Home
|
About IAC
|
Contact
|
A-Z Index
|
Donate
|
Shop
|
SUBSCRIBE
Immunization Action Coalition
IAC Home
|
IAC Express
|
2014 Issues
|
Issue 1134
IAC Express: Weekly immunization news and information

Issue 1134: July 24, 2014

Ask the Experts: CDC Experts Answer Your Questions


The questions and answers in this edition of IAC Express first appeared in the July 2014 issue of Needle Tips.

IAC extends thanks to our experts, medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN, both from the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).

Hepatitis B Vaccine



Hepatitis B Vaccine
Q: In December 2013, CDC released a new document titled CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. Does the content of this document update ACIP recommendations on healthcare personnel vaccination and hepatitis B?

A: The new guidance published by CDC (CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management (MMWR 2013;62[RR-10]) does not constitute new recommendations of ACIP. The CDC guidance was created based on the opinions of an expert panel convened by CDC. According to the document, the guidance from CDC "augments the 2011 recommendations" of the ACIP document titled Immunization of Health-Care Personnel published November 25, 2011 (www.cdc.gov/mmwr/pdf/rr/rr6007.pdf), for evaluating hepatitis B protection among healthcare personnel and administering postexposure prophylaxis. Back to top


Q: Does CDC now recommend routine pre-exposure anti-HBs testing of all healthcare personnel who were previously vaccinated?

A: In general, no, but the type of testing (pre-exposure or postexposure) depends on the healthcare worker's profession and work setting. An expert panel convened by CDC acknowledged that the risk for hepatitis B virus (HBV) infection for vaccinated healthcare personnel (HCP) can vary widely by setting and profession. The risk might be low enough in certain settings that assessment of hepatitis B surface antibody (anti-HBs) status and appropriate follow-up can be done at the time of exposure to potentially infectious blood or body fluids. This approach relies on HCP recognizing and reporting blood and body fluid exposures and might be applied on the basis of documented low risk, implementation, and cost considerations. Trainees, some occupations (such as those with frequent exposure to sharp instruments and blood), and HCP practicing in certain populations are at greater risk of exposure to blood or body fluid exposure from an HBsAg-positive patient. Vaccinated HCP in these settings/occupations would benefit from a pre-exposure approach. Figure 6 on page 13 of the guidance document provides an algorithm for settings where the choice is to use a pre-exposure approach. Table 2, found on page 14 of the document, provides the algorithm when postexposure management is implemented. The document, tables, and figures are available at www.cdc.gov/mmwr/pdf/rr/rr6210.pdf.

Back to top


Q: If an employee receives both HBIG and hepatitis B vaccine after a needlestick from a patient who is HBsAg positive, how long should one wait to check the employee's response to the vaccine?

A: Anti-HBs testing for HCP who receive both hepatitis B immune globulin (HBIG) and hepatitis B vaccine can be conducted as soon as 4 months after receipt of the HBIG. However, a new recommendation in the 2013 document is to test for hepatitis B core antibody (anti-HBc) and hepatitis B surface antigen (HBsAg) among certain HCP (those previously unvaccinated, incompletely vaccinated, or revaccinated) with an exposure from an HBsAg-positive or unknown HBsAg-status patient at the time of the exposure and approximately 6 months after the exposure (that is, after the HBV incubation period). The CDC expert panel determined that it would be more efficient to do all the follow-up testing at one time, and recommended testing at 6 months after the exposure. Anti-HBs could be measured at a minimum of 4 months after the administration of HBIG, but testing for infection would then follow approximately 2 months later.

Back to top


Q: At our facility we do routine pre-employment anti-HBs testing regardless of whether the employee has documentation of a hepatitis B vaccination series and consider those who are anti-HBs positive to be immune. Is this the recommended strategy?

A: No. HCP with written documentation of receipt of a properly spaced 3-dose series of hepatitis B vaccine AND a positive anti-HBs can be considered immune to HBV and require no further testing or vaccination. Testing unvaccinated or incompletely vaccinated HCP (including those without written documentation of vaccination) is not necessary and is potentially misleading because anti-HBs of 10 mIU/mL or higher as a correlate of vaccine-induced protection has only been determined for persons who have completed a hepatitis B vaccination series. Persons who cannot provide written documentation of a complete hepatitis B vaccination series should complete the 3-dose series, then be tested for anti-HBs 1 to 2 months after the final dose.

