it's not necessary. Back when we were doing all the titers automatically, we did the QFT/IGRA because as you said its much more convenient, but it was very expensive for the clinic to cover.

Stephanie Perkins, MSN RN
Employee Health Nurse
Clinical Educator
North Bend Medical Center
541.267.5151 X 1667
[cid:image001.png at 01DA8057.F80E0770]
"We are dedicated to providing the best healthcare for our community with compassionate, accessible, and high quality service."

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Sunday, March 24, 2024 2:29 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Thanassi, Wendy <Wendy.Thanassi at va.gov<mailto:Wendy.Thanassi at va.gov>>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

Am curious... whenever I see people still using the TST I'm curious....
You're drawing blood for MMR/VZV, Hep B, so why doesn't your facility use QFT/IGRA for such an important test? It's much more convenient, expeditious and accurate, as you know.
Is it because your volume is low? The hospital is undoubtedly already doing or contracted to do IGRAs for patients: can you make everyone's life easier by using them in OHS?

Wondering!
Wendy

Wendy Thanassi
VA Palo Alto

From: MCOH-EH <mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net<mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net>> On Behalf Of Stephanie Perkins
Sent: Friday, March 22, 2024 12:56 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

Thank you all so much for the suggestions. We do have a policy in place for PPDs and employee health, but at the time of their hire we didn't. When I spoke with them, they wouldn't give me an answer as to their hesitation with either the PPD or the blood draw. I did end up getting their manager involved and explained if we weren't able to figure it out amongst us that I would have to get HR involved. Thankfully, they agreed to doing the PPD. I'm not sure why the hesitation, especially since they've had them in the past. I will follow up with HR and make sure in our hiring process that applicants are aware of this requirement.

Stephanie Perkins, MSN RN
Employee Health Nurse
Clinical Educator
North Bend Medical Center
541.267.5151 X 1667
[cid:image001.png at 01DA8057.F80E0770]
"We are dedicated to providing the best healthcare for our community with compassionate, accessible, and high quality service."

From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Carr, Jennifer L.
Sent: Friday, March 22, 2024 12:34 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: TB testing (TST): tuberculin skin testing

We have ours written into our pre-employement screening policy and a screening test is a condition of employment. If they refuse the onboarding process would stop.
Since you are finding it upon review, may be a challenge to enforce. However it is an opportunity to review policy and process and make sure everything is clear. A surveyor is going to look for the follow up action. What did you put in place to prevent reoccurrence as much as how you dealt with the delinquent finding.
Let us know how it turns out.
Jennifer
________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> on behalf of Mindy T. Dube via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Sent: Thursday, March 21, 2024 2:34 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Mindy T. Dube <Mindy.T.Dube at hitchcock.org<mailto:Mindy.T.Dube at hitchcock.org>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB testing (TST): tuberculin skin testing


If you have an institution policy that will back your request for the PPD or Quantiferon then that is what you use to support the request.  A policy which outlines mandatory PPD or Quantiferon will allow you to push the issue and take it to the employee's Manager to enforce that they are compliant.  If you get no where with management then you can step it up to the HR level to enforce compliance.  However without an institutional policy that mandates employees having a PPD or Quantiferon makes it tough to push the issue.





Mindy

Mindy Dube, MSN, APRN, FNP-C

Nurse Practitioner

Occupational and Environmental Medicine

Dartmouth-Hitchcock Medical Center

Lebanon, NH  03756

Tel (603-) 653-3850 | Fax (603) 650-0928

Dartmouth Hitchcock Medical Center

[cid:image002.jpg at 01DA8057.F80E0770]<https://www.dartmouth-health.org/>



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From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Stephanie Perkins
Sent: Thursday, March 21, 2024 1:23 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB testing (TST): tuberculin skin testing **EXTERNAL**



How do you handle an employee who is refusing to do a PPD or Quantiferon-gold? This employee was a rehire in 2015, when this employee was initially hired in the 90's they had PPDs done, several actually, as they were still checking them

How do you handle an employee who is refusing to do a PPD or Quantiferon-gold? This employee was a rehire in 2015, when this employee was initially hired in the 90's they had PPDs done, several actually, as they were still checking them annually. When this employee was rehired in 2015, they declined to redo the PPD. I've been working on getting all our employee health files completed, and I came across the incomplete screening in their fire (they filled out the questionnaire, but nothing was administered), reached out to them and they're declining both a PPD or Quantiferon-gold.



Any suggestions, resources, recommendations, etc. would be much appreciated.



Stephanie Perkins, MSN RN

Employee Health Nurse

Clinical Educator

North Bend Medical Center

541.267.5151 X 1667

[cid:image001.png at 01DA8057.F80E0770]

"We are dedicated to providing the best healthcare for our community with compassionate, accessible, and high quality service."



From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Deanna Prater
Sent: Thursday, March 14, 2024 12:21 PM
To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
Subject: [MCOH-EH] TB testing (TST): tuberculin skin testing



We allow new hires to have their TB test read at other facilities.  The form is signed by a licensed healthcare worker.



Deanna Prater BSN, RN

Director of Infection Control, Employee Health & Safety

Lower Umpqua Hospital

600 Ranch Road

Reedsport, Oregon 97467

Office:  (541) 271-6323

Fax:  (541) 271-6353

dprater at luhonline.com<mailto:dprater at luhonline.com>



"If you change the way you look at things, the things you look at change."




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