I think it needs to be understood that there is a difference between immunity and longevity of immunity. So bear in mind what you are trying to achieve. In most occupational programmes it is long term immunity so the exposed worker can go away safe and stay safe over time.
Even one dose of Hep B is likely to produce some immunity.
The second dose ensures that the number of people who are starting to become immune increases and the third dose is to try and increase that number AND prolong the period that the immunity lasts. If someone was going travelling 2 doses one week apart is likely to provide sufficient lasting protection for their holiday.
A standard 3 dose primary course given at 0,1, 6 months is the recommended primary course for resources and efficacy and if over 100, you're done. No more 5 year booster.
Testing down the line, post needlestick perhaps, may show a reduction over time but probably still>10 which is still immune. Theoretically even less than 10 may still be immune as there is an amnestic response potential when the immunity is not measurable by current processes but would kick in if body is infected with antigen. You would still give a booster NOT to provide immunity as they already have it but to again send them away safe over time.
The Hepatitis board did some research which said if after a compliantly attended primary course the level was less than 20 miu/ml, 2 boosters one month apart was more likely to get the individual >100 than 1 booster alone. Think how many times you have boosted tested and had to give a second. It saves a blood test and costs a vaccine dose so who knows if it is worth it.
Most of America DOES NOT test based on the amnestic principle though some of them are introducing it now.
Regards
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 Sarah L Redfearn
> Sent: 18 April 2013 08:59
> To: [log in to unmask]
> Subject: Re: [OCC-HEALTH] Hepatitis B Serology
>
> Hi Cathy,
>
> We vaccinate the student healthcare workers here in Hull as they commence
> their training. When the scheduling for Hep B changed in the Green Book
> we considered it and the reason for the changes. We interpreted the
> information to mean that the scheduling changed as a result of non
> compliance of the course of vaccinations in a sexual health setting with their
> patients.
>
> Given the environment that we are in we decided to continue with the 0, 1
> & 5 month regime as we have a relatively reasonable compliance rate. The
> other considerations where whether there was any evidence to suggest that
> if a student didn't have their course exactly as scheduled, would this cause
> them some risk and of course cost is always considered as the extended
> schedule includes an extra vaccine and having the students released from
> lectures.
>
> I have attached the information we received from Glaxo and this assisted us
> to make the decision to stick with the shorter schedule as we (the team) feel
> that this is the best option for us and our clients.
>
> I know that I haven't answered your question exactly but it might offer you
> something useful.
>
> Sarah
>
>
>
> ...................................................................................................................
>
> Sarah Redfearn Dip HE Occupational Health Occupational Health Nurse
> Advisor University of Hull Hull, HU6 7RX
>
> www.hull.ac.uk
> 01482 466010
>
>
> -----Original Message-----
> From: [log in to unmask] [mailto:[log in to unmask]] On
> Behalf Of Cathy Howells
> Sent: 17 April 2013 11:16
> To: [log in to unmask]
> Subject: Re: [OCC-HEALTH] Hepatitis B Serology
>
> Dear List,
> Following on from Diane's excellent advice below, I would like to ask if
> anyone does postpone Hep B serology until after the 4th dose, especially in
> Health Care Workers (EPP and non EPP)?
> Some of our nurses are asking why we are still testing after the third dose
> when the guidance is to wait and test after the 4th dose. My response has
> been that this then delays our knowledge of the employee's hep B status.
> I would be interested to hear if anyone does do this and whether or not it
> causes any concerns?
>
> Thank you
>
> Cathy
>
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