Should employers check titers periodically?

Emergent, RN · Feb 3, 2019

I found information about this that is worth looking over:

http://www.immune.org.nz/vaccines/efficiency-effectiveness

Quota, BSN, RN · Feb 3, 2019

Different field but in my previous career of diagnostic lab work Hep B vaccine was required due to exposure risk. They checked my titers when I started the job and roughly every 5 years or so after. I was told people often need a Hep B booster around the 10 year mark once. I finished my initial Hep B series in ‘95 and my last titer check a little less than 2 years ago for starting nursing school still showed strong immunity still.

I think it’s a good idea to screen titers every 5 or so years just to be safe. People’s immune responses vary and it’s good to keep an eye on. Some may need boosters and other may have immunity for life. Never know until you check.

evastone, BSN, RN · Feb 3, 2019

I believe it would be a good idea to check for titers every 5 or ten years. I have a pregnant coworker who got exposed to measles and when they tested her titers they were nonexistent. They were fine years ago when she was first hired. Luckily she didn't catch it but we were all scared for her during the incubation period.

Interestingly enough, ob's don't even test those titers when you are pregnant. You get tested for hep b, STDs, toxoplasmosis, and get a TDAP vaccine but immunity to MMR and varicella are not tested. Perhaps in other states they are but not here.

KatieMI, BSN, MSN, RN · Feb 3, 2019

It may be good idea, but it wouldn't be cost effective.

We do not know, actually, which titer is how much protective, and to whom, and in which situation. Titers are "that second" measures, and they are relative. Furthermore, they do not predict IG M=> G=> A "surge" should the patient gets exposed to virulent agent. Pregnancy, recent flu, that recent pack of Medrol (yeah, you know it was not that needed but you had to work with that sinusitis) - all can affect them, in poorly predictable way. And, if they run low, you are going to get a shot (not a big deal, but still $$) and then more titers =>> see above.

On the other hand, for example, MMR induces "protective" titers for measles in about 95% of healthy recipients. We do not actually know what happens with remaining 5%. Everything we do know is that they are "serologic non-responders". Statistically, only like 10 to 25% get clinically sick if exposed. What happens with the rest is not exactly known except that they do not get clinically sick while not developing protective antibodies of the class(es) we look for if exposed to "wild" virus. We cannot do anything with this facts, and the numbers stay the same for decades.

This is the reason why workers in areas of "very high risk" exposure (like vets and military) are just mandatory vaccinated without too much hassle with titers.