CDC: Test your staff for Hep B immunity on hire
Those immunized as children may be vulnerable
By Michelle Cohen Marill, Executive Editor, Hospital Employee Health, published by AHC Media. Web: http://www.reliasmedia.com/public/products/Hospital-Employee-Health.html.
A growing number of healthcare workers are coming into their professions with childhood vaccination against the hepatitis B virus (HBV). Yet 5% to 10% of them might unknowingly be non-responders, according to the Centers for Disease Control and Prevention (CDC).1
The most protective strategy would involve serologic testing of these previously vaccinated employees at hire, the CDC says in recently released guidance. If they do not have antibody levels of at least 10 mIU/ml, they should receive a booster dose of the vaccine and retesting, the CDC says. They may receive up to three new doses of HBV vaccine, the agency says.
Yet the CDC also says employers may adopt a post-exposure approach, based on risk and cost factors. "The risk in certain occupations is an important consideration, as well as whether the person is a trainee or a non-trainee," says Trudy Murphy, MD, a medical epidemiologist and unit leader for the CDC’s vaccine unit and a co-author of the guidance.
For example, some communities or hospital units might have a low prevalence of HBV, and employees who are not involved in direct patient care would have a lower risk, Murphy notes. Conversely, trainees have a higher rate of bloodborne pathogen exposures and therefore would be at higher risk, she says.
In a post-exposure program, healthcare workers would receive HBV serologic testing at the time of an exposure and would be revaccinated if they have antibody levels below 10 mIU/ml. If the source patient is positive for Hepatitis B surface antigen (HBsAg) or the HBsAg status is unknown, those exposed healthcare workers also would receive one dose of Hepatitis B immune globulin.
A post-exposure approach hinges on prompt reporting and follow-up. Yet only about half (54%) of percutaneous and 17% of mucocutaneous exposures are reported, CDC notes.
- Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for Hepatitis B. Virus protection and for administering postexposure management. MMWR 2013; 62(rr10); 1-19.