Dr. Swift. Thank you so much for this insightful and informative content. Your recommendations are very helpful and integrating the newer vaccine option is additionally helpful. Have a very good day and thanks
again!
Curtis
Curtis Chow, FNP, PA, MBA
Employee Health Coordinator
Employee Health Department
Dignity Health
Mercy Medical Center Redding
2175 Rosaline Ave
Redding, CA 96001
530-225-6194 (O)
530-526-5150 (M)
530-225-7281 (F)
Caution: This email is both proprietary and confidential, and not intended for transmission to or receipt by any unauthorized persons. If you believe that it has been received by you in error,
do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.
From: Swift, Melanie D., M.D. [mailto:Swift.Melanie@mayo.edu]
Sent: Wednesday, May 15, 2019 6:15 AM
To: MCOH/EH
Cc: Chow, Curtis - MMCR
Subject: RE: New question
Dignityhealth.org made the following annotations
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STOP, THINK, READ. This is an external email. Exercise extra caution responding to it, opening attachments and following links.
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Curtis, this is a complex issue and really boils down to an institutional financial and risk/benefit decision. You can adopt one of two possible strategies:
Option A. Establish immune response in all new employees who are potentially exposed.
Confirm or offer the vaccine series, and if they do not have a prior sAb documenting vaccine-mediated immunity, obtain this at hire. Younger staff who were born after 1990 were likely to be vaccinated in childhood, and a very high percentage of these
will not demonstrate detectable sAb (estimates vary, but plan on at least half having a negative sAb.) This means giving a challenge dose and retesting, and if they do not demonstrate an immune response (and usually it's an impressive anamnestic response)
you must complete the series.
OR
Option B. Establish immune response, if not previously known, at the time of an exposure. You must still confirm or offer the vaccine series at hire, and certainly obtain records of prior sAb if they have one. If they were
recently vaccinated (and you can pick your definition of “recent” – up to a year is reasonable) then you could obtain serology at hire, but otherwise do nothing at hire. If/when they sustain an exposure, you can establish their immune status.
Option A has the potential to prevent more hepatitis B infections, but is more expensive by quite a long shot. See Hoerger, et al “Cost-effectiveness of ensuring Hepatitis B protection for previously vaccinated healthcare personnel”
in ICHE, 2014. I will attempt to attach the article but I’m not sure if that works on the listserv.
Given the entry of new HCP who were born in the universal childhood vaccine era, and assuming a continued downward trend in occupational HBV infections due to near universal (if not always serologically evident) immunity, I predict that
the value of Option A will decline over time – however once entrenched in institutional policy I suspect many programs will continue the practice unexamined. (My opinion.) If you choose option A, the option to use the new adjuvanted vaccine (Heplisav) rather
than traditional HBV vaccine presents another interesting cost/benefit question. Younger HCP are very likely to have a serologic response to the challenge dose regardless of vaccine type. However if your population includes a lot of older HCP who were remotely
vaccinated, they may respond better to Heplisav, and those who don’t respond can complete their second series within a month, with just one more dose. This saves 5 months plus “tracking down time” to determine vaccine response and find nonresponders more quickly.
Good luck!
Melanie
Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Erika Sweet
Sent: Tuesday, May 14, 2019 6:11 PM
To: MCOH/EH
Cc: Chow, Curtis - MMCR
Subject: [EXTERNAL] Re: [MCOH-EH] New question
I find the attached CDC FAQ very helpful.
Documentation of completed series and + HBsAb equals immunity for the HCW.
Thanks, Erika
Erika Sweet, RN, MSN, NP, COHN-S
Director of Employee Health Services
Los Angeles County Department of Health Services
NOTE: New Office Number: (424) 306-4060
-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Chow, Curtis - MMCR via MCOH-EH
Sent: Tuesday, May 14, 2019 3:44 PM
Cc: Chow, Curtis - MMCR <Curtis.Chow@DignityHealth.org>
Subject: [MCOH-EH] New question
Hello All. Please help refresh my brain regarding Hep B screening of existing and onboarding employees. According to the CDPH regs (see below), we should have proof of series. Along the way, it was interpreted that we need to perform
HBsAb testing even w records. I'm requiring our students and staff to be tested for HBsAb but is that too much if they have existing records of a completed series? Based on the CDPH recommendation below what do you do? Our system policy reflects:
Hepatitis B: Must be offered to all HCP who are at risk of occupational exposure to blood or body fluids. All HCP must have valid documentation (vaccination record or laboratory titers). Refer to CDC guidelines for series dosing and
serological testing.
CDPH Guidelines 2015:
Hepatitis B vaccine
All HCP who are at risk for occupational blood or body fluid exposure should have documentation of 3 doses of hepatitis B vaccine (or a signed declination form). HCP who have recently completed the 3-dose series, should undergo anti-HBs
(immunity) testing. Anti-HBs testing should be performed 1-2 months after administration of the last dose of the vaccine series.
HCP with documentation of 3 doses of hepatitis B vaccine, but no documentation of immunity may undergo anti-HBs testing upon hire or matriculation. Qualitative testing is sufficient. This approach is most appropriate for settings with
HCP-trainees and HCP in occupations with higher risk of exposure (e.g., surgeons), and when the prevalence of HBV is increased in the patient population served. Alternatively, employers may choose to perform anti-HBs testing only if such HCP later report a
blood or body fluid exposure.
Curtis Chow, FNP, PA, MBA
Employee Health Coordinator
Employee Health Department
Dignity Health
Mercy Medical Center Redding
2175 Rosaline Ave
Redding, CA 96001
530-225-6194 (O)
530-526-5150 (M)
530-225-7281 (F)
Caution: This email is both proprietary and confidential, and not intended for transmission to or receipt by any unauthorized persons. If you believe that it has been received by you in error, do not read any attachments. Instead, kindly
reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.uesti
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