Centre for Occupational Health
Norfolk & Norwich University Hospitals Foundation NHS Trust
OHP 2c - Procedure for Immunisation Assessment
1. Introduction
1.1 This procedure should be used in conjunction with the following Norfolk &
Norwich University Hospital Trust Guidelines:
Hepatitis B protection for Health Care Workers and guidance relating to
Exposure Prone Procedures

Varicella Zoster vaccination for Health Care Workers

Trust Guideline for the Immunisation of new and existing health care workers

Trust Guideline for the Prevention of TB & Management of TB exposure in
HCWs
1.1 This procedure is designed to ensure that all Occupational Health Advisers
(OHA) undertake an immunisation and vaccination check correctly in order to protect
health care workers from contracting occupational acquired disease and to establish
accurate details of the immunity of all health care staff.
1.2 All vaccinations are administered in accordance with the Trust Nursing Policies
and Practice.
All OHAs must have signed a Patient Group Direction before
administering any vaccination.
1.3 All information relating to immunisations is taken from the Dept of Health
Immunisation against Infectious Disease 1996 and the 2005/6 updated chapters.
2. Handling and Storage of Vaccines
2.1 Ordering
It is the responsibility of all OHAs undertaking clinics to assess vaccine stock levels
at the end of each clinic and to order further vaccines from the pharmacy as
appropriate using the pharmacy order book which can be located in the surgery at
NNUH. On completion of the stock order form please remove the yellow sheet only
and take to pharmacy. Do not take the order book to pharmacy.
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2.2 Receipt of Vaccines
OHAs are responsible for the collection of vaccines previously ordered from the
pharmacy, for checking the order for discrepancies, leakage or damage and for
recording the date of receipt, vaccine types, quantities, batch numbers and expiry
dates on the relevant label and sticking it in the pharmacy order book with the
corresponding order counterfoil. Vaccines must be refrigerated immediately on
receipt and must not be left at room temperature. Please document on the order
counterfoil the time frame between delivery and refrigeration i.e. refrigerated
immediately or refrigerated within 15 minutes etc.
2.3 Storage of vaccines
All vaccines are Prescription Only Medicines (POMs) and must be stored under
locked conditions. Refrigerators must either be lockable or within a room that is
locked when not occupied by a member of staff. At NNUH the refrigerators must be
locked at the end of the day and the keys locked in the filing cabinet in the office. At
Rouen Road the refrigerators must be locked at the end of the day and the keys
placed in the key box in the main office.
Vaccines must be kept in their original packaging when stored, so that they retain
information on batch numbers and expiry dates. The packaging is also part of the
protection against light and changes in temperature.
Refrigerators must be of pharmaceutical grade and temperature controlled. It is the
responsibility of the duty nurse to checked and record the refrigerator temperature at
the start of every day on the monitor charts located on the fridge door. All vaccines
are sensitive to some extent to heat and cold. Heat speeds up the decline in potency
of most vaccines, thus reducing their shelf life. Effectiveness cannot be guaranteed
for vaccines unless they have been stored at the correct temperature. Freezing may
cause increased reactogenicity and loss of potency for some vaccines. It can also
cause hairline cracks in the container, leading to contamination of the contents.
Vaccines must not be stored in the door, in the bottom drawers or adjacent to the
freezer plate of the refrigerator. If there are temperature variations outside of the
recommended +2˚C to +8˚C range, they usually occur in these parts of the
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refrigerator. Sufficient space should be allowed in the refrigerator so that air can
circulate freely. Ice should not be allowed to build up within the refrigerator, as this
reduces effectiveness.
Annual portable appliance testing (PAT) is performed by the Trust Clinical
Engineering team.
Cleaning of the inside of the fridge should occur on a monthly basis and be recorded
on the temperature monitoring form.
In the event of a refrigerator failing, vaccines will be transferred to one of the other
Occupational Health refrigerators, labelled/marked to ensure that they are used first.
If the failure cannot be identified as occurring within the last 24 hours i.e. over a
weekend or public holiday please seek advice from pharmacy prior to disposing of
the vaccines.
Validated cool boxes (with maximum – minimum thermometers) and cool packs from
a recognised medical supply company should be used to distribute or transport
vaccines. Individual manufacturers’ instructions should be strictly adhered to.
Vaccines must be kept in the original packaging, and placed into a cool box with cool
packs as recommended by the manufacturer’s instructions.
2.4 Disposal of vaccines
All reconstituted vaccines and opened multi-dose vials must be used within the
period recommended by the manufacturers and disposed of at the end of an
immunisation session by sealing in a ‘sharps’ box. Any out of date stock should be
returned to pharmacy for disposal and a record of this should be inserted on a yellow
pharmacy order form and identified clearly as returned stock for disposal.
2.5 Anaphylaxis
All health professionals responsible for immunisation must attend annual training
sessions for resuscitation and the recognition and management of anaphylaxis. An
anaphylaxis pack containing two ampoules of adrenalin 1:1000, four 23G needles
and four graduated 1 ml syringes and oxygen must be available whenever vaccines
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are given. In the event of anaphylaxis 0.5 ml of the adrenaline should be
administered intramuscularly and repeat after 5 minutes if no improvement in
symptoms. Please see Appendix F for anaphylactic reactions and treatment flow
chart.
All OHAs undertaking vaccination must be familiar with the procedure for contacting
the emergency services relevant for that area.
3. The Purpose of Immunisation
3.1 To protect Health Care Workers (HCW) from any occupational risk of contracting
communicable disease that is preventable by vaccination.
3.2 To protect patients and colleagues from acquiring vaccine preventable disease
from an infected HCW.
4. Definition of HCW
4.1 HCWs who work within a healthcare setting may be directly or indirectly involved
with patient care. For the purpose of occupational risk the following categories of
HCWs are defined as:

