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HomeMy WebLinkAbout6.b. Hepatitis B Vaccine PolicyEXECUTIVE SUMMARY FOR: ACTION CITY COUNCIL MEETING DATE: APRIL 2, 1991 AGENDA ITEM: HEPATITIS B VACCINATION POLICY AGENDA SECTION: NEW BUSINESS PREPARED BY: SUSAN M. WALSH, CITY CLERK AGENDIM # 6B ATTACHMENTS: POLICY, MEMORANDA, CONSENT/ APS OVE BY: REFUSAL FORM, INFORMATION ON HEPATITIS B Attached for your review and consideration is a proposed city policy entitled, "Hepatitis B Vaccine Policy". Adoption of this policy would allow staff to go forward with implementing a Hepatitis B vaccination program for the City's volunteer firefighters, sworn police officers and police reserve officers. Listed below are summaries of the attached exhibits: (1) Exhibit A:G Memo to Council (a) Identifies the need to adopt a Hepatitis B Vaccination Policy due to mandates from OSHA. (b) Rosemount Family Physicians, 15120 Chippendale Ave. would administer the three vaccinations. The total cost would be an amount not to exceed $9,000.00 and would be expended from Account No. 101-41110-01-598, (2) Exhibit B: Information; on Hepatitis B and Aids The intent of this exhibit is to provide Council with information on Hepatitis B. (3) Exhibit C: The "Hepatitis B Vaccine Policy" for Council approval. (4)Exhibit D: Memorandum to Police Officers, Police Reserves & Firefighters If Council adopts the Hepatitis B Policy, this memorandum will ,be furnished to the employees. Also attached to this memo would be the Consent/Refusal form and information on Hepatitis B and the Hepatitis B vaccine. EXHIBIT A TO: Mayor Napper Councilmembers Klassen, Oxborough, Willcox, Wippermann FROM: Susan M. Walsh, City Clerk DATE: March 29, 1991 SUBJECT: Hepatitis B Policy The Federal occupational Safety and Health Administration (OSHA) has directed all employers to evaluate their employees to assess their risk of Hepatitis B infection as it relates to their jobs. If an increased risk is assessed, the employer must offer to those employees the Hepatitis B vaccine at no cost to the employee. Staff has identified sworn police officers, police reserve officers and our volunteer firefighters to be considered "at risk" of Hepatitis B infection. These employees are the city's personnel who perform tasks that put them in direct contact with blood or potentially infectious body fluids, either routinely or in emergency situations. We currently have 33 firefighters, 11 police officers and 4 police reserve officers who are candidates for the Hepatitis B vaccinations. The immunization program is optional. Attached is a consent or refusal form which will be submitted to these employees. I have made arrangements with Rosemount Family Physicians, 15120 Chippendale Avenue to administer the vaccinations. The vaccine is given by injection on three separate dates. The first two doses are given one month apart, and the third dose, 5 months after the second. (0 days, 30 days, 180 days) Six to eight weeks after the third shot, a post -vaccination blood test will be conducted to verify immunity. If this post -vaccination blood test is positive, the Center for Disease Control estimates the vaccine should last for at least seven years. In consultation with Dr. Detlefsen's office, he has advised a blood test be given three to five years after the last injection to confirm immunity status. I propose to have this issue reviewed in three years with Dr. Detlefsen or other medical professionals to determine at what point our employees should be check to confirm their immunity status. If the six to eight week post -vaccination blood test is negative, the employee will be referred to his/her family physician for consultation. There is an overall 4% negative test result rate from the vaccine -- the older the person, the higher the percentage of a negative test result. The attached yellow sheet is information on Hepatitis B which I have taken from a text entitled, "A Curriculum Guide for Public - Safety and Emergency -Response Workers", published by the Department of Health and Human Services, Public Health Service, and Centers for Disease Control. In addition to Hepatitis B information, I have also provided you information on AIDS and how Hepatitis B and AIDS are similar and different. It appears to be very common for people to confuse the two diseases. I have also invited Kathy Tolley, Medical Assistant from Rosemount Family Physicians, to answer any questions you may have regarding the Hepatitis B or the vaccinations. Rosemount Family Physicians is willing to provide the three vaccinations and post -vaccination blood test at a cost of $185.00 per employee. Cost for the vaccine is $155, and the cost for the blood test is $30. This fee would also include pre -vaccination blood screening (blood pressure, medical history, etc.) of each employee. Apple Valley Medical Center provided a quote of $251 per employee, and a company out of Brooten, Minnesota, Am -Care Health, Inc. provided a cost of $230 plus post test. If all 33 firefighters, 11 police officers and 4 police reserves consented to the vaccinations, the total cost would be at this point in time $8,880.00. Of course, if the City employed new firefighters, police officers, or police reserves