At our institution, we accept documentation of complete Hep B series.  A titer (HepB sAb) alone or with verbal history of immunization is not sufficient.  In Oregon, they can decline the vaccine, but I always discourage.  I much prefer giving Hep B immunizations before an exposure to HBIG after an exposure. 

At the time of exposure, we do consider a positive HepB sAb as evidence of immunity at that moment (i.e. HBIG not indicated and follow-up testing not necessary).  Of course the big problem is when a worker with a past positive HepB sAb and verbal hx of immunization has a negative titer at time of a high-risk exposure.  In that instance, I would recommend HBIG, while if immunizations were documented and subsequent titer was positive, we could forgo HBIG even if titer was negative at time of exposure. 

Tim Crump, MSN, FNP

Tim Crump, MSN, FNP

Family Nurse Practitioner

Multnomah Pavilion 1 SE, Suite 1110

Occupational Health

Healthcare Human Resources

Oregon Health & Science University

3181 SW Sam Jackson Park Rd

Mail code: UHN 89

Portland, OR 97239-3098

Department Phone: 503-494-5271

Office Phone: 503-346-1152

Fax: 503-494-4457

Email: crumpt@ohsu.edu

Mon-Fri, 7:30-4:00

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From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Therese Bovee-McKelvey
Sent: Tuesday, May 08, 2018 12:22 PM
To: mcoh-eh@mylist.net
Subject: [MCOH-EH] Incompletely Vaccinated HepB & Immunity Titers

Greetings;

CDC states that healthcare workers must have documentation of 3 valid HepB vaccinations followed by titer to determine immunity. 

Clinician Consultation Center states “ If exposed person is known to be immune (e.g., they were told they had a positive response to a complete HBV vaccine series, indicated by post-vaccination HBsAb titer …), they are considered to have lifelong immunity and need no hepatitis B testing or post-exposure treatment. 

Many healthcare workers come in with no or partial documentation of completing a HBV vaccine series but most have documentation of a positive HBsAb titer.  Does your facility accept documentation of completed HBV series and/or HBsAb titer to confirm immunity?  Or so you require documentation for both?

If worker (History as above) later has exposure to positive HBV source patient how do you follow-up with them?  Do you follow the Clinician Consultation Center Recommendations for Post-Exposure Prophylaxis After HBV Exposure under the category of “Unvaccinated or Incompletely Vaccinated” and follow-up for 6 months ?  Or would you do another HBsAb titer?

Thanks for any responses, it all helps.

Therese

Therese Bovee McKelvey, MN, RN Sr. Employee Health Nurse - Employee Health

425.899.2278 (P)  |  425.899.2277 (F)  | TMBoveeMcKelvey@evergreenhealth.com

EvergreenHealth MS-42, 12040 NE 128th St., Kirkland, WA 98034

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