New HCW – these people are individuals who are commencing a post for the
first time within the NHS and having patient contact, Commencing a post (or
training) for the first time that involves EPP procedures or individuals that are
returning to work in the NHS after a break.

New HCWs who have previously worked in another NHS Trust but had
continuous service – to be known as ‘Continuous Service New HCW’

Laboratory workers and other staff who have direct contact with potentially
infectious clinical specimens and may be exposed to pathogens in the
laboratory.

Non clinical staff who may have social contact with patients but not usually of
a prolonged or close nature ( e.g. ward clerks, porters, cleaners, admin staff in
ward / department areas, maintenance engineers, cleaners)
If a job change occurs the immunisation status of an individual should be reviewed to
ensure it meets their specific requirements.
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5. Prior to Immunisation and Vaccination update
5.1 All health care staff will have their immunity and vaccination history updated in
accordance with this procedure.
5.2 All HCW immunisation status will be reviewed when undertaking the preemployment health screening procedure (see OHA 2a). Depending on the post
applied for will depend on what immunisation will be required.
5.3 Those roles which require EPP procedures or are considered to be in areas of
high risk to TB are required to have their immunisations updated prior to their
commencement of employment unless all documentary evidence has been provided.
6. Immunisation and Vaccination Update
6.1 All immunisation and vaccination information must be reviewed, updated and
entered onto the green immunisation form / entered onto the NOHS database.
6.2 If vaccines are administered then the vaccine administration form for that
particular vaccine should be completed and signed by the Occupational Health
Adviser with appropriate consent gained from the individual agreeing to have the
vaccination.
6.3 The Occupational Health Adviser must ensure all staff are assessed and comply
with the mandatory immunisation requirements of the healthcare post.
6.4 If an individual refuses to have the vaccination then their manager and HR
manager for their divisional area should be informed via email.
6.5 If an individual cannot have the vaccination due to a permanent contra-indication
then the file should be passed onto the Senior OH Physician who will advise on the
most appropriate course of action.
7. Chicken Pox
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7.1 All staff who have contact with patients must have their immunity to Varicella
assessed and immunisation offered to those health care workers who are not
immune. Particular attention should be given to those who work in high risk clinical
areas

Oncology

Haematology

Rheumatology OPD

Genito urinary medicine

Paediatrics

Obstetric and Neonatal Intensive Care
7.2 Immunity will be assessed as follows:
A definite history of having the disease unless they are HCW who has arrived
from a tropical country regardless of history when serological testing will be
required.

A definite history of shingles

Documentary evidence of x2 doses of Varicella Zoster Virus vaccine.

If the employee is unsure regarding their immunity the OHA must take a
sample of blood for VZV antibody to confirm current immunity status (yellow
bottle and sent to Trust Microbiology).
7.3 All healthcare workers who are not immune to Varicella will be offered the
chicken pox vaccine.
See Trust guideline on the management of varicella zoster for health care
workers. See Appendix A
8. Measles Mumps Rubella (MMR)
8.1 All staff who work in clinical areas must have their immunity to Measles, Mumps
and Rubella assessed and immunisation offered to those health care workers who
are not immune.
8.2 Immunity will be assessed as follows:-
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
Documentary evidence of having received two doses of MMR

Positive antibody test for Measles, Mumps and Rubella.

