CDC Responds to Medical Facilities Requiring EMS Personnel to have Titers

Titer test resultsMedical facilities around the country have been requiring EMS personnel who do not have proof of a positive titer to the hepatitis B vaccine series be tested prior to clinical rotations. If the titer is <10mlU/ml, those facilities administer an additional dose of vaccine. These costs, which can be significant, are passed on to the EMS providers or their departments.

So, why are medical facilities requiring proof of positive titers from EMS personnel and is this practice justified? This question was posed to the Centers for Disease Control and Prevention (CDC) Immunization Services Division. Their response provided the following quote from CDC’s Advisory Committee on Immunization Practices (ACIP) hepatitis B recommendations:

“An increasing number of HCP have received routine HepB vaccination during childhood. No post-vaccination serologic testing is recommended after routine infant or adolescent HepB vaccination. Because vaccine-induced anti-HBs wanes over time, testing HCP for anti-HBs years after vaccination might not distinguish vaccine non-responders from responders. Pre-exposure assessment of current or past anti-HBs results upon hire or matriculation, followed by one or more additional doses of HepB vaccine for HCP with anti-HBs <10 mIU/mL and retesting anti-HBs, if necessary, helps to ensure that HCP will be protected if they have an exposure to HBV-containing blood or body fluids”

The following is their response specific to public safety personnel:

“Healthcare/public safety personnel who do not have documentation of post-vaccination positive titers are treated differently, in the event of an exposure to the blood of a hepatitis B positive patient, than those who have documentation of a post-vaccination titer.” Their response then referenced the following flow chart included in the ACIP hepatitis B recommendations cited above.

This flow chart illustrates that that EMS personnel can be followed up post-exposure to a positive hepatitis B patient and, depending on the titer report on the exposed provider, preventative care can be rendered at that time. Post exposure costs go the EMS agency.

HBV flow chart

In addition, it has long been established and stated in all CDC hepatitis B vaccine guidelines that Anti-HBs levels decline over time, but responders continue to be protected. This currently is termed anamnestic response; in earlier CDC documents this was referred to immunologic memory.

In light of this information, it would appear that the medical facilities requiring emergency responders to provide proof of a positive titer to the hepatitis B vaccine is unwarranted. If medical facilities in your area are requiring HBV titers, please share this information from the CDC with the facility.

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