this vaccinations would be offered. I would like to point out that Rosemount is in the company of several cities in the metropolitan area whose staff have recently learned of their responsibility to provide the vaccine, and who have not budgeted for this cost. It was in 1990 that the Federal OSHA set the standards for compliance, and the Minnesota OSHA became responsible for implementation and enforcement. This ruling first came to my attention in December, 1990 and then again in January 1991 through an article published in the League of Minnesota Cities magazine. Unfortunately, Minnesota OSHA did not inform employers of this new standard, and apparently this standard only came to the attention of some cities through Employee Right -to -Know materials. Although the City could possibly be cited for a "non -serious violation" at this point in time, the City could be cited for a "serious violation" if found in non-compliance once Minnesota OSHA sets the same standards as Federal OSHA in May of this year. Normally the seriousness of the violation (or amount of fine) is based upon the length of time the violator has not been in compliance. I have also learned the National Fire Protection Agency is proposing that all firefighters who are 1st responders be vaccinated against the Hepatitis B virus. 2 Notwithstanding the City's need to meet OSHA standard, the most important element in all of this is the protection of our firefighters, police officers and police reserve officers. In conclusion, I am very aware of the large amount of information I have provided to you on this matter. obviously, I cannot attest to understanding Hepatitis B infection or the Hepatitis B vaccine. I have discussed this item with staff members from other cities and with the health care specialist at Employee Benefit Administration Co. (EBA is the company who administers our worker's compensation program offered through the League of Minnesota Cities). I feel confident in recommending adoption of the policy. Very simply, OSHA rules and regulations require the City, as the employer, to offer the vaccine at no cost to these employees. By adopting the Hepatitis B Vaccine policy, the City will be in compliance, and our police officers, police reserve officers and firefighters can be vaccinated against the Hepatitis B virus. One final note, if you have any medical questions concerning Hepatitis B or the vaccine, I would appreciate your contacting me before the April 2 meeting. I will find out the answers to your questions from Dr. Detlefsen, or refer you directly to him. Kl EXHIBIT B HEPATITIS B INFORMATION What is Hepatitis B? • Hepatitis B is caused by hepatitis B virus (HBV). • Hepatitis B is a disease that causes liver damage, the severity of which can range from mild or even inapparent to severe or fatal. a. Approximately 251/6 of infected individuals develop acute hepatitis. b. Of infected individuals, 6% to 10% will become HBV carriers. Carriers are at risk of developing chronic liver disease, including active hepatitis, cirrhosis, and primary liver cancer, and are infectious to others. How widespread is HBV? • In 1987, CDC estimated the total number of new HBV infections in the United States to be 300,000 per year. • CDC estimates that 12,000 health care workers whose job-related duties involve exposure to blood become infected with HBV each year. a. 500 - 600 health-care workers are hospitalized each year. b. 200 -`300 infected health-care workers die each year from diseases associated with chronic or acute hepatitis caused by hepatitis B. What personal behaviors put you at risk for infection with HBV? • As with the risks for HIV, you can become infected with HBV through sexual contact (anal or vaginal) with someone who is infected with HBV. • You can become infected by sharing drug needles and syringes with an infected person. e Since blood is screened for HBV, the chance of being infected through transfusion is extremely small. What situations put a public safety worker or emergency medical technician at risk? The same situations that cause a worker to encounter blood or other possibly infectious fluids with HIV --that is, by needlestick or contact with an open wound or broken, nonintact skin, or mucous membranes of the eyes, nose or mouth --have the potential for infection with HBV also. e One additional body fluid has the potential for transmission of HBV. Saliva of an HBV infected person injected into another person through a bite can transmit HBV. HEPATITIS B INFORMATION (CONT'D) How can public safety workers or emergency medical technicians protect themselves against HBV? The same protective equipment and procedures that will be discussed for HIV in the rest of this training session will protect the worker against HBV. Are there ways to test blood to determine if a person is infected with HBV? Blood tests are available that detect antibodies for HBV in an infected person. Is there a vaccine against HBV? • Available vaccines provide protection against HBV infections and provide over 90% protection against hepatitis B for 7 or more years. • The vaccines are also 70% to 88% effective when given within one week after HBV exposure. • Hepatitis B immune globulin (HBIG) provides some