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Recently, Hospital Employee Health offered answers from experts on frequently asked questions about employee immunizations. We’ve since received other questions from readers. Here they are, with a response from Miriam J. Alter, PhD, chief of the epidemiology section in the division of viral hepatitis at the Centers for Disease Control and Prevention in Atlanta.
Q. A new employee says she received the hepatitis B vaccine five years ago, but she has no documentation and never was tested for immune response. Should we test her for an HBV antibody response? What should we do if she shows no evidence of immunity?
A. Employees who were not tested within two months after completion of the series should not be tested unless it is part of postexposure management. In persons who respond to the vaccine, anti-HBs titers may wane over time, although they are still protected from hepatitis B. Booster doses or periodic serologic testing to monitor antibody concentrations are not recommended. If an exposure occurs and that employee’s immune response is not known, the CDC recommends testing for HBV antibodies. If the test is positive, no further treatment is necessary. If the test is negative and the source is known to be positive for HBV, the employee should receive one dose of HBIG and a vaccine booster. If the test is negative and the source status is unknown, the CDC recommends giving the employee a vaccine booster and rechecking for titer in one to two months.
Q. An employee previously showed immunity to HBV after a three-shot series. Several years later, she has a bloodborne exposure involving an HBV-positive patient. Should she be tested for an HBV antibody response?
A. No treatment, and no testing, is recommended for exposed employees who are known responders to the HBV vaccine. A responder is a person with adequate levels of serum antibody to HBsAg (i.e., anti-HBs>10 mIU/mL).
1. Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR June 29, 2001; 50(RR11):1-42.