Ask the expert: Workers who don’t respond to the hepatitis B vaccination
Q: What does OSHA require from an employer when a new employee fails to respond to the hepatitis B vaccination?
A: OSHA requires adherence to the CDC’s “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis,” published in the June 29, 2001, Morbidity and Mortality Weekly Report.
The guidelines require that employees who don’t respond to the primary vaccine series receive a second three-dose vaccine series. First-series nonresponders have a 30%–50% chance of responding to a second three-dose series.
Nonresponders to a second vaccination series who are HBV surface antigen (HBsAg)-negative are susceptible to HBV infection. These people should receive education about preventing HBV infection and the need to obtain HBV immune globulin (HBIG) prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood, according to the guidelines.
Nonresponders who are HBsAg-positive should receive counseling about preventing HBV transmission to others and regarding the need for medical evaluation.
Of course, document these efforts in the employee’s confidential OSHA file or medical record.
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David LaHoda
David LaHoda, the managing editor of Medical Environment Update and OSHA Watch, has produced healthcare training videos and consulted for medical practices and ambulatory healthcare facilities.
David has written 196 posts.
Comments
Is it an osha requirement to obtain post-vaccination titer of HepB vaccine on newly hired employees? (not post-exposure)
If the employer is administering the vaccine, it is a requirement as explained in the USPHS publication referenced above. That has been the case since December 1997. Here is the OSHA letter of interpretation as verification: 03/10/2000 – HBV antibody testing is required after vaccination series; HBV booster not required.
I mentioned this letter in a previous post which you may find useful: Top-ten list of OSHA interpretation letters.
If the new employee has already had the hepatitis B vaccination but records show that HBV antibody testing was not performed, then the employer is not required to obtain a titer, since a titer done more than one to two months after the last shot in the vaccination series cannot confirm immunity.
In such a situation where there is an exposure incident, you would treat the exposed employee as a non-responder to the hepatitis B vaccine, according to the USPHS Guideline.
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