temporary protection following exposure to HBV. After exposure to the virus, a combination of the vaccine with HBIG is over 90°k effective in preventing hepatitis B. How are HBV and HIV similar? different? Mode of transmission: Blood Semen Vaginal secretion Saliva (from a bite) Target in the body Risk of infection after needlestick exposure to infected blood High number of viruses in blood Vaccine available HBV HIV yes yes yes yes yes yes yes no liver immune system 6-30% 0.5°fo yes no yes no CITY OF ROSEMOUNT POLICY TITLE• POLICY NUMBER• PREPARED BY• DATED APPROVED BY CITY COUNCIL: EXHIBIT C HEPATITIS -B VACCINE POLICY PE - 5 ADMINISTRATION APRIL 2, 1991 PURPOSE The purpose of this policy is to identify those employees who may be at substantial risk of Hepatitis B infection and to implement a Hepatitis B vaccine program for these employees. POLICY Hepatitis B is a viral liver infection which can be debilitating and in some cases fatal. Because Hepatitis B is transmitted through body fluids such as blood, certain groups of people are at a greater risk of infection than others. The Federal Occupational Safety and Health Administration (OSHA) has stated that all employers must evaluate their employees to assess the risk of Hepatitis B infection, as it relates to their jobs. If a substantial exposure risk is assessed, the employer must offer the vaccine to those employees at no cost to the employee. Substantial exposure risk is defined as regular exposure to infectious agents, body fluids, or needle sticks during the course of performing one's job duties. The employees within the City of Rosemount who have been identified at substantial risk of Hepatitis B infection are: * Firefighters * Sworn Police Officers * Police Reserve Officers PROCEDURE Current medical standard require three doses of Hepatitis vaccine. The timeframe of the doses are: one initial dose, a second dose at 30 days and the third dose at 180 days. Any employee who, while on the job, is exposed to blood, body fluids or needle stick exposures is required to: 1. Contact their supervisor as soon as possible. 2. Complete a First Report of Injury Form. If the exposure is found to be a significant exposure, the supervisor will initiate appropriate action. IMPLEMENTATION The City of Rosemount is committed to protecting their employees by providing the vaccine to current members of the above-named groups and to all new members of these groups at the time of employment. The City will also conduct annual vaccination review during open enrollment for employees who wish to receive the vaccination. The City shall implement the Hepatitis B policy upon adoption of this policy. The program shall be administered by the City Administrator's office. Immunization records shalt be retained by the City Clerk. Employees who wish to receive the vaccine shall contact the City Clerk. EXHIBIT D TO: Sworn Police Officers Police Reserve Officers Firefighters FROM: Susan M. Walsh, City Clerk DATE: April 3, 1991 RE: Hepatitis B Vaccinations The Federal Occupational Safety and Health Administration (OSHA) has directed all employers to evaluate their employees to assess their risk of Hepatitis B infection as it relates to their jobs. If an increased risk is assessed, the employer must offer to those employees the Hepatitis B vaccine at no cost to the employee. The City of Rosemount has identified the following employees to be considered "at risk" of Hepatitis B infection in the performance of their job: * police officers * police reserve office * firefighters The City plans to utilize Rosemount Family Physicians, 15120 Chippendale Avenue, Rosemount, MN to conduct Hepatitis B immunization clinics. It is highly recommended that the employees who have been identified as among the at risk groups be immunized against the Hepatitis B virus. Immunization for Hepatitis B is optional. Although it is recommended that employees be immunized, there are exceptions including: persons who have had Hepatitis B; persons who have previously been immunized against Hepatitis B; and persons with severely compromising cardiopulmonary (heart and lung) problems. You may wish to consult your physician prior to being immunized. It is necessary for the City to determine the number of our at risk employees who wish to receive the vaccine. Please complete the attached blue release form, even if you are not interested in obtaining the vaccination, and return it to your Chief by April 15, 1991. e Rosemount Family Physicians will hold an immunization clinic on April 23rd for the first vaccination, and on May 21 for the second vaccination. These dates were chosen to coincide with the Fire Department's meetings in an effort to accommodate most of the firefighters. Firefighter who choose to have their vaccinations on the above dates, will first meet at the fire hall and then go to the clinic in groups. on the two meeting dates, police officers or police reserves can go directly to Rosemount Family Physicians anytime between the hours of 6:30 p.m. and 8:00 p.m. If you consent to the vaccinations and are not available on those dates, you can make your own appointment by calling Rosemount Family Physicians, at 423-4114. Rosemount Family Physicians office hours