Back to top


Q:  Does CDC still recommend routine anti-HBs testing of HCP who are at risk for occupational blood or body fluid exposure following the hepatitis B vaccination series?

A: Yes. This recommendation has not changed.

Back to top


Q: Is there now a recommendation for a routine booster dose of hepatitis B vaccine?

A: No. HCP who have documentation of receiving a 3-dose series of hepatitis B vaccine and who tested positive for anti-HBs (defined as anti-HBs of 10 mIU/mL or higher) are considered to be immune to hepatitis B. Immunocompetent persons have long-term protection against HBV and do not need further testing or vaccine doses. Some immunodeficient persons (including those on hemodialysis) may need periodic booster doses of hepatitis B vaccine, as described in the 2006 adult hepatitis B vaccine ACIP recommendations (MMWR2006;55[RR-16]:26–9 www.cdc.gov/mmwr/pdf/rr/rr5516.pdf). These recommendations have not changed.

Back to top


Q: Does CDC now recommend restarting the hepatitis B vaccine series in the event the series is interrupted?

A: No. This recommendation has not changed. The series should not be restarted. Simply continue from where you left off.

Back to top
 
How to submit a question to Ask the Experts

IAC works with CDC to compile new Ask the Experts Q&As for our publications based on commonly asked questions. We also consider the need to provide information about new vaccines and recommendations. Most of the questions are thus a composite of several inquiries.

You can email your question about vaccines or immunization to IAC at admin@immunize.org.

As we receive hundreds of emails each month, we cannot promise that we will print your specific question in our Ask the Experts feature. However, you will get an answer.

You can also email CDC's immunization experts directly at nipinfo@cdc.gov. There is no charge for this service.

If you have a question about IAC materials or services, email admininfo@immunize.org.

Please forward these Ask the Experts Q&As to your colleagues and ask them to subscribe to IAC Express.

Back to top
 

About IAC Express 
We encourage you to reprint any of these Q&As in your own newsletters. Please credit the Immunization Action Coalition and the Centers for Disease Control and Prevention. Please refer to IAC's preferred citation style.
If you have trouble receiving or displaying IAC Express messages, visit our online help section.
IAC Express is supported in part by Grant No. U38IP000589 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: bioCSL Inc.; MedImmune, Inc.; Merck Sharp & Dohme Corp.; Novartis Vaccines; Ortho Clinical Diagnostics, Inc.; Pfizer, Inc.; and sanofi pasteur.
IAC Express Disclaimer
ISSN: 1526-1786

Our mailing address is
Immunization Action Coalition
2550 University Avenue West, Suite 415 North
Saint Paul, MN 55114


Copyright (C) 2014 Immunization Action Coalition
All rights reserved.
Subscribe Today: IAC Express, Needle Tips, and Vaccinate Adults: the up-to-date immunization information you need
IAC Express
IAC Express Home
2015 Issues
2014 Issues
2013 Issues
2012 Issues
2011 Issues
2010 - 1997 Issues
Praise for IAC Express
Help
Disclaimer
Issue Abbreviations
AAFP: American Academy of Family Physicians; AAP: American Academy of Pediatrics; ACIP: Advisory Committee on Immunization Practices; CDC: Centers for Disease Control and Prevention; FDA: Food and Drug Administration; IAC: Immunization Action Coalition; MMWR: Morbidity and Mortality Weekly Report; NCIRD: National Center for Immunization and Respiratory Diseases; VIS: Vaccine Information Statement; WHO: World Health Organization
Publication Staff
Executive Editor: Deborah L. Wexler, MD
Editor: Mary Quirk
Associate Editor: Teresa Anderson, DDS, MPH
Consulting Editor: Marian Deegan, JD
Production Editor: Janelle Tangonan Anderson, MA
Additional Information
News & Information
Media coverage about vaccines and vaccine-preventable diseases
Calendar of Events
Conferences and meetings on immunization
Shop IAC
Record cards, laminated schedules and more
 