History of the disease is NOT evidence of immunity
8.3 If vaccinations are refused then both the manager of the area and HR Divisional
manager need to be informed. A serology test for rubella and measles should be
taken. If this is negative then it may be necessary to place restrictions on working in
certain areas.
8.4 Staff with a known or suspected latex allergy can have the vaccination however
the MMR powder should be diluted with water for injection not the reconstitution
solution and a 2ml syringe used in place of the syringe provided. The needle should
be changed after diluting the powder prior to administering the vaccination.
8.5 If the individual has a permanent contra-indication that prevents them from
having the vaccine, then a serology test for rubella and measles should be taken. If
this is negative then it may be necessary to place restrictions on working in certain
areas.
9. Polio / DTP
6.1 All Staff who may be exposed to polio in the course of their work in microbiology
laboratories and clinical infectious disease units are at risk and must be protected.
The Department of Health 2006 states that a total of five doses of vaccine at the
appropriate intervals are considered to give satisfactory long term protection.

Staff regularly handling faecal specimens should be offered a polo booster
every 10 years.
10. Pulmonary TB
10.1 Evidence of Immunity
As indicated by one of the following: 
Documented positive tuberculin test (a grade 2 or more Heaf Test or greater than
6mm Mantoux test) in the previous 5 years.

Evidence of a BCG vaccination resulting in a pale, flat, circular scar.
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
Documentary evidence of a BCG vaccination. See OHP 5
If no evidence of scar refer for Mantoux +/- BCG appointments.
7.2 High risk areas where staff would require documentary evidence of immunity /
scar check by an OH professional prior to employment are described in OHP 5
11. Hepatitis B
11.1 Staff working in a Clinical Environment or who come into contact with
blood and body fluids
Staff who will come into contact with blood and body fluids will be advised to
commence a course of Hepatitis B vaccinations which can be administered by the
Centre for Occupational Health.
11.2 Hepatitis B vaccination programme
Vaccine:
Hep B VaxPro 10 micrograms.
Engerix B (vial) may be used if staff are sensitive to Latex, this will
need to be ordered through pharmacy.
Route:
Intramusular injection into deltoid muscle
Frequency: Primary course of three doses at day 0, 1 month and 6 months followed
by a blood test to check the anti-HBs titre level 8 weeks after the third
vaccine has been administered.
NB: When taking blood for an antibody level, ensure that consent is gained
from the individual to undertake a Hep B Surface antigen and Hep B Core test
on the blood if their response to the vaccination is <10 miu/ml.
11.3
In special circumstances (e.g. if a staff member had not been immunised and
had a blood exposure incident or if a staff member is starting in employment and
doing a high level of EPPs or working in area that is considered high risk for Hepatitis
B and has no immunity) an accelerated course may be used (0, 1, 2, 12 months).
11.4
Eight weeks after the third dose the HCW should attend the COH for a blood
test to measure their antibody response to the vaccine (anti-HBs titre). The
significance of the results and actions required (DoH recommendations) are as
follows:
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Optimal response (>100 mIU/mL). A single booster is required after 5 years
without reassessment of titre.
Poor response (10-100 mIU/mL). An additional booster dose is required and
the titre must be repeated in 8 weeks. If the repeat Titre is satisfactory then a
further single booster is required at 5 years without reassessment of titre.
Non-responder (<10 mIU/mL). Confirm if Hep B Surface antigen and Hep B
core antibody is negative – if so repeat the full course of 3 vaccinations
followed by a titre at 8 weeks. If the level remains at <10 mIU/mL then the
individual is defined as a non-responders.
If level >10 mIU/mL they will
require 5 year booster (as above).
o If level remains <10 miu/ml then will be classed as a non- responder.
o If the HBsAg and / or Hep B Core level is positive, then the file must be
passed to a SOHNA / OH Nurse manager so that further testing can be
instigated (see section 8.6 + Appendix D for further advice).
o If the level becomes >10 miu/ml then the individual will require a 5 year