are: 9:00 a.m. to 5:00 p.m., Monday -Friday, and until 5:30-6:00 pm. on Thursdays. The last date on which you can receive your first vaccination is Friday, May 3rd. If you consent to the vaccinations, it is imperative that you receive your first vaccination by this deadline, or you will not be able to participate in this year's Hepatitis B program. The date for the third shot will be October 22nd, which is also a fire department meeting date. The clinic will be held again. Again, if you cannot receive your third shot on this date, you may individually make an appointment at Rosemount Family Physicians. You will be sent a reminder notice one month's time before this date. In order that we can have an idea how many will receive their shots on April 23rd and May 21, please indicate on the blue Consent/Refusal form whether you will get your shots on the two drill nights or make your own appointments. Please read the attached Hepatitis B Policy and the information sheet entitled "Important Information About Hepatitis B and Hepatitis B Vaccine". If you have any questions regarding the vaccination, please feel free to call me at 322-2002. You may also submit your questions to your appropriate Chief, and we will find out the answers for you. I also urge you to contact your family physician on any questions you may have. CITY OF ROSEMOUNT HEPATITIS -B VACCINE CONSENT/REFUSAL FORM I have read the policy statement and the information sheet about Hepatitis B and the Hepatitis B vaccine. I have had a_chance to ask questions. I have all the information I desire and understand the benefits, risks and possible adverse effects consenting to or refusing the Hepatitis vaccination. I accept those risks. I understand that if I consent to the vaccination I must have three separate vaccinations I understand it is my responsibility to receive the doses according to the schedule. I further understand that the vaccine has been offered to me at no cost. I wish to receive the Hepatitis vaccinations. Name signature Date I prefer not to receive the Hepatitis B vaccine and decline the opportunity to be vaccinated. I'do understand that I may receive the vaccination series in the future at my request. Name signature Date If you consented to receiving the vaccinations, please indicate one of the following: I plan on getting my vaccinations at the clinic on April 23rd and May 21. I shall make my own appointment at Rosemount Family Physicians. IMPORTANT INFORMATION ABOUT HEPATITIS B AND HEPATITIS B VACCINE Please Read This Carefully WHAT IS HEPATITIS B? Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). The term "viral hepatitis" is often used for and may include hepatitis B and other similar diseases which affect the liver but are caused by different viruses. Acute hepatitis generally begins with mild symptoms that may or may not become severe. These symptoms may include loss of appetite, a vague feeling of oncoming illness, extreme tiredness, nausea, vomiting, stomach pain, dark urine, and jaundice (yellow eyes and skin). Skin rashes and joint pain can also occur. In the United States about 300,000 persons, mostly young adults, catch hepatitis B each year. About one-fourth will develop jaundice, and more than 10,000 will need to be hospitalized. About 250 people die each year from severe acute hepatitis B. Between 6 and 10 of every 100 young adults who catch hepatitis B become chronic carriers (have HBV in their blood for 6 or more months) and may be able to spread the infection to others for a long period of time. Infants who catch hepatitis B are more likely to become carriers than adults. About one-fourth of these carriers go on to develop a disease called "chronic active hepatitis." Chronic active hepatitis often causes cirrhosis of the liver (liver destruction) and death due to liver failure. In addition, HBV carriers are much more likely than others to get cancer of the liver. An estimated 4,000 persons die from hepatitis B -related cirrhosis each year in the United States and more than 800 die from hepatitis B -related liver cancer. The risk of catching hepatitis is higher in certain groups of people because of their occupation, lifestyle, or environment. Because of the risks of serious problems associated with hepatitis B infection, vaccination to help prevent infections is recommended for these groups. HEPATITIS B VACCINE: Hepatitis B vaccine is made two ways. Plasma -derived vaccine is made from HBV particles that have been purified from the blood of carriers. The method used to prepare the plasma -derived hepatitis vaccine kills all types of viruses found in human blood, including the virus that causes Acquired Immunodeficiency Syndrome (AIDS). Recombinant vaccines are made from common baker's yeast cells through genetic engineering. The yeast -derived vaccines do not contain human blood products. The vaccine is given by injection on three separate dates. Usually, the first two doses are given 1 month apart, and the third dose, 5 months after the second. After three doses, the hepatitis B vaccine is 85 %-95 % effective in preventing hepatitis B infection in those who received vaccine. An alternative schedule for 4 doses of vaccine given at 0, 1, 2, and 12 months is approved for one vaccine. Protection for normal healthy adults and children given vaccine lasts at least 7 years. Booster doses of vaccine are not routinely recommended at the present time. WHO SHOULD GET HEPATITIS B VACCINE? The vaccine is recommended for persons at high risk of catching HBV infection who are or may be unprotected. These groups include: 1. Persons with occupational risk. Health care and public safety workers who are exposed to blood or blood products or who may get accidental needlesticks should be vaccinated. 