May 3, 2000

Christopher S. Taylor, M.D.
Deputy Regional Flight Surgeon
Federal Aviation Administration
Aviation Medicine
1601 Lind Avenue, S.W.
Renton, Washington 98055-4056

Dear Dr. Taylor:

Thank you for your March 29 letter to the Occupational Safety and Health Administration's (OSHA's) [Directorate of Enforcement Programs (DEP)]. You had specific questions regarding postvaccination antibody testing for the hepatitis B virus (HBV) vaccination series, as it applies to public safety officers such as police, firefighters, or accident investigators. Please be aware that this response may not be applicable to any questions not delineated within your original correspondence. We hope that this letter will serve as clarification of the applicability of the HBV vaccination requirements of the Bloodborne Pathogens Standard, 29 CFR 1910.1030, to this group of professionals.

As a preliminary matter, please note that the Federal OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030, directly applies only to the private sector [see 29 USC 652 (5) and (6)]. However, pursuant to 29 USC 668 and 29 CFR 1960.16, federal agencies are required to comply with Federal OSHA standards or alternate standards adopted by the agencies and approved by the Secretary of Labor with respect to their employees.

Employees of state and local governments, such as police and firefighters, are not covered by Federal OSHA standards [see 29 USC 652 (5) and (6)]. However, employees of such governments in states with state occupational safety and health enforcement programs approved by Federal OSHA are protected by state standards "at least as effective as" the Federal OSHA standards [29 USC 667(c)(6)]. The state plan states in your region are Oregon, Utah, Washington, and Wyoming. Therefore, the following information applies only to public safety officers employed by the federal, state, or local governments in these states, and the private sector.

Paragraph (f)(1)(ii)(D) of the Bloodborne Pathogens Standard requires that all medical evaluations and procedures, including the HBV vaccination series, among other things, must be provided in accordance with the recommendations of the U.S. Public Health Service (PHS). The Centers for Disease Control and Prevention (CDC) are part of the PHS. The CDC recommends testing for the hepatitis B surface antigen (anti-HBs) in "healthcare workers (HCWs) who have blood or patient contact and are at ongoing risk for injuries with sharp instruments or needlesticks" as presented in CDC's Morbidity and Mortality Weekly Report (MMWR) Immunization of Health-Care Workers, December 1997 (Appendix G of the current Bloodborne Pathogens directive, [CPL 02-02-069 (formerly CPL 2-2.69)]).

The CDC Guidelines define healthcare workers (HCWs) as "[p]ersons who provide health care to patients or work in institutions that provide patient care, e.g., physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers, and administrative support staff in healthcare institutions." Not only are those HCWs in hospitals and health departments included, but also first responders and those in private physician's offices, nursing homes, schools, and laboratories.

Police and firefighters in airports or at airplane accident sites often serve as emergency medical personnel and thus are "healthcare workers... who have blood or patient contact" within the meaning of the CDC guidelines. However, it is unlikely that they would have an "ongoing risk for injuries with sharp instruments or needlesticks." Thus, the anti-HBs testing would not be required, unless in a particular situation they meet both defining CDC criteria. Aircraft accident investigators are not generally healthcare workers because they do not provide care to patients or work in institutions that provide patient care. Thus, anti-HBs testing would not be required for them, unless in a particular situation they meet the CDC criteria.

If these workers do meet the CDC criteria, we would make the following comments about the timing of the test: As you know, the CDC recommends that testing for the anti-HBs is done approximately one to two months after the completion of the vaccination series for a proper indication of vaccine efficacy, as anti-HB levels are most accurately detectable for the first 30-60 days. Antibody testing is not clinically recommended after a six-month period, as the reliability of the antigen as a true marker of a recent HBV infection or vaccination is not as accurately portrayed.

Following the HBV vaccination series given for employees who do not fall within the CDC criteria for anti-HBs testing and who have not had an exposure incident, it would not currently be mandatory to test for the anti-HBs. However, OSHA does recommend that antibody testing be done for all occupationally exposed employees within a period of one to two months following the vaccination, as this would indicate the effectiveness of the vaccination series and the subsequent risk of contracting HBV if a needlestick or exposure incident were to occur. Ultimately, the medical opinion of the employee health practitioner in your facility should indicate if antibody testing for all employees is necessary and/or feasible.

The lack of requirements for anti-HBs testing for the group of workers that you describe, does not mean that they are not covered by other provisions of the standard. The broad, performance-oriented nature of the Bloodborne Pathogens Standard applies to "all occupational exposure to blood or other potentially infectious materials (OPIM)." More specifically, it applies to those employees who, within the normal scope of their duties, have a reasonable likelihood of coming into contact with blood or OPIM. Therefore, if it is reasonably likely that employees may be exposed to blood or OPIM, it must be documented in your Exposure Control Plan, universal precautions must be used, and other preventive actions must be taken, as mandated by 29 CFR 1910.1030.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. Please be aware that the enforcement guidance contained in this response represents the views of OSHA at the time the letter was written based on the facts of an individual case, question, or scenario and is subject to periodic review and clarification, amplