Download FAQ Pre-Hire Immunization Policy(MS Word Doc)

Frequently Asked Questions: Pre-Hire Immunization Policy
1. If the applicant has never had a tuberculin skin test (TST) or an Interferon Gamma
Release Assay (IGRA) blood test, what test needs to be completed?
A 2 step baseline TST, or a blood test (BAMT), Q-gold or Tspot, must be completed.
After the first step of the TST is completed with a negative PPD (purified protein
derivative) test and the history/exam is not suggestive of TB, the employee can begin
work pending the read of a second PPD. However, the second PPD must be
completed.
2. Why is the two-step testing recommended if there has never been a TST or IGRA
blood test completed?
The reason that two-step testing is recommended for employment screening, is for 2
reasons: 1) if the employee is negative after initial employment PPD and positive at
one year, it is not clear whether the positive is due to booster phenomenon or
conversion after an exposure. It is in the institution’s advantage to rule out a booster
phenomenon by using the two-step series. 2) The other reason for the two-step is to
proactively identify latent disease if the employee has TB, so prophylactic therapy
with INH (Isoniazid) can be given and lessen the chance of the employee developing
active TB that would put patients at risk.
3. If the applicant has had a previous negative TST result greater than 12 months ago,
what needs to be completed?
A new TST or BAMT test must be completed.
4. If the applicant has had a previous documented negative TST result less than 12
months ago, what needs to be completed?
Documentation must be sent to the Employee Health & Wellness Clinic of the
negative TST or a BAMT.
5. If the applicant has had a previous positive TST or previous positive BAMT, what
needs to be completed?
The individual will not need another TST or BAMT. Instead the applicant will need
the results of a chest x-ray stating no active tuberculosis and a negative symptoms
screen and a letter from a licensed provider, stating that patient has had an
evaluation for latent TB.
6. If the applicant has a new positive TST or BAMT at the EHWC, what needs to be
done?
Evaluation by a licensed provider with a letter stating that the result of the CXR is
negative for evidence of active TB, that the person is negative for symptoms of active
TB, and that the person was counseled about the pros and cons of INH of other
prophylactic therapy.
7. If the applicant has their first positive TB skin test after placement at the EHWC,
what needs to be done?
Any employee with a first time positive TB skin test after placement at the EHWC
will need a TB evaluation. If the evaluation is done at the EHWC, this can be done at
the employee cost, unless the hiring department approves the cost of the
evaluation. Applicants can do TB evaluation with a health care provider of their
choice. If the applicant goes to health care provider of choice it will be
applicant’s/employees cost, and they must submit the copy of the chest x-ray and a
letter stating they are free of active TB symptoms and whether they were started on
INH therapy or not.
8. If the applicant has had the BCG (Bacillus Calmette–Guérin) vaccination, what needs
to be done?
The applicant must have a negative TST (if the patient has not had a previous
positive TST), a BAMT, or results of chest x-ray stating no active tuberculosis and a
negative symptoms screen and a letter from a licensed provider, stating that patient
has had an evaluation for latent TB.
9. Will there be a cost to the applicant for the hepatitis B virus (HBV) vaccination
series?
There will be no cost to the employee for the hepatitis B vaccination series. The cost
will be the responsibility of the hiring department.
10. What guidelines will be utilized for HBV evaluation?
The EHWC will utilize the following CDC guidelines for evaluation:
· Documentation exists that the applicant/employee has previously received
the series or
· Medical evaluation shows that vaccination is contraindicated.
The Employee Health & Wellness Clinic follows the most recent ACIP/CDC
recommendations which state that only written and dated records should be accepted as
evidence of vaccination. In the absence of a prior infection with Hepatitis B virus, the use
of serologic titers as a measure of prior vaccination is not recommended. Using titers in
place of vaccine records could potentially indicate a positive result in someone who has
not completed the full vaccine series and this person may not have sufficient protection
for future exposures.
Here is the CDC data and reference:
In the majority of clinical practice settings, providers should accept only written and dated
records as evidence of vaccination. Although vaccinations should not be postponed if
records cannot be located, providers should try to locate missing records by contacting
previous health-care providers and asking patients to search for personally held records.
Persons whose records cannot be located should be considered susceptible and started or
continued on the age-appropriate vaccine schedule.
Determining immunity from previous infection through serologic testing is an alternative
to vaccination. However, using serologic testing to assess immunity from vaccination in
persons with unknown or uncertain vaccination status can be problematic (see
Prevaccination Serologic Testing for Susceptibility).
In addition, an anti-HBs-positive result can occur even for persons who received >1 dose of
vaccine but did not complete the series. However, long-term protection has been
demonstrated only for persons who have completed a licensed vaccination series and
have ever had an anti-HBs concentration of >10 mIU/mL; persons with an anti-HBspositive
result but who did complete a vaccine schedule might not have long-term protection from
HBV infection.
Reference:
MMWR December 8, 2006;55(RR-16)1-33.
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B
Virus Infection in the United States
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Part II: Immunization of Adults
11. Can an employee start work without completing the full HBV vaccination series?
If the employee accepts the Hepatitis B virus vaccination series, the employee must
have started the series before beginning work. However, judgment should be made
if the employee would be at a high risk of exposure without completion of the full
series. It is less concerning for those that work in positions of lower risk.
12. Can an employee decline the Hepatitis B virus vaccination? If so, how?
Employees may decline the offer for vaccination for various reasons. The employee
must sign a declination form. Employees who decline may request and obtain the
vaccination at a later date at no cost. Documentation of refusal of the vaccination is
kept by the EHWC.
13. Do employees have to complete the Hepatitis B virus vaccination series before
starting patient care activities?
Employees must complete the vaccination series before starting any patient care
activities, or must sign a form stating that they understand that they will not achieve
the maximal protection from the vaccine until the series is completed.
14. How soon must the Hepatitis B virus vaccination be available after initial hire?
As per OSHA requirements, “The hepatitis B virus vaccination must be made
available within 10 working days of the initial assignment, after appropriate training
has been completed. Thus, arranging for the administration of the first dose of the
series must be done at a time which will enable this schedule to be met “. Thus based
on OSHA guidelines, employee’s job classification and the Risk assessment form
EHWC will notify HR or the departments if whether the employee requires
completing the hepatitis vaccine series before the start date or can be cleared after
the first immunization is administered.
15. What are the risks associated with TB skin test and HBV vaccination?
Hepatitis B is a very safe vaccine. Most people do not have any problems with it.
The vaccine contains non-infectious material, and cannot cause hepatitis B infection.
Some mild problems have been reported