2. Clients and staff of institutions for the developmentally disabled. The special behavioral and medical problems of these persons make this a high-risk setting. Risk in institutions is related to contact with blood and also with bites and contact with skin lesions and other body fluids that contain HBV. Clients and staff of group and foster homes where a carrier is known to be present should also be vaccinated. 3. Hemodialysis patients. Although the hepatitis B vaccine is less effective in these patients, it should still be offered to all hemodialysis patients. Higher doses and/or special preparations are required for these persons. 4. Homosexually active men. 5. Users of unlawful injectable drugs. Sharing needles is an extremely high-risk activity for transmitting hepatitis B. 6. Recipients of certain blood products. Persons such as hemophiliacs who received special products to help their blood cloture at high risk of infection. 7. Household and sexual contacts of HBV carriers. When HBV carriers are identified, household and sexual contacts should be offered vaccine. S. Adoptees from countries with high rates of HBV infection. Families with orphans or unaccompanied minors from such countries should have the child checked for HBV carriage, and, if positive, family members should be vaccinated. �. Other contacts of HBV carriers. Vaccine use should be considered in classroom and other day settings were deinstitutionalized developmentally disabled HBV carriers behave aggressively or have special medical problems that may expose contacts to their blood or body secretions. Teachers and aides have been shown to be at significant risk in these settings. Other persons who have casual contact with carriers at schools and offices are at little risk of catching HBV infection and vaccine is not recommended for them. 10. Special populations from areas with high rates of hepatitis B. These groups include Alaskan natives, native Pacific islanders, immigrants and refugees from eastern Asia and sub-saharan Africa, and their U.S. born children. 11. Inmates of long-term correctional facilities. The risk of inmates catching HBV infection may be due to use of unlawful injectable drugs and male homosexual practices. 12. Heterosexuals who come in for treatment of other newly acquired sexually transmitted diseases who have histories of sexual activity with multiple sexual partners in the past 6 months. 13. Persons who plan to travel to areas outside the United States that have high rates of hepatitis B infection, stay in these areas for more than 6 months, and have close contact with the local populations; and, persons traveling for shorter durations who may have contact with blood from or sexual contact with local persons in areas where HBV infection is common. Persons traveling abroad who will perform medical procedures in areas where HBV infection is common are at very high risk. ADDITIONAL VACCINEES: Hepatitis B vaccine is also recommended as part of the therapy used to prevent hepatitis B infection after exposure to HBV. Postexposure use of hepatitis B vaccine is recommended for the following persons: (1) infants born to mothers who have a positive blood test for hepatitis B surface antigen (HBsAg); (2) persons having accidents involving HBsAg -positive blood where there is entry through the skin or a mucous membrane; (3) infants less than 12 months old whose mother or primary caregiver has HBV infection; and, (4) persons having sexual contact with someone who has a positive blood test for HBsAg. The hepatitis B vaccine series should be started at the same time as other therapy, primarily, treatment with hepatitis B immune globulin (HBIG). POSSIBLE SIDE EFFECTS FROM THE VACCINE: The most common side effect is soreness at the site of injection. Illnesses, such as neurologic reactions, have been reported after vaccine is given, but hepatitis B vaccine is not believed to be the cause of these illnesses. As with any drug or vaccine, there is z rare possibility that allergic or more serious reactions or even death could occur. No deaths, however, have been reported in persons who have received this vaccine. Giving hepatitis B vaccine to persons who are already immune or to carriers will not increase the risk of side effects. PREGNANCY: No information is available about the safety of the vaccine for unborn babies; however, because the vaccine contains only particles that do not cause hepatitis B infection, there should 1p no risk. In contrast, if a pregnant woman gets a hepatitis B infection, this may cause severe disease in the mother and chronic infection in the newborn baby. Therefore, pregnant women who are otherwise eligible can be given hepatitis B vaccine.