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Alan I would appreciate it if you could supply the references for the information regarding HBsAg for all EPP workers as we are updating our protocol. Thanks, Eileen Smith -----Original Message----- From: Swann, Alan B [mailto:[log in to unmask]] Sent: 08 December 2004 13:40 To: [log in to unmask] Subject: Re: More Hep B debate... Immunity to Hep B infection is achieved if, following a complete course of vaccination, the person achieves an anti-HBs level of >10miu/ml. The 100miu/ ml level used to be thought necessary to achieve lasting immunity (stimulating production of memory cells- the amnestic response). However, studies have now shown that this is achieved at levels greater than 10. Another reason 100miu/ml was considered important in the past was the belief that this was proof the person was not infected with HepB. Chronic HepB infection tends to produce low levels of anti-HBs [if the person could produce a strong response, they'd clear the infection]. A level of >100 could only be produced through vaccine-induced anti-body response. This is now questioned as some HepB virus variants do not stimulate anti-HBs production & so a person might produce a good response to HepB vaccination, despite already having been infected & still infectious with one of the mutant strains. This is why direct serological tests for infection [HBsAg] is now required for all EPP workers, rather than only testing those who failed to respond well to vaccination. So the 100miu/ml level has no special relevance now. We should perhaps encourage our pathology colleagues to stop classifying anti-HBs tests into the <10, 10-99 and >100 ranges and especially get rid of the 'poor response' label to the 10-99 range. If it's greater than 10, it is good enough! Dr. Alan Swann, BM, AFOM Director of Occupational Health Occupational Health Service Imperial College London Southside building South Kensington Campus London SW7 2AZ Tel: +44 (20) 7594 9385 Fax: +44 (20) 7594 9407 https://www.imperial.ac.uk/spectrum/occhealth -----Original Message----- From: Glenn Raybone [mailto:[log in to unmask]] Sent: 08 December 2004 12:27 To: [log in to unmask] Subject: More Hep B debate... Hello everyone, at the risk of appearing daft can I ask for comments on the following please; we're aware of the 'Green Book' guidelines for Hepatitis B titre levels and whether boosters are required or not. As I understood it Immunity was classed as being a result >100 miu/ml. This also stems from HSG(93)40. However, the addendum to this document clearly states in Annex B that >10miu/ml can be classed as Immune. How are others interpreting this? Good to meet some of you at the RCN conference this year, and can I be one of the first to wish you all a restful festive season and a peaceful 2005. regards Glenn Raybone ~~~~~~~~~~~~~~~ Please remove this footer before replying. For list archives and documents, go to http://www.jiscmail.ac.uk/lists/occ-health.html for list archives For jobs in Occupational Health, go to http://uk.groups.yahoo.com/group/OHJobs/ ~~~~~~~~~~~~~~~ Please remove this footer before replying. For list archives and documents, go to http://www.jiscmail.ac.uk/lists/occ-health.html for list archives For jobs in Occupational Health, go to http://uk.groups.yahoo.com/group/OHJobs/ ~~~~~~~~~~~~~~~ Please remove this footer before replying. For list archives and documents, go to http://www.jiscmail.ac.uk/lists/occ-health.html for list archives For jobs in Occupational Health, go to http://uk.groups.yahoo.com/group/OHJobs/