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.