Untitled Document

Frequently Asked Questions (FAQ’s) re: Pre-entrance Immunization Requirements

Students call with questions about these required immunizations. Before you call your dean’s office or the Student Health Service to ask a question about the pre-entrance immunization program please review the following:)

1. “Why do I need to go through all this?” A: OHSU policy requires it. OHSU is a clinical campus and trainees in the health sciences are epidemiologically the same as health care workers. Even those who are not clinicians but do bench research, or spend all their time in the library are mingling with health care workers who work on the wards and in the clinics.

Employees and students at OHSU are part of a community on Marquam Hill that includes vulnerable patients, some of whom are at high risk because of debilitating disease or even compromised immunity from HIV or treatment, such as chemotherapy or stem cell transplantation. If you are starting a training program in a health science field now, it is likely that after you graduate and go on to further training or employment you will again be required to show immunity to these or perhaps other diseases. The work that you do now to comply with the OHSU pre-entrance requirements will save you time when you have to do it all over again later. The OHSU Student Health Service will maintain your personal immunization information and provide it to you later upon your written request if you need it for such a future purpose.

The CDC (Center for Disease Control) promulgates recommendations for immunizations for health care workers and these are the basis for the OHSU requirements imposed on all students as a condition of enrollment. You may review a summary of these recommendations at the following website: http://www.immunize.org/acip/

2. “My doctor told me I don’t need two tuberculin skin tests.” A: If you have documentation of annual negative skin tests for each of the last five years, including one in the past 12 months, if you provide this documentation you do not need a two step test. Otherwise you do and it does consist of two TB skin tests (TST’s). These must be done at least a week apart, but not more than a year apart. (Read on.)

“I had a quantiferon gold test and it was negative. I was told that is just as good as the TST. Is that true?” A: Some institutions are now using the quantiferon gold test in lieu of TST’s for screening purposes. Although we do not use this test for screening here at OHSU, we will accept the official dated lab report showing a negative quantiferon gold test in lieu of the two step TST. The following year we will require an annual TST as part of routine TB surveillance if you continue as a student at OHSU.

3. “My doctor told me I don’t need two MMR’s.” A: For adequate protection against measles you do. If you were born before 1957 you still need one MMR after 1989. (Although being born before 1957 very likely means you are immune, 27% of the cases of active measles in one survey occurred in health care workers born before 1957.) Alternatively, if you choose, you can have the antibody titer and if it shows that you are immune, you do not need a shot. But you must produce the laboratory report. These three options are detailed on the immune status form.

4. “I sent in the form, is there anything else I need?” A: Please go to the Student Health Service website and review the immune status form and the Plan to Complete form again. All the requirements are there. If you believe that you have a special circumstance, be prepared to be specific when you call with your question, or better, email your specific question to askshs@ohsu.edu . Be sure to identify yourself including which school and class you will be in, and the first day of school. Please do not call with an open-ended question such as “Is there anything else I need?” This requires a RN to find your file, review it on the spot, get back on the phone with you and discuss it.
Our procedure is to review all forms that we receive in an orderly process, and email or call you only if there is a problem. If there is no problem and you have a clear “plan to complete” (if not fully compliant at the time of review) we assign a recheck date corresponding to your plan to complete. At that recheck date, if we do not have your completed data, we will have to contact you to find out from you where you stand with the pre-entrance immunization requirements and will report to the school that you are not
compliant. If at the initial review, all requirements are met, we report to your school that you are compliant.

5. “If I was born or lived in a foreign country where hepatitis B is endemic, should I have a hepatitis B surface antigen test?” A: If you were to get the hepatitis B surface antigen (a test for the carrier state for the Hepatitis B virus) and it were negative, you would still need to proceed with the 3 shots and the titer. However, before getting the shots, since in your case there is a high likelihood that you may have had the disease and are immune (even though you do not know whether you had the disease) getting the Hepatitis B surface antibody test and the Hepatitis B core antibody test might be useful if it did reveal you already had had the disease and are immune. In other words, if these tests were positive, showing immunity, you could check on your immune status form that you have had the disease (the number 2 criterion) and that you have had the titer and are immune (number 3 criterion.) However, it would not be useful if, having done this, the tests were negative, showing that you are not immune. Then you would still need to proceed to getting the 3 required shots (number 1 criterion) followed by the titer (number 3).
Discuss these things with your personal physician or health care provider or public health officer if you need help with these concerns.