booster as above.
11.4.1 If the OHA receives or makes a telephone call to an individual employee
regarding their Hepatitis B status (e.g. to inform / explain poor response / seek
consent for HBsAg / HB Core tests or outcome of further tests) then this should be
logged on the NOHS system as a journal entry – under the drop down box title ‘Hep
B Telephone Call’. If however, the nurse is contacting a specific external company to
provide a general update of where employees are on their course and
recommendations of those needing to attend further appointments this will be
included in the Hep B course pricing.
11.5
HCWs who have been previously immunised but have no record of immunity
status should have an anti-HBs titre undertaken and if indicated by the risk
assessment performed by COH, given a booster dose of vaccine. If the level is
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returned <100 miu/ml then a repeat antibody test will be performed at 8 weeks post
vaccination.
11.6 Heptiatis B Surafce antigen or Core antibody positive results
8.6.1 If the HBsAg and / or Hep B Core level is positive, the file must be passed to a
SOHNA / OH Nurse manager so that further testing can be instigated (see Appendix
C for further advice).
11.6.2 Where appropriate ensure that the laboratory is proceeding to undertake the
Anti HB Core IgM, HB e antigen and HB e antibody tests to assess the level of
infectivity. Consideration should be given as to whether the worker is involved in EPP
activities – see OHP 3 for guidance on restriction of these activities when Hepatitis B
positive and further testing that is required.
11.6.3 On receipt of the results, it is vital that the individual is seen by an OHP so that
information can be given as well as appropriate referral made to GP or Hepatologist.
If the employee is an EPP worker viral load testing may need to be undertaken. EPP
activity may also need to be suspended.
11.6.4 The SOHNA must ensure that the results are inputted into NOHS system and
the appropriate description of infectivity is given (see appendix D).
11.6.5 A 6 monthly report should be pulled from NOHS on all Hepatitis B positive
employees within the contracts that are covered. These employees should be
contacted to identify if they have remained in the same place of work and also offer
general support. This conversation should be logged in their records and followed up
with an OHP appointment if their circumstances have changed.
12.0 EPP
Members of staff must provide evidence of a United Kingdom accredited laboratory
result indicating Hepatitis B antibody level and Hepatitis B Surface antigen and where
appropriate Hepatitis C antibodies and HIV antibodies and antigen. The OHA should
use the ‘Consent form for Hep B, C and HIV Bloods / EPP Bloods’. This form
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incorporates the Pre-test discussion issues that need to be considered when
undertaking these tests.
See procedure for EPP clearance.
13. Hepatitis C and HIV tests for non-EPP workers
13.1 All HCW commencing employment should be offered an opportunity to have
Hepatitis C and HIV testing.
13.2 The OHA can offer this test when undertaking the immunisation assessment
and should use the Consent form for Hep B, C and HIV Bloods / EPP Bloods. This
form incorporates pre-test discussion issues that need to be considered when
undertaking these tests.
14. Tetanus
14.1 Staff whose work involves contact with soil i.e. gardeners, maintenance workers
will be advised to ensure they are protected against tetanus. Staff will be advised to
attend their General Practice for this vaccination to be administered
14.2 The Department of Health recommends the following vaccination programme:
A primary course of three doses of 0.5ml adsorbed tetanus vaccine one month
between each dose. A reinforcing dose is recommended after the primary
course and again ten years after that. There is little justification for boosting
with tetanus vaccine beyond the recommended 5-dose regimen.
15. Audit
15.1 This procedure will be audited as indicated by the Centre for Occupational
Health. All results will be discussed with the team and changes in practice
implemented where needed in line with current best practice.
16. Process for Development
16.1 This procedure has been agreed by the Occupational Health Team and is
reviewed regularly.
17. Dissemination
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17.1 Copies of this procedure will be held in the Centre for Occupational Health in a
