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Evening Karen We use this course for our student nurses and midwives due to compliancy issues and it seems to work better than the traditional course. However, getting them in for their 12 month injection is a problem and we are working closely with their university to ensure compliance. As we have only just got an IT system we have to paper track students which is very costly and time consuming. We are about to make a final decision for the rest of our Trust staff and other universities we look after and it is highly likely that we will move over in May to the accelerated course for all clinical staff. Compliance issues have been addressed by our Executive and all new staff from January this year must be fully compliant with their OH vaccinations or we refer their non compliance back to their managers and escalate from their. I remember from about 3-4 years ago, a paper stating that if you got a level over 40mIu/mls eight weeks after the third accelarated injection, then you had a good response. It had DoH approval, but I can't find it at the moment. Maybe someone on the list remembers the sources. If I can get onto PubMed then I will search later in the week. Hope this helps a little. Regards Iain Date: Wed, 15 Apr 2009 13:33:02 +0100 From: [log in to unmask] Subject: Re: [OCC-HEALTH] Hepatitis B primary course (healthcare workers) To: [log in to unmask] Hi Karen The Green Book does recommend this quicker course for 'high risk groups and for post-exposure prophlaxis' and in my experience we have done that; offered an accelerated course of vaccine to EPP workers who have not been previously vaccinated and staff who have received a contamination incident who again haven't been vaccinated. Other lower staff received the 0,1 & 6 month option. It is also worth a mention that engerix B (GSK) is also licensed for a super accelerated course of 0, 7 & 14 days. As regards the Anti HBs levels, we used to still check them after the initial 3 vaccines of the accelerated course. The rational is that folk should still have a response after these 3 injections, and the 4th dose is to make the protection sustainable until the 5 year booster dose is due. Where there is confusion is with the 'gold standard' of achieving Anti HBs >100 as the Green Book states that >10 is acceptable. Hope this helps Michael Date: Wed, 15 Apr 2009 12:56:24 +0100 From: [log in to unmask] Subject: [OCC-HEALTH] Hepatitis B primary course (healthcare workers) To: [log in to unmask] Hi I have recently referred to the Green Book in relation to the primary course of Hepatitis B, and I note that (on page 175) the accelerated course is recommended (zero, one and two months), rather than zero, one and six months. There appears to be a change of emphasis on the accelerated course rather than the standard course. I have spoken to one of the medical team at GlaxoSmithKline regarding the titre level to enquire about when the titre level should be taken in this schedule. They informed me, that the forth dose is part of the primary couse, and therefore the titre level should be taken 1-4 months after the 12 month dose. I would be pleased to hear from anyone that is working in the health service sector as to whether you are vaccinating healthcare workers on the accelerated course now. In the Green Book, the issue of compliance is given as a reason for vaccinating on the accelerated course, but I would have thought there are equal concerns about compliance in relation to returning for the 4th dose at 12 months, and subsequent titre level. Does anyone have any comments. Thank you. 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