required immunizations for work

[TWR]

Working in FP in Katy TX and employer states that the TX law says I have to have MMR, Varicella, Tdap, and Hep B.  My insurance would be billed but what it does not cover the practice will cover.  I get an EOB from medicare that I will likely get a bill for $293.00.  I was born before 1957 and argued that I did not need the vaccines other than tdap and I had hep B.  Still had to do titres.  Now told that the balance is my responsibility.  Somehow this is sticking in my throat as not being correct.  Am I wrong?  Thanks

[GetMeOuttaThisMess]

CDC recs, not state law (that I'm aware of). HCP in Tx, regardless of titer, are asked to have two documented MMR doses. If low varicella it doesn't mean you aren't immune, it only implies titers have dropped off (same with hep B titers since intro in '85). HCP's probably should have titer 1-2 mos after completing hep B series just for future documentation (and avoids need for future repeat series regardless of future titer values).

[Guest Paula]

Not sure if I am understanding this correctly.  Are you saying your practice now won't cover the balance?  I've had two series of Hep B and do not convert. 

[GetMeOuttaThisMess]

^^^. Wow, you ARE rare (<1%). For OP, can't believe employer doesn't cover.

[Will352ns]

As a side-note, I am a non-converter as well.  2 rounds of vaccines, negative titers.  Sorry to highjack.

[rev ronin]

If vaccines were covered, titers SHOULD be covered in lieu of vaccines.  My employer paid for all of it.

[ventana]

Hand the bill and the paperwork stating it is a requirement to the practice manager for reimbursement - they need to pay it and you should make a stink if they do not.

 

As you have put it - they have gone back on their word - not a good thing....

[skyblu]

Not sure if I am understanding this correctly. Are you saying your practice now won't cover the balance? I've had two series of Hep B and do not convert.

Same here. Found out the first time after a critical exposure.

Went through the whole series again, had new titers done...still not converted.

[GetMeOuttaThisMess]

Must be a government conspiracy then (CDC stats).  Can't believe that there are so many of you who are conversion negative following SIX immunization doses.

[Guest Paula]

I vaguely remember a conversation with the state health department physician who said that some people do not show the titers but will still be immune if exposed.  It was recommended that no more Hep B series should be undertaken. 

[GetMeOuttaThisMess]

From that perspective I agree.  I'm antibody negative as well at present time, however, I did have a qualitative value obtained many years back while in the ED at the request of the hospital where our group contracted.  It was "positive" though no quantitative value was obtained.  As a result, I'm good to go per CDC standards.

[ventana]

last I read on Hep B and vaccine

 

if you prove you have had the series and one booster there is no need for further.....

[GetMeOuttaThisMess]

"What should be done if a person’s postvac- cination anti-HBs test is negative (less than 10 mIU/mL) 1–2 months after the last dose of vaccine?"

Repeat the 3-dose series and test for anti-HBs 1–2 months after the third dose of vaccine.

 

Per our friends in Georgia

[ventana]

  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

 

updated 12/20/2013

      Postvaccination Serologic Testing

HCP who have written documentation of a complete, ≥3-dose HepB vaccine series and subsequent postvaccination anti-HBs ≥10 mIU/mL are considered hepatitis B immune. Immunocompetent persons have long-term protection against HBV and do not need further periodic testing to assess anti-HBs levels (Figure 6).

All HCP recently vaccinated or recently completing HepB vaccination who are at risk for occupational blood or body fluid exposure should undergo anti-HBs testing. Anti-HBs testing should be performed 1–2 months after administration of the last dose of the vaccine series when possible. HCP with documentation of a complete ≥3-dose HepB vaccine series but no documentation of anti-HBs ≥10 mIU/mL who are at risk for occupational blood or body fluid exposure might undergo anti-HBs testing upon hire or matriculation. Testing should use a quantitative method that allows detection of the protective concentration of anti-HBs (≥10 mIU/mL) (e.g., enzyme-linked immunosorbent assay [ELISA]).

• Completely vaccinated HCP with anti-HBs ≥10 mIU/mL are considered hepatitis B immune. Immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels.
• Completely vaccinated HCP with anti-HBs <10 mIU/mL should receive an additional dose of HepB vaccine, followed by anti-HBs testing 1–2 months later. HCP whose anti-HBs remains <10 mIU/mL should receive 2 additional vaccine doses (usually 6 doses total), followed by repeat anti-HBs testing 1–2 months after the last dose. Alternatively, it might be more practical for very recently vaccinated HCP with anti-HBs <10 mIU/mL to receive 3 consecutive additional doses of HepB vaccine (usually 6 doses total), followed by anti-HBs testing 1–2 months after the last dose.