computerised format.
References
Department of Health (2005) Immunisation against Infectious Diseases
Health and Safety Executive (2002) Control of Substances Hazardous to Health
Regulations.
http://www.hse.gov.uk/healthservices/index.htm
Department of Health (2006) .Immunisation Against Infectious Disease 3rd edition,
(“Green Book”)
http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_
4097254
Department of Health (2007) Health clearance for tuberculosis, hepatitis B, hepatitis
C and HIV: New Health Care Workers
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_073132
Department of Health (2007) Hepatitis B infected healthcare workers and antiviral
therapy.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_073164
Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. (1998)
Guidance for Clinical Health Care Workers: Protection against infection with Bloodborne viruses. (HSC 1998/063)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAnd
Guidance/DH_4002766
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European Consensus Group on Hepatitis B Immunity. (2000) Are booster
immunisations needed for lifelong Hepatitis B immunity? Lancet; 355: 561-565
NHS Management Executive HSG (93)40, Protecting Health Care Workers and
Patients from Hepatitis B addendum Sept 96 (EL(96)77) Sept 96.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthserviceg
uidelines/DH_4084234
Depart of Health (2000) HSC 2000/020 Hepatitis B infected Health Care Workers.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthserviceci
rculars/DH_4004553
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Appendix A
Assessing Immunity to VZV + Indication for Vaccination
Does the Health Care Worker (HCW) have a
definite history of VZV infection(chicken pox or
shingles) or documented evidence of x2 doses
of varicella vaccine?
Yes
Have they come to the UK from a
tropical country?
No
No
Yes
Consider Immune
No further action
required
VZV antibody test
Antibody test result
positive?
Yes
No
Are they immuno-compromised e.g
steriods / HIV / cancer treatment etc?
Yes
No
Vaccination is contraindicated
unless immunosupression
resolves
Is this a female member of
staff?
Yes
No
Offer vaccination
Slicylates should be avoided from time
of 1st dose to 6 weeks post 2nd dose.
2nd dose should be given 4-8 weeks
after first dose
Pregnancy should be avoided for 3
months following each vaccination.
Are they pregnant or
suspect they might be?
No
Yes
Occ Health
Defer vaccination until
pregnancy finished or
pregnancy is not
confirmed
Routine Follow up
serological testing is not
routinely required.
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HCW
If rash develops post
vaccination see
Occuaptional Health
prior to patient contact
09/02/2016
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Appendix B
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Quick Reference Guideline - Occupational Health pre employment standard and additional health clearance checks for New HCWs
ALL NEW AND EXISTING HCWS UNDERTAKING EPPS MUST BE SEEN BY OCCUPATIONAL HEALTH (OH) FOR ADDITIONAL HEALTH CLEARANCE CHECKS PRIOR TO
EMPLOYMENT UNLESS IVS DOCUMENTED EVIDENCE IS AVAILABLE
ALL NEW & EXISTING HCWS MUST BE SEEN BY OH WITHIN THE FIRST WEEK OF EMPLOYMENT TO UNDERTAKE STANDARD & ROUTINE HEALTH CLEARANCE CHECKS
UNLESS IVS DOCUMENTED EVIDENCE IS AVAILABLE
New Health Care Worker (NHCW)
1.First time with direct patient contact
2.New to post or training involves EPPS
3.Returning to work following a break
( OH to assess)
Direct Patient
Contact &
undertaking EPPS
Additional Health
Clearance Check
to be undertaken prior to
employment
1.HIV antibody
2.Heb B surface antigen&
antibody
3.Hep C antibody
Standard Health
Clearance Check for
1.TB
2. Hep B clearance as
above
Routine Immunisation
Check
1. VZV
2. MMR
3. Advise on Diphtheria.
Tetanus and Polio
Direct Patient
Contact & NOT
undertaking EPPS
Standard Health
Clearance Check
within first week of
employment
1.TB ( if in high risk
area clearance
required prior to
employment)
2. Advice on Hep B
3. Offered test for
Hep C & HIV
Routine Immunisation
Check
1. VZV
2. MMR
3. Advise on Diphtheria.
Tetanus and Polio
New Health Care Workers
who have previously worked in an
NHS Trust-continuous service
Direct Patient Contact &
undertaking EPPS
Direct Patient Contact &
NOT undertaking EPPS
Additional Health Clearance
Check to be undertaken prior to
employment
1. Hep B surface antigen &
antibody
2. Hep C - antibody ( if
commenced EPPs after Jan 2003
