CDC: Test HCWs for Hep B immunity on hire, those immunized as children may be vulnerable to infection

January 12th, 2015

A growing number of health care workers are coming into their profession with childhood vaccination against hepatitis B. Yet 5% to 10% of them may unknowingly be non-responders to the vaccine, leaving them at risk if they have a bloodborne pathogen exposure, the Centers for Disease Control and Prevention reports.

The most protective strategy would involve serologic testing of these previously vaccinated employees at hire, the CDC says in newly 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, CDC says. They may receive up to three new doses of HBV vaccine, the agency says.

Yet 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 CDC’s vaccine unit and a co-author of the guidance.

For example, some communities or hospital units may have a low prevalence of hepatitis B, and employees who are not involved in direct patient care would have a lower risk, she 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, health care 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 hepatitis B surface antigen-positive or the HBsAg status is unknown, those exposed health care 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.

--Michele Marill

For more on this story see the March 2014 issue of Hospital Employee Health