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Post Vaccination HBV Immunity Testing

Q: How soon after employees complete the HBV series vaccine should they be tested for immunity? Exactly which test should be ordered?

A: Perform the HBsAb test one to two months after the last dose of the HBV vaccine.

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Posted by Quality America on December 30, 2005 | Comments (8)

Comments

I understand that the employer is responisble to titer for Hep B after the series is complete. My question is regarding new employees that have documentation of a complete series but no titer. Are we responsible to get them titers or can we make that a pre-employement requirement at their expense?

Posted by: P Harms at February 1, 2006 09:54 AM

OSHA regulations don't address your question specifically. In my opinion, technically, you could make vaccination and titer a prerequisite for employment, since OSHA regs don't "kick in" until you become the employer.

Posted by: Dr. Dunn at February 2, 2006 10:32 AM

What is the recommended time frame to keep having the titer done? Ever year? Every 3-5 years? This will be for a Manufacturing facility. Does OSHA have anything to say about it?

Posted by: Jason J Toboyek at October 11, 2006 12:50 PM

OSHA's Bloodborne Pathogen Standard requires employers to provide hepatitis B vaccination to workers who have risk for occupational exposure to blood or other potentially infectious body fluids. Depending on the type of manufacturing you do, your employees may fall under OSHA's BBP guidance. For example, the BBP standard applies if you do pharmaceutical manufacturing such as making Factor VIII from human source blood, etc. OSHA also states hepatitis B vaccination and follow up will be provided according to current US Public Health Service (i.e. CDC) recommendations. The CDC calls for titering of employees 1 to 2 months after completing the 3-dose HBV vaccine series. Presuming the titer shows immunity, it never needs to be reperformed. If the employee is not immune, offer the employee the 3-shot vaccine series again. Perform the titer again after the second vaccination series. A medical evaluation is called for if the employee is a non-responder after the second vaccination series.

Posted by: Sarah Alholm at October 24, 2006 12:28 PM

In reading the OSHA blog, which I greatly appreciate and thank you for the great information, I see we are required to titer for Hep B 2 months after last dose. If it has been longer than 2 months even 1-2 years do we still need to titer? Also what if an employee refuses to have their blood drawn for the titer? If an employee is never exposed to BBP are we required to titer them also? Employees that provided proof of their Hep B series but no titer, do we titer them also?

Posted by: Debbie Manning at December 21, 2006 04:41 PM

The main purpose of the titer is to determine the employee's immune status so you can act according to the latest US Public Health Service (CDC) guidelines in case of a BBP exposure. Unfortunately, the HBV 3-series vaccine isn't always effective, so titering reveals instances where the employee may need an additional administration of the vaccine series to be protected.

If an employee has no risk of exposure to bloodborne pathogens there is no need to offer them hepatitis B vaccination, or to do a titer for HBV immunity. However, please ensure these non-clinical personnel are NOT accidentally listed on either of your Exposure Determination Lists (not on list #1 nor list #2). OSHA uses the Exposure Determination Lists to verify you offered the appropriate training and protection to employees, so you don't want it to seem like these employees have a chance of exposure if in reality there is no risk.

The CDC's Advisory Committee on Immunization Practices (ACIP) says not to do titers on employees several years after they were vaccinated because antibody concentrations decline over time, but HCWs remain protected.

For HCWs who have been vaccinated in the past but who do not have a documented titer showing response to vaccination, ACIP recommends HBV titers only if an exposure occurs.

If cost is not a great concern or if an employee or employer wants documented assurance of immunity, a revaccination series can be undertaken followed by testing 1 to 2 months after the 3rd dose of hepatitis B vaccine.

For employees with negative titers, offer the entire 3-shot series again. Of course, the employee may decline the re-administration of the series. If this is the case have them sign a declination form. Write in the comments section of the declination form that the employee received the series once, but were re-offered it because of an insufficient titer result. Sign and date your comment.

An employee may refuse to have their blood drawn for a titer, make sure this is documented. I have attached a form for you to do this.

Posted by: Sarah Alholm at December 21, 2006 04:42 PM

At our agency we have been doing titer checks on our employees. I have noticed that when they have a high titer of >150 within 7-10 years they show a very low to neg titer. We have been sending them back for the 2nd set of Hep B. It is my understanding that we are not required to do follow up titers unless there is an exposure, is that correct?

Would you please tell me where the information is found with OSHA and the CDC?

Posted by: Kimi at May 2, 2007 04:31 PM

The situation you describe at your agency, antibody titers lowering over time, is normal. The CDC states at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm

"Vaccine-induced antibodies to HBV decline gradually over time, and less than or equal to 60% of persons who initially respond to vaccination will lose detectable antibodies over 12 years (CDC, unpublished data). Studies among adults have demonstrated that, despite declining serum levels of antibody, vaccine-induced immunity continues to prevent clinical disease or detectable viremic HBV infection? Periodic serologic testing to monitor antibody concentrations after completion of the three-dose series is not recommended."

Your understanding that it is not required to do follow up titers unless there is an exposure is correct. Table 3 in the Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis, June 29, 2001 / 50(RR11);1-42 (link below), details the follow-up that is required in the case of an employee exposure.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

Hope this helps!

Posted by: Sarah Alholm at May 7, 2007 12:02 PM




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