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Hepatitis B Vaccine and Healthcare Workers

January 17, 2019

Hepatitis B vaccine and Healthcare workers

 

The Occupational Safety and Health Act of 1991 mandated that the Hepatitis B vaccine be made available at the employer's expense to all healthcare providers who are occupationally exposed to blood or other infectious materials or sharps. By the mid- 1990s most states required vaccination of all school-aged children. Therefore, it is likely that most health care worker applicants have been vaccinated with Hepatitis B in their past.

Titers to test whether an employee has adequate protection against Hepatitis B are only accurate if tested within 4-8 weeks of the last dose of vaccine. As is it rare that a healthcare worker presents for their pre-employment exam within 4-8 weeks of their last Hepatitis B vaccine, Champlain Medical Urgent Care (CMUC) will be administering a booster dose of the Hepatitis B vaccine and seeing the employee back in the 4-8 week time window to obtain a titer to assess their immune status.

Vaccination is both safe and effective with seroprotection being achieved in 92 % of healthcare providers aged <40 years and 84 % aged ≥ 40 years. In a study of 159 health care providers who were vaccinated between the ages of 18 and 60 years, approximately 75 % of individuals had protective Hepatitis B surface antibody (anti-HBs) levels 10 to 31 years after they received their initial vaccine series. Unfortunately, 5 to 21 % of health care providers do not develop a protective level of anti-HBs after three doses of vaccine and may need additional doses. Lower rates of seroconversion are associated with increasing age, greater immunocompromise, current smoking, and higher body mass index.

If your employee’s titers at 4-8 weeks are not protective (i.e. less than 10 milli-international units/mL), CMUC will administer two more vaccines: one immediately and one a month later. Repeat titers will be obtained in the 4-8 week time window after the third vaccine. Approximately half of these employees will be expected to have an adequate titer greater than or equal to 10 milli-international units/mL.

Those that do not have adequate titers, will be considered “nonresponders” and should receive Hepatitis B immune globulin (HBIG) in the event of an occupational exposure to both known Hep B positive exposures and to unknown blood borne pathogen exposures with a high risk of Hep B (such as needle stick by a larger gauge hollow bore needle with visible blood in which the source patient’s Hepatitis B status cannot be determined). As UVM Emergency room is the only local facility that stocks HBIG, please send any of these higher risk exposures in a nonresponder directly to the ER for timely administration of HBIG.