The definition of a true non-responder is someone who has had 2 course of course compliant vaccine (given on time at the correct prescribed intervals) and who are still less than 10.
Anyone more than 10 has responded but maybe not well - unless you find they have had the infection hence why doing Anti-HBc is important in low responders.
Giving annual boosters to this latter group has not been advocated and we go back to the cellular memory and boost in the event of an exposure. They will not be given HBVIG if they have had a course of vaccine
You need to be careful for over extending the screening for EPP into areas which raise more questions than answers. As Lindsay says you need the absence of infectivity OR the presence of immunity. The only reason to do both is to avoid doing regular antigen testing which you don’t need if the person is immune which is >10 and not >100.
The best thing is to ensure you have the options covered in your imms schedule and that it is supported by the vaccine manufacturer and the doctor who signs them off.
Cheers
Sue
Susan Gorton | OH Nurse Manager | Occupational Health Department | Great Ormond Street Hospital NHS Foundation Trust | Level 3, Ormond House, 26-27 Boswell St., London WC1N 3JZ |020 7405 9200 Ext 0247 | DD to OHD 020 78138554 | Direct Fax 020 78138355 | Mobile 07833294568
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-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Lindsey Hall
Sent: 11 September 2013 20:30
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Hep B antibodies and boosters
Hi Jo
My understanding is that if you are involved in EPP, you must have documentary evidence of either immunity to Hep B or absence of infection. I am assuming you should have evidence of absence of infection to Hep C and HIV also within a reasonable timescale although I am getting a bit hazy here as it is a while since I did any work in the NHS
Therefore a course followed by blood test indicating immunity and one booster at 5 years is all you need providing the employee hangs on to their documentary evidence. The problem comes when they lose their documentary evidence so can't prove to you they are immune. They can tell you they are immune but you don't know without a blood test and, as we know, antibody levels drop so immunity may not be apparent. You are quite right though in that the immune memory would react to the virus if needed. Because you can't accurately test someone after about 16 weeks after a dose, I would have thought you have no choice but to give a booster and then test in the required timescale. You can sometimes test after a year or more and come up with a positive result in someone whose antibody level was initially very high but you are taking a chance and the farther you are away from the dose, the bigger the chance.
On the comment about levels lower than 10, if they say that have had a course in the past and been immune, I wouldn't give a further course - just a booster. I have recently had someone (lab environment) go from 2 to over 1000 with a booster.
As I say, it's a while since I did some NHS work so I stand to be corrected by those currently in the thick of it.
Thanks
Lindsey
Lindsey Hall
Director and Independent Occupational Health Adviser Split Dimension Ltd
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-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Joanna Edwards
Sent: 11 September 2013 08:53
To: [log in to unmask]
Subject: [OCC-HEALTH] Hep B antibodies and boosters
Dear All
I'm sure those of you working in the NHS have come across this before and I would value your advice please.
Sometimes we see new employees for exposure prone procedures clearance who have not had validated bloods taken for HBV Abs in their previous employment. Although they might have formerly demonstrated good immunity immediately after their initial course of HBV vaccinations, on repeating the test here in order to provide the required validated sample, they may only demonstrate a 10 -99 level (at which point should we then be giving an immediate booster?) or even, more rarely a <10 level (indicating the need for a repeat course?).
I'm unclear about required action here and am looking for the evidence for either doing/not doing this. My understanding is that although there may be an apparent reduction in the number of antibodies, immune memory would ensure good protection. Do we therefore need to provide further vaccine?
Very grateful for your advice or link to any evidence so that we can develop guidance for future management.
Many thanks as ever!
Jo
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