6. “I had my first hepatitis B shot and then had the antibody titer and it showed immunity. Do I still need all 3 shots?” A: Yes. Ordinarily for health care workers we do not do pre-immunization serologic screening (see above #5 for a possible exception). In the case that you have already started your shots, we do not know whether the antibody response is to that shot or prior disease. The immunity from only one or two shots is not lasting, and three shots are required. You should complete the series

7. “I am supposed to have a booster for tetanus/diptheria in the last ten years. Is this the same as a Td?” A: Yes. See next item.

8. “What about the new Tdap shot? Should I get that instead of a Td?” A. Yes, this is a new and effective and safe replacement for the Td that also provides protection against pertussis. If you are due for a Td booster and haven’t had a Tdap, you should get the Tdap.

You can learn more about this vaccine at the following website: http://www.cdc.gov/nip/vaccine/tdap/default If you are not yet due for a Td booster, a clinical teaching rotation may recommend or require a Tdap shot because of concern for vulnerable patients, such as infants under 12 months, or immuno-suppressed patients, particularly if there has been pertussis in the community. The CDC now says that such health care workers should have Tdap down to only two years since the last Td booster. Also, there are circumstances in which even shorter periods than 2 years might be recommended. At this time, the Student Health Service will provide Tdap for those students who are otherwise up to date with pre-entrance requirements, who are required by these rotation site administrators to have the Tdap and have not already had it.

8. “Why is polio not on the list?” A: At the present time, polio is not on the list of diseases for which vaccination is recommended for health care workers because it has been contained to very well-defined and very limited regions of the world. However, there is a question about the long term control of this disease, and it may return to the list at some time in the future. Also, because health science students these days often travel in the course of their studies to far-flung areas of the globe, it may be recommended for certain itineraries, so it would be a good idea to document if you have had and when you have had polio immunization.

9. “What shots can I get at the Student Health Service?” A. Your pre-entrance requirements are “pre-requisites” and must be met at your own expense. If you wait until you arrive at OHSU to get these done after you begin your training, you will risk not being able to start a clinical rotation because these are incomplete and you may be excluded from required clinical training until they are complete. Also, you will have to pay charges that are similar and likely greater than you would pay in your community or at the public health department in your community. We urge you to get these done as early as possible and before you start your program at OHSU.

10. “Mumps vaccine is now required, but the information I got earlier (before June, 2006) didn’t indicate mumps. Why are you adding this requirement?” A. In early 2006 there have been significant outbreaks of mumps in Oregon and the rest of the US . This places the entire OHSU community, including vulnerable patients, at risk. In mid-May, 2006, the Advisory Committee on Immunization Practice recommended a higher level of protection for health care workers than was previously the case. Because of the current outbreaks, it was felt necessary to add this requirement immediately as a pre-entrance requirement for students entering fall term, and this has been done as of June 7, 2006, with a communication from their specific program administrators to all new OHSU students entering fall term, 2006. Most students will have had two MMR shots as their method of meeting the measles recommendation, and thus are already satisfying the mumps requirement with these two shots. However, some may have met the measles requirement in a different manner, or do not have documentation of their MMR’s, so may need to get the antibody titer showing immunity to mumps, or may decide to get two mumps live virus vaccine shots, or two MMR shots to meet this new requirement.

11. “I am one of the entering students who has had a positive TST. What can I expect at the required appointment at the Student Health Service within two weeks of my starting my academic program at OHSU?” A: It depends on your circumstances. If you had BCG vaccination as a child we may obtain a quantiferon gold test to help us ascertain if this was a false positive TST. This would be at your cost and currently costs about $50.00 if we draw it here and send it to the Oregon State Public Health Laboratory. If your TST was a conversion from negative to positive, then we would proceed to evaluate to see if you have active TB, healed TB, or latent TB. The first step would be a chest X-ray. If you know you have such a circumstance, you should have a PA chest X-ray and bring the printed report from the radiologist with you to that appointment. If you have latent TB we recommend a program of antiTB medication (isoniazid) daily for 9 months in a standard protocol that is known to markedly reduce the likelihood of conversion to active TB. If you have already gone through such a treatment program elsewhere, you will be asked to obtain written proof of that treatment by requesting such records from the treating doctor, clinic, or public health agency.

In the course of your training at OHSU, once you have met all the pre-entrance requirements, you will subsequently be provided an annual TST, a Tdap booster as needed, at no charge. If you need other vaccines or titers not required at OHSU for travel in another country or to go on to subsequent training these will be provided but there will be a charge for them as well.

Immunization FAQ06072007.htm