Health Care Immunization FAQs

What are Antibody Titers?
An antibody titer is a laboratory test that measures the level of antibodies in a blood sample. The IgG titer is a blood test that determines whether you have immunity to certain diseases by measuring your antibody level to those diseases. If you have had the disease in the past or have been vaccinated for it, you are likely to show evidence of immunity through a positive titer, or antibody, level.  A positive IgG titer result may be used in lieu of most immunization records.  The IgG titer is required for both MMR and Varicella.
The following antibody titer tests are available:

• MMR (Measles/Rubeola, Mumps, Rubella)
• Hepatitis B
• Varicella/Chickenpox
• Tetanus
• Diphtheria QuantiFERON-TB Gold Blood Test (alternative to skin test/X-Ray)
• Polio
• Pertussis

What preservatives are used in vaccines?
Thimerosal, a mercury-containing organic compound which is approximately 50% mercury by weight, has been one of the most widely used preservatives in vaccines.  Thimerosal has been widely used as a preservative in a number of biological and drug products, including many vaccines, to help prevent potentially life threatening contamination with harmful microbes.  However, Thimerosal has been removed from or reduced to trace amounts in all vaccines routinely recommended for children 6 years of age and younger, with the exception of inactivated influenza vaccine, a preservative-free version of the inactivated influenza vaccine (contains trace amounts of thimerosal) is available in limited supply. Some vaccines such as Td, which is indicated for older children (≥ 7 years of age) and adults, are also now available in formulations that are free of thimerosal or contain only trace amounts. Vaccines with trace amounts of thimerosal contain 1 microgram or less of mercury per dose. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228

A student’s refusal to obtain the required vaccinations due to the presence of Thimerosal is not a recognized excuse or exception.  All students must prove the required immunizations by either proof of a positive titer or an immunization record (see declination or waiver information below).

Can I use a declination or waiver for the required immunizations?
The College does not provide a waiver or declination of any immunization, with the exception of the rabies vaccination.  However, some of our clinical affiliates may allow for the use of a waiver or declination under certain circumstances.  These circumstances include, but are not limited to, medical reasoning and religious reasoning.  You MUST check with your program manager to verify whether or not the facility that you will be attending will allow for your circumstances.  Medical reasoning, including a recommendation from your physician, does not automatically guarantee that you will be given a waiver or declination ability.  Further, if you have obtained a waiver/declination from one facility and then are rotating into a different facility, the waiver/declination will not be valid in the new facility.

Hepatitis B FAQ

What it is Hepatitis B?
Hepatitis B is an infection of the liver caused by hepatitis B virus. This is a blood-borne disease and can be very serious.

How can it affect me?
Hepatitis B causes a flu-like illness with loss of appetite, nausea, vomiting, rashes, joint pain, and jaundice. The virus stays in the liver of some people for the rest of their lives and can result in severe liver diseases, including fatal cancer.

Can a patient receive the first dose of Hepatitis B vaccine from one manufacturer and subsequent doses from another manufacturer?
Yes. No differences in immune response are observed when vaccines from different manufacturers are used to complete the vaccine series.

If there is an interruption between doses of Hepatitis B vaccine, does the vaccine series need to be restarted?
No, the series does not need to be restarted.

• If the vaccine series was interrupted after the first dose, the second dose should be administered as soon as possible.
• The second and third doses should be separated by an interval of at least 8 weeks.
• If only the third dose is delayed, it should be administered as soon as possible.

Is it harmful to administer an extra dose(s) of Hepatitis A or Hepatitis B vaccine or to repeat the entire vaccine series if documentation of vaccination history is unavailable?
No. If necessary, administering extra doses of Hepatitis A or Hepatitis B vaccine is not harmful.

Can Hepatitis B vaccine be administered concurrently with other vaccines?
Yes. When Hepatitis B vaccine has been administered at the same time as other vaccines, no interference with the antibody response of the other vaccines has been demonstrated. Separate body sites and syringes should be used for simultaneous administration of injectable vaccines.

How long does protection from Hepatitis B vaccine last?
Studies indicate that immunologic memory remains intact for at least 20 years among healthy vaccinated individuals who initiated Hepatitis B vaccination >6 months of age. The vaccine confers long-term protection against clinical illness and chronic Hepatitis B virus infection. Cellular immunity appears to persist even though antibody levels might become low or decline below detectable levels. Among vaccinated cohorts who initiated Hepatitis B vaccination at birth, long-term follow-up studies are ongoing to determine the duration of vaccine-induced immunity.

Who should get the Hepatitis B vaccine and when?
Children and adolescent:

• Babies normally get 3 doses of hepatitis B vaccine: Some babies might get 4 doses, for example, if a combination vaccine containing hepatitis B is used. (This is a single shot containing several vaccines.) The extra dose is not harmful.
• Anyone through 18 years of age who didn't get the vaccine when they were younger should also be vaccinated.

Adults:

• All unvaccinated adults at risk for hepatitis B infection should be vaccinated. Adults getting hepatitis B vaccine should get 3 doses — Your doctor can tell you about other dosing schedules that might be used in certain circumstances.
  http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.pdf 
  http://www.cdc.gov/vaccines/adults/rec-vac/hcw.html