- Guide to immunize.org -
A-Z INDEX
ABOUT IAC
ACIP RECOMMENDATIONS
ADDITIONAL RESOURCES
ADULT VACCINATION
ADULT VACCINATION GUIDE
ASK THE EXPERTS
Combination Vaccines
Diphtheria
Hepatitis A
Hepatitis B
Vaccine Storage and Handling
>> view all
BILLING & CODING
BIRTH DOSE GUIDEBOOK
CALENDAR
CDC INFORMATION
CDC SCHEDULES
CLINIC TOOLS
Administering Vaccines
Documenting Vaccination
Scheduling Vaccination
Screening for Contraindications
Storage & Handling
Vaccine Recommendations
>> view all
COALITIONS
CONTRIBUTE TO IAC
DEAR COLLEAGUE LETTER
HPV VACCINE
DEAR COLLEAGUE LETTER
MCV4 DOSE #2
DISEASES & VACCINES
Diphtheria
Hepatitis A
Hepatitis B
Influenza
Varicella
>> view all
DONATE TO IAC
EMAIL NEWS SERVICES
EDUCATIONAL MATERIALS
FAQs
FAVORITES (WEB SECTIONS)
FDA PRODUCT APPROVALS
GIVE BIRTH TO THE END OF
HEP B
HANDOUTS FOR PATIENTS &
STAFF
Administering Vaccines
Adult Vaccination
Documenting Vaccinations
Managing Vaccine Reactions
Parent Handouts
Patient Schedules
Questions & Answers
Recommendations
Screening Checklists
Standing Orders
Storage & Handling
Talking with Parents
Temperature Logs
Top Handouts
Translations
Vaccine Index
>> view all
HEPATITIS B BIRTH DOSE
HONOR ROLLS
HepB Birth Dose
Influenza Vaccination for HCP
IAC EXPRESS
IMAGES
IMMUNIZATION TECHNIQUES
DVD
LAMINATED SCHEDULES
MANUFACTURERS
NATIONAL ADULT & INFLUENZA IMMUNIZATION SUMMIT
NEWS & INFORMATION
OFFICIAL RELEASES
ACIP
CDC
FDA
>> view all
PACKAGE INSERTS
PARTNERS
PHARMACISTS
PHOTOS
POWERPOINT SLIDE SETS
PRESS ROOM
PROTECT NEWBORNS
FROM HEP B
PUBLICATIONS
IAC Express
REGISTRIES
RESOURCE DIRECTORY
SHOP IAC
Immunization Techniques DVD
Laminated Schedules
Patient Record Cards
>> view all
SITE MAP
SLIDE SETS
STANDING ORDERS TEMPLATES
STATE INFORMATION
State Websites
State Laws
State Immunization Managers
>> view all
SUBSCRIBE
SUPPORT IAC
TECHNICALLY SPEAKING
TRANSLATE FOR IAC
TRAVEL (INTERNATIONAL)
UNPROTECTED PEOPLE REPORTS
Chickenpox
Diphtheria
Hepatitis A
Hepatitis B
>> view all
VACCINATING ADULTS: A STEP-BY-STEP GUIDE
VACCINE CONCERNS
Adjuvants & Ingredients
Alternative Medicine
Autism
Importance of Vaccination
>> view all
VACCINE INFORMATION STATEMENTS
Translations
Vaccine Index
>> view all
VACCINE MANUFACTURERS
VACCINE POLICY & LICENSURE
ACIP
FDA
WHO
>> view all
VACCINE SAFETY
VACCINES & DISEASES
VIDEOS (VIDEO OF THE WEEK)
WHAT'S NEW OR UPDATED AT IAC
Handouts
VISs
Web Sections
>> view all
 
Immunization Action Coalition  •  2550 University Avenue West  •  Suite 415 North  •  Saint Paul, Minnesota  •  55114
tel 651-647-9009  •  fax 651-647-9131
 
 
 
This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.