Soreness where the shot was given (up to about 1 person 4)

Temperature of 99.9°F or higher (up to about 1 person in 15).
Severe problems are extremely rare. Severe allergic reactions are believed to occur about
once in 1.1 million doses. A vaccine, like any medicine, could cause a serious reaction. But
the risk of a vaccine causing serious harm, or death, is extremely small. More than 100
million people in the United States have been vaccinated with hepatitis B vaccine. This
information was taken directly from the Hepatitis BVIS (http://www.cdc.gov/vaccines/vacgen/side-effects.htm)
TB Skin Test
There is a very slight risk of having a severe reaction to the tuberculin skin test, especially
if you have had tuberculosis (TB). An allergic reaction can cause a lot of swelling and pain
at the site. A sore may be present. You cannot get a TB infection from the tuberculin skin
test, because no live bacteria are used for the test.
After the test, some redness at the skin test site is expected. The site may itch, but it is
important that you do not scratch it, since this may cause redness or swelling that could
make it hard to read the skin test. If itching is a problem, put a cold washcloth on the site
and then dry it.
A strong positive reaction may cause mild pain. Talk to your doctor if you have:



A fever.
Swelling in your arm.
Swollen lymph nodes in your armpit.
16. If I have completed the HBV vaccination series, but don’t remember if I completed the
antibody titer, what steps should be taken?
If you have not completed the antibody titer, contact the Employee Health & Wellness
Clinic to schedule an appointment.
17. If I have completed the HBV vaccination series and have a negative antibody titer, what
steps should be taken?
The employee should contact the Employee Health & Wellness Clinic for further
guidance.
CDC Recommendations – If there are 3 documented immunizations and a negative
antibody titer, then the healthcare worker will require an additional 3 vaccines of
Hepatitis B and a retesting of the titer. If the second titer is still negative the worker will
need to be checked for hepatitis infection. Once everything is clear, if the employee has
an exposure they will need to get a Hepatitis B immunoglobulin vaccine.
18. If I am working with commercially-available human cell lines, am I still required to
complete the HBV vaccination series?
Although the risk is low, it is recommended that HBV vaccinations are completed for
work with human cell lines. Employees have the option to accept or decline the offer of
vaccination.
19. What should be done if the HBV vaccination series was not completed?
Contact the Employee Health & Wellness Clinic to resume the vaccinations.
20. Are immunizations required for temporary employees who are brought from an outside
agency and working at the Health Science Center delivering patient care?
Yes, the immunizations are required for working in a clinical area. The outside agency
must provide the required immunizations to the temporary employee.
Resources:
http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm
http://www.cdc.gov/hepatitis/b/bfaq.htm#
For questions or concerns, please contact:
Environmental Health & Safety, 1.343T DTL
(210)567-2955
http://research.uthscsa.edu/safety
Or the
Employee Health & Wellness Clinic, 1.445 NSG
(210)567-2788
http://ehwc.uthscsa.edu/