Hep B immunity in health care personnel (HCP) can only be “guaranteed” by the presence of 3 documented, appropriately administered doses of hepatitis B vaccine.

It is usually in the purview of states whether Hepatitis B, or other VPD vaccines, are required by health care personnel.  Or individual institutions.  

We do not require that HCP have hepatitis B immunity, however, we educate all HCP to ensure they have a full understanding of the risks of potential exposure. 

With the new generation of HCP coming on board, most have had 3 doses, since it has been required as a routine immunization for all children since 1994.  However, most were never tittered to determine if they responded to the vaccine. 

Our current process is to ask all HCP to bring their immunization records. We routinely screen on pre-hire for hepatitis B immunity. 

 If they have 3 documented doses and a positive titer, we are done.

If they have 3 documented doses and a negative titer, we boost with one and re-titer.

If they do not have 3 documented doses and a negative titer,  we evaluate on an individual basis.  If less than 3 doses, we complete the series and re-titer.   If no records at all, we begin the series and titer at the end. This is particularly important for those HCP in category 1 as defined by OSHA.   The risk of exposure to a potential Hepatitis B positive patient in our setting is significant enough to warrant our costs. 

Maria

Maria C. Lanzi, MS, MPH, ANP-BC, COHN-S, CTH

Nurse Practitioner/Program Coordinator

Employee Occupational Health

Corporal Michael J Crescenz Veterans Affairs Medical Center

3900Woodland Avenue

Philadelphia, PA 19104

Work:  215 823 5800 x 2592

Fax:  215 823 5968

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Grubbs, Scott
Sent: Monday, July 09, 2018 3:58 PM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] #ExtMail# Incompletely Vaccinated HepB & Immunity Titers AND ? requiring Hepatitis B vaccination for employees?

Most of our applicants evidently don’t come with records of either. 

Which raises a question.  Hepatitis B vaccination is recommended by CDC, but is not required by OSHA, as I understand it.  Do any of your institutions require Hepatitis B vaccination/immunity to hire or continue working?

Scott Grubbs, MD

WorkWell Occupational Health

St. Francis Hospital System

Greenville, SC

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Therese Bovee-McKelvey
Sent: Tuesday, May 08, 2018 3:22 PM
To: mcoh-eh@mylist.net
Subject: #ExtMail# [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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