Yes, but it is extraordinarily rare to have someone who actually performs Category 3 SHEA (category 1 OSHA) “exposure-prone” procedures AND who cannot get their viral load below the recommended permissible levels
with treatment. Bear in mind that drawing blood, giving shots, suturing, skin procedures, and other types of routine care and procedures do not fall into that category.
These cases should all undergo review by an expert panel including ID, OH, legal, etc, and yes, Occupational Health would be the appropriate employer entity to ensure the monitoring is done and to secure those
confidential medical records.
Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
Associate Medical Director, Occupational Health Service
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
www.mayoclinic.org
From: MCOH-EH [mailto:mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net]
On Behalf Of Thanassi, Wendy via MCOH-EH
Sent: Tuesday, November 12, 2019 3:15 PM
To: MCOH-EH; Occ-Env-Med-L@listserv.unc.edu
Cc: Thanassi, Wendy; Tacoronti, Rudolph V.
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load
Wait- wow- really? Do you actually restrict practice? Does anyone require these twice-yearly test results be given to OH?
Wendy
Chief, OH
PAVAHCS
From: MCOH-EH <mcoh-eh-bounces@mylist.net> On Behalf Of
Lanzi, Maria via MCOH-EH
Sent: Tuesday, November 12, 2019 8:33 AM
To: MCOH-EH <mcoh-eh@mylist.net>; Occ-Env-Med-L@listserv.unc.edu
Cc: Lanzi, Maria <Maria.Lanzi@va.gov>
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load
Thanks Melanie!
From: MCOH-EH <mcoh-eh-bounces@mylist.net>
On Behalf Of Swift, Melanie D., M.D., M.P.H. via MCOH-EH
Sent: Tuesday, November 12, 2019 11:26 AM
To: mcoh-eh@mylist.net;
Occ-Env-Med-L@listserv.unc.edu
Cc: Swift, Melanie D., M.D., M.P.H. <Swift.Melanie@mayo.edu>
Subject: [EXTERNAL] Re: [MCOH-EH] Genome Equivalents as a measure of viral load
Conversion differs slightly for each virus. I got this from something published (or presented, can’t recall) by Mark Holodniy, MD, FACP, CIC, Professor of Medicine, Stanford University School of Medicine and Palo Alto VA. Viral load results
may be expressed in copies/ml or genome equivalents (GE)/ml rather than international units (IU.) But, IU conversion factors are:
For HIV, 1 IU = 1.74 copies.
For HBV, 1 IU = 5.6 copies.
For HCV, 1 IU = 3.8 copies.
Following are recommended viral loads for infected HCW performing invasive procedures under SHEA guidelines compared to CDC:
SHEA recommendations:
|
Clinical Activities |
Recommendation |
Permissible Viral Load |
|
“Category 1 or 2” de minimis, or theoretical but unlikely risk |
No practice restriction Receive follow-up by personal physician Adhere to optimal infection control procedures Double glove for Category 2 procedures |
N/A |
|
“Category 3” Definite Risk Procedure |
Viral load check twice yearly Restricted from high risk procedures if viral load above permissible level Receive follow-up by personal physician Adhere to optimal infection control procedures Double glove for high risk procedures |
HBV <10,000 GE/mL (about 2000 IU/ml) HCV <10,000 GE/mL (about 2500 IU/ml) HIV <500 GE/mL (about 300 IU/ml) |
CDC Recommendations (Hepatitis B only)
|
Clinical Activities |
Recommendation |
Permissible Viral Load |
|
“Category 2” Low or No Risk Procedure |
No panel oversight needed Receive follow-up by personal physician |
N/A |
|
“Category 1” Definite Risk Procedure |
Viral load check twice yearly Restricted from high risk procedures if viral load above permissible level Receive follow-up by personal physician Adhere to optimal infection control procedures |
HBV < 5,000 GE/mL
(about 1,000 IU/ml) |
Hope this helps,
Melanie
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Galaid Edward I
Sent: Tuesday, November 12, 2019 10:19 AM
To: mcoh-eh@mylist.net;
Occ-Env-Med-L@listserv.unc.edu
Subject: [EXTERNAL] [MCOH-EH] Genome Equivalents as a measure of viral load
This is pertaining to the unit of measure that is used in the SHEA HCP with HBV/HCV/HIV infection document (https://www.shea-online.org/images/guidelines/BBPathogen_GL.pdf)
to quantify viral load.
My Lab Director and his colleagues have not been able to come up with a conversion factor to express viral load as copies/mL or IU’s.
Appreciate any info on how you’re handling this. This is not a new issue. I am just stumped.
And maybe the SHEA document from 2010 is due for an update.
Thanks
Ed Galaid
Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Roper St. Francis Physician Partners Occupational Medicine
Charleston, SC
Member, ACOEM Task Group, Guidance for the Medical Evaluation of Law Enforcement Officers
(O) 843-402-5053
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