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Medical Pre-Matriculation Vaccination Requirements and Non-Responder Status

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Oct 14, 2011
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I got my pre-matriculation packet recently. Expecting this I got IgG's done on the commonly requested vaccine series. I have no response for HepB and Varicella ( vaccinated for varicella and experienced breakthrough infection after, so i'm not surprised I guess). The school says they "require" proof of adequate immunity for HepB. I'll be repeating both vaccine series, hopefully in time for the deadline, however, how do schools typically handle non-responders when they say they "require" an antibody response and it cannot be achieved? Specifically in regards to HB? (HBsAg negative, so it is not because of acute/chronic infection)

Similarly, they ask for full disclosure on all medications I take and medical conditions. I have some medical conditions that won't affect my technical or mental abilities, but create a medication list that might... raise eyebrows (benzodiazepines, opiates, amphetamines, barbiturates, heart medications etc). Will they discriminate based on this? I know they *will not* discriminate by their standards or openly, but I fear the more silent discrimination from it. Would it be better I leave some information out and not disclose the myriad of annoying medical conditions I experience and keep it bare minimum to explain the meds that would show on a drug screen? (no mental health issues on that list, other than ADD technically)
Since you have already been accepted, these questions can best be answered by your student health services office (which should keep those records for the entire university). That information should remain confidential except for those who have to know in the medical school. You will likely have to be drug tested prior to working in clinics or schools, so it's good to know what would likely be positive due to a prescription.

I would also check if your university administers HepB series vaccines. If it is required, the University should pay for it. Again, student health services is the go-to office.
 

gutonc

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Okay, thank you, I'll send an email.

Also, how are health care professionals that are non-responders to the HepB vaccine series handled in the medical field? Just considered higher risk and advised not to work with known HepB patients?
The important thing to understand here is that these Occ Health requirements are in place solely for the liability protection of the school/hospital, NOT in any way to protect any specific individual student/employee/patient. So they don't really care if you're a responder or have immunity or not, as long as they can check a box on your file that will keep the lawyers at bay.
 

lord999

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Well, as you say it is up to the practitioner to be up to date. My point is that if the practitioner is a vaccine non-responder and physiologically cannot develop an immune response despite multiple attempts, they are not, "not up to date" (sorry double negative). So the practitioner is not negligent and is following policy.

I have heard of the restrictions you mentioned, but I've heard of them in the opposite case - where the practitioner has HepB and the risk of transmission in certain fields (from physician to patient) is high, such as surgery or OB/gyn and therefore they are not suited to those specialties. I have not heard of discrimination against immunocompromised physicians in a way that affects their ability to practice any specialty, just that there is (obviously) a higher conferred risk and they may be reassigned to areas with lower risk.

Pardon my wording. I meant that the practitioner are "up-to-date" with the attempt (so if you titer negative but did not have a recent vaccine challenge, you do it, but if you have had a challenge, the attempt is valid).

Yes and no on the restrictions. Hopefully, they work out that way, but there have times where it was a forced reassignment. It is not discriminatory in either way, but if you cannot meet the minimum performance due to an inability to practice in an environment, ADA accommodations may include reassignment (and that is much less benign than lower risk). Again, I worded it a bit poorly. It is not negligent on the part of the institution though if you titer negative yet get assigned to the area if that is part of the normal rotation of practitioners unless it is known that the patient is at risk.

Here is a way to think of the difference. If you cannot meet ever titer positive from a HepA challenge, you probably will not be assigned to any HepA patients diagnosed without being forewarned in the clinical system or without PPE. But, that does not go so far as to keep you from being assigned to ER duty, which you might very well get an acute case of Hep that is undiagnosed until you figure it out, but that is not a planned matter nor is it unexpected in that environment. You still have to work with it.

This applies to diseases like tuberculosis. For an asthmatic like me, this is especially risky, and so if I am to be assigned to care for them, I need to know that to get the right PPE on. But, if I work ER, I really could run into a TB patient and get infected. That is not negligent behavior on the hospital's part. It would be if the hospital knew that the patient was TB but was not put in an acceptable standard of care environment for treatment if reasonably possible and then assigned me to that patient without knowledge or protection.

In fact, in almost all cases, the training is that everyone is sick with a contagious disease until proven otherwise in certain practice settings. We do HIV PEP when we have an unknown, unconscious patient show up and accidentally stick ourselves. They probably do not have HIV, but until you know that, you do take on the known risk of doing PEP until you can establish that.

Thank you, that clarifies what I was confused about. My greatest worry is obstruction from certain specialties. I am particularly interested in surgery, but I suppose I'll just have to see. Thank you for the explanation and your time.
 
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