If you have a HCW who is exposed to measles and was either presumed immune due to being born before 1957, or you did not have documentation of 2 doses of MMR at hire, you could go ahead and give an MMR (extra doses are not harmful!) and draw your serology at the same time. If your serology is negative and you are in the furlough window, I would still send it to the state lab for more sensitive IgG testing. Even if it does take 3 days, a 3-day furlough is better than the full 2 week furlough!

 

All this becomes much easier to handle if you enforce 2 MMRs at hire.

 

Melanie

 

From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net] On Behalf Of Lanzi, Maria via MCOH-EH
Sent: Tuesday, May 07, 2019 8:08 AM
To: MCOH/EH
Cc: Lanzi, Maria
Subject: [EXTERNAL] Re: [MCOH-EH] Re: MCOH-EH Digest, Vol 254, Issue 125. Measles Prevention in Non-immune Appropriately Vaccinated

 

Kathleen,

 

Thank you for that discussion.  The issue for those of us in the field however, is that state testing, in most cases, doesn’t come back until after the 3 day window for prophylaxis vaccination in the event of a true negative.   So I would follow Larry Budnick comments as noted below as the “real world” will often impact decision making.

 

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 <mcoh-eh-bounces+maria.lanzi=va.gov@mylist.net> On Behalf Of Harriman, Kathleen@CDPH
Sent: Monday, May 06, 2019 2:36 PM
To: mcoh-eh@mylist.net
Subject: [EXTERNAL] Re: [MCOH-EH] MCOH-EH Digest, Vol 254, Issue 125. Measles Prevention in Non-immune Appropriately Vaccinated

 

CDC does not recommend serologic testing for measles, mumps or rubella for employees with two documented doses of MMR vaccine (past or present). If such employees are  inadvertently tested and found to be measles IgG negative or equivocal, CDC recommends trusting the vaccine history rather than the serologic results, and considering such employees presumptively immune to measles. See: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm.

 

What is important to know, and I don't think is well known, is that commercial measles IgG testing is often not sensitive enough to identify people who would mount an adequate immune response to measles if they were exposed.

 

In California, if a HCW (or any other person) is exposed to measles and it is likely that they have received MMR vaccine but they are measles IgG negative or equivocal at a commercial lab, we ask that the blood specimen be sent for retesting at our state laboratory where it is almost always IgG positive.

 

If a HCW is actually exposed to measles, we do not consider birth before 1957 adequate proof of immunity, and would want such HCWs tested for measles IgG. Similarly, we would want to retest exposed HCWs with a history of being measles IgG negative or equivocal after a history of two doses of MMR vaccine. If either category of HCW was then tested at a commercial lab and found to be measles IgG negative or equivocal, we would request retesting at our state lab to determine their true measles immune status.

 

In our experience, falsely measles IgG negative or equivocal results are not uncommon, and we don't want to furlough or quarantine people unnecessarily.

 

Kathleen Harriman

California Department of Public Health

Richmond CA

kathleen.harriman@cdph.ca.gov

 

Today's Topics:

 

1.      Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees (Leibu, Rachel)

2.      Re:  Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees (Lawrence Budnick)

 

----------------------------------------------------------------------

 

Message: 1

Date: Mon, 6 May 2019 01:28:20 +0000

From: "Leibu, Rachel" <Rachel.Leibu@atlantichealth.org>

To: MCOH/EH <mcoh-eh@mylist.net>

Cc: "Cuoco, Lisa" <Lisa.Cuoco@atlantichealth.org>

Subject: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

Message-ID:BN6PR16MB14264476103AA6C9E49CB476F2300@BN6PR16MB1426.namprd16.prod.outlook.com

       

HI Everyone,

 

With the ever growing measles outbreak, how are you handling those employees who have appropriate proof of vaccination for measles but have a negative measles titer post vaccination.  What are you doing for this cohort of employees both prophylactically and in the event of an actual measles  exposure?

 

Rachel Leibu, MD, MBA, MS, FACOEM

Medical Director Occupational Medicine Services Atlantic Health System

973-829-4277

 

Message: 2

Date: Mon, 6 May 2019 12:37:08 +0000

From: Lawrence Budnick <budnicla@njms.rutgers.edu>

To: MCOH/EH <mcoh-eh@mylist.net>

Cc: "Cuoco, Lisa" <Lisa.Cuoco@atlantichealth.org>

Subject: Re: [MCOH-EH] Measles Prevention in Non-immune Appropriately Vaccinated Healthcare Employees

Message-ID:BN6PR1401MB1969959930C1AEA3A5DE8B50FE300@BN6PR1401MB1969.namprd14.prod.outlook.com

       

Attached is the guidance document from our state health department. Based on it and measles exposure incidents on our campus in 2013 and 2014, we would give a third dose of vaccine and retiter in 6-8 weeks, to help guide future potential exposures. It is possible that the negative titer the person had was taken long after the 2nd measles vaccination. In addition, as the state guidance notes several times, "Extra doses of MMR are not harmful" as long as there are no contraindications.

 

Lawrence D. Budnick, MD, MPH

Professor of Medicine

Director, Occupational Medicine Service

Rutgers University - New Jersey Medical School

65 Bergen Street, Suite GA-167, Newark, NJ 07107 tel 973.972.2900 fax 973.972.2904 lawrence.budnick@rutgers.edu<mailto:lawrence.budnick@rutgers.edu>