I agree with the comments about unreliability of the individual
remembering whether they had the disease.
I am aware of some OH units in the NHS accepting a definite history of
Rubella /MMR vaccination
(ideally with some written evidence) as being satisfactory for staff in
contact with patients in 'low risk' areas
(e.g. general surgery, orthopaedics) but routinely testing all staff
(regardless of vaccination history) in
'high risk' areas (e.g. midwifery, O&G).
I would be interested to hear whether others on the list think this is
a reasonable rationale.
Jon.
>>> [log in to unmask] 09/12/04 09:50:43 >>>
Memory recall of rubella will have zilch validity. There are many
other
infections with (superficially) similar signs & symptoms. Doctors
often
get it wrong too. The HPA figures for the last quarter show 273
notifications of suspected rubella (diagnosis based on clinical
grounds). 242 of these had tests for Rubella serology. Infection was
confirmed in only 1 case i.e. in the other 241 cases, the illness
thought to be rubella wasn't.
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: Sandy Townsend [mailto:[log in to unmask]]
Sent: 08 December 2004 20:16
To: [log in to unmask]
Subject: Re: More Hep B debate...
Glen
I would be sad to see the Old Year go out without you stimulating a
debate and also what better than the Hep B topic.
Our Trust has been working on the assumption that if good immunity
i.e.
>100miu/L a booster is given at 5 years and the programme considered
complete.
10-100 then the individual is given an immediate booster and a booster
at 5 years.
In the case of a needle stick injury bloods are obtained for storage
and
if evidence of immunity exists then no further action unless a Hep B
positive serology is identified in the donor.
Recently this was questioned by a new member of staff who feels that
there should be an automatic re-assessment of titre levels if the
previous serology is more than two years prior to the incident. The
argument is that the individual may have been immunosuppressed to some
degree and then the effectiveness of the vaccine not be protection
against acquiring the disease. We already ask a routine question when
taking details of the incident as to whether the recipient is/has been
knowingly immunosuppressed.
Do other OH departments recheck titre levels after NSI? Why is 2 years
a
time frame to take further action?
Also whilst we are in the immunization mode- re routinely screen (by
evidence of serology check) for rubella in employees going to work in
obs/gynae or potentially with the pregnant mum (no we we don't resort
to
the crystal ball) We include health visitors and nurses working in
the
perinatal team, For varicella we are reviewing all new employees and
doing a look back exercise of those in the high risk areas.
I am concerned that the Green Book reads that all NHS staff should be
screened for rubella and the DoH guidelines stated all staff for
varicella.
Do you all do serology for rubella or is a verbal history of
remembering
having had the disease or rubella vaccine sufficient. We don't think
twice if someone says they have had chickenpox in the past.
Season Greetings to all from a confused NHS OHNA
Sandy
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