[MCOH-EH] [EXTERNAL] Re: Re: Measles IVIG for severely immunocompromised HCWs with presumptive immunity?

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

Workers compensation may not cover treatment if there is no illness. Some employers opt to cover PEP through internal funding. Others may be self-insured for workers' comp and decide internally to accept claims for exposure without infection.

Melanie

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Carr, Jennifer L.
Sent: Tuesday, April 9, 2024 4:31 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Employee Health <Employee_Health at Valleymed.org>
Subject: [EXTERNAL] Re: [MCOH-EH] Re: Measles IVIG for severely immunocompromised HCWs with presumptive immunity?

If it is a work related exposure then this would be covered under your workers compensation policy and the treating provider should evaluate and determine the individuals risk for returning. If you provide your own workers compensation evaluation then I recommend exploring this avenue. It further allows evaluation of the individual situation surrounding the employee history and context of the exposure allowing a decision to be made based on the MMWR CDC treatment guidance provided.
If a community exposure then their treating provider should determine their risk and advise accordingly. In this scenario if they were to be out for an extended period of time their other benefits such as short term disability would be sought to provide compensation for time medically unable to work.
This is a complex question with a magnitude of approaches. Do you anticipate large scale exposure potential for your employees in your area?
Jennifer


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From: MCOH-EH <mcoh-eh-bounces+carrj=monhealthsys.org at mylist.net<mailto:mcoh-eh-bounces+carrj=monhealthsys.org at mylist.net>> on behalf of Lisa Dyrdahl <Lisa_Dyrdahl at Valleymed.org<mailto:Lisa_Dyrdahl at Valleymed.org>>
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Subject: [EXTERNAL] Re: [MCOH-EH] Measles IVIG for severely immunocompromised HCWs with presumptive immunity?

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Lisa Dyrdahl, RN BSN

Employee Health Nurse

Valley Medical Center

Ph 425-690-3088

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From: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>> On Behalf Of Haq, Farah via MCOH-EH
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Cc: Haq, Farah <Farah.Haq at stonybrookmedicine.edu<mailto:Farah.Haq at stonybrookmedicine.edu>>
Subject: [MCOH-EH] Measles IVIG for severely immunocompromised HCWs with presumptive immunity?



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In the event of a measles exposure, do any of your institutions plan to offer IVIG to severely immunocompromised healthcare workers regardless of measles vaccine/immunity status?



Our hospital is considering offering IVIG and furloughing severely immunocompromised HCWs who are exposed to measles, even if they have documentation of presumptive immunity to measles, which virtually all our HCWs do



The rationale is the following MMWR CDC guidance for measles-exposed immunocompromised patients (but which could presumably include exposed immunocompromised HCWs as well):



Immunocompromised patients. Severely immunocompromised patients who are exposed to measles should receive IGIV prophylaxis regardless of immunologic or vaccination status because they might not be protected by the vaccine. Severely immunocompromised patients include patients with severe primary immunodeficiency; patients who have received a bone marrow transplant until at least 12 months after finishing all immunosuppressive treatment, or longer in patients who have developed graft-versus-host disease; patients on treatment for ALL within and until at least 6 months after completion of immunosuppressive chemotherapy; and patients with a diagnosis of AIDS or HIV-infected persons with severe immunosuppression defined as CD4 percent <15% (all ages) or CD4 count <200 lymphocytes/mm3 (aged >5 years) and those who have not received MMR vaccine since receiving effective ART. Some experts include HIV-infected persons who lack recent confirmation of immunologic status or measles immunity.



https://www.cdc.gov/infectioncontrol/pdf/guidelines/IC-Guidelines-HCP-H.pdf<https://urldefense.com/v3/__https:/www.cdc.gov/infectioncontrol/pdf/guidelines/IC-Guidelines-HCP-H.pdf__;!!DXsSFrK4Q_c!fANLcW0HG2-OXGCYSO4yZ4l56x87zX9250sOBuhRU-0FnRQ8rr33v2QrryVbqfRy9vXnRw_JUgSInVfBxVjkTNY$>



I am interested to know if any other hospitals are considering this?



Thank you,





Farah Haq MD, MPH

Division Head, Occupational, Environmental and Clinical Preventive Medicine

Clinical Assistant Professor

Dept. of Family, Population and Preventive Medicine

Stony Brook Medicine



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