3. HIV antibody ( if commenced
EPPs after 2008)
4. If HCW has been undertaking
EPPs prior to Jan 2003 HCW
must be offered a test for Hep C &
HIV. Mandatory Hep C & HIV not
required
Standard Health
Clearance Check
1.TB (if in high risk
area clearance
required prior to
employment)
2. Advice on Hep B
3. Offered test for
Hep C & HIV
Standard Health Clearance
Check
1. TB
2. Hep B clearance as above
Routine Immunisation Check
1. VZV
2. MMR
3. Advise on Diphtheria. Tetanus
and Polio
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Routine Immunisation
Check
1. VZV
2. MMR
3. Advise on
Diphtheria. Tetanus
and Polio
09/02/2016
Ref (3)
Laboratory Workers
including non
technical staff
Regularly handle
pathogens or
potentially infected
specimens
Standard Health
Clearance Check
1.TB ( if in high risk area
clearance required prior
to employment)
2.Advice on Hep B
3. Offered test for Hep C
& HIV
Routine Immunisation
Checks
1. VZV
2. MMR
3.Advise on Diphtheria.
Tetanus and Polio
following risk
assessment and advice
from manager
Non Clinical
Health Workers
Social contact with
patients e.g ward clerks
porters & cleaners
Standard Health
Clearance Check
1.TB ( if in high risk
area clearance
required or work
involves social contact)
2. Advice on Hep B
Routine Immunisation
Checks
1. VZV
2. MMR
3.Advise on Diphtheria.
Tetanus and Polio
Centre for Occupational Health
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Appendix C
Action required on obtaining an anti-HBs level of <10
mIu/ml
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Appendix C - Action on obtaining an anti-HBs level of <10 mIu/ml
Hep B Antibody taken. Result<10 miu/ml
Request lab to undertake Hep B Surface
antigen (HBsAG) + Hep B Core (HB Core)
No
HBsAG positive?
Yes
File to Senior OH
Nurse Adviser
(SOHNA)
HB Core
positive?
No
Yes
Repeat primary course (if
approraite) or confirm
True Non reponder
No requirement for Anti
core IgM or e status tests
as not currently infectious
Ensure lab are undertaking
Anti HB Core IgM
HB e antigen
HB e antibody
to assess level of infectivity
Profile = immune following
previous infection.
No further action unless patient
becomes immunosuppressed
No
EPP worker?
Arrange for DNA viral load
tests to be undertaken.
2 samples one week apart
(see seperate flow chart for
specific EPP guidance)
Results back to SOHNA
Yes
No
Anti HB Core IGM Positive?
(showing recent infection)
Yes
No
HB e antigen positive
and Anti HB e
Negative?
HBe antigen positive and
Anti HB e negative
No
Yes
HBe antigen positive
and Anti HB e negative
HB e antigen
negative and AntiHB
e positive?
Yes
HB e antigen negative
and AntiHB e negative?
Yes
Yes
Profile = Recovery of
infection
High risk of infectivity.
Repeat blood test in 4
weeks Referral ASAP to
Heaptologist
No
Profile = Acute infection
High risk of infectivity.
Repeat blood test in 2-3
months
Profile = Chronic infection.
High risk of infectivity
Profile = Chronic infection.
Risk of infectivity
Book OHP appt for referral to hepatologist / inform
primary care practitioner
U/procedures & Competences/OHA procedures/pre employment/immunisation
Date of issue July 2004
Update Feb 2009 Review due March 2010
Profile = Possible Chronic
Infection
Risk of infectvity
Repeat blood test in 4 weeks to
ascertain whether
seroconversion has occurred
09/02/2016
Ref (3)
Centre for Occupational Health
Norfolk & Norwich University Hospitals Foundation NHS Trust
Appendix D
Nohs Profile Table
U/procedures & Competences/OHA procedures/pre employment/immunisation
Date of issue July 2004
Update Feb 2009 Review due March 2010
09/02/2016
Ref (3)
Centre for Occupational Health
Norfolk & Norwich University Hospitals Foundation NHS Trust
Outcome of results profiles for Hepatitis B
HBsAg
Anti-HBs
Anti-HBc
Anti-HBc IgM
HBeAg
Anti-HBe
Negative
Positive
(rarely
negative)
Positive
Negative
Not Required
Not
Required
Positive
Negative
Positive or
Negative
Positive
Positive
Negative
Positive
Negative
Positive
Negative
Positive
Negative
Positive
Negative
Positive
Negative
Negative
Positive
Negative
Positive
Positive
Negative
Negative
Positive
Negative
Positive
Positive
Negative
Positive
U/procedures & Competences/OHA procedures/pre employment/immunisation
Date of issue July 2004
Update Feb 2009 Review due March 2010
09/02/2016
Ref (3)
Positive
Centre for Occupational Health
Norfolk & Norwich University Hospitals Foundation NHS Trust
U/procedures & Competences/OHA procedures/pre employment/immunisation
Date of issue July 2004
Update Feb 2009 Review due March 2010
09/02/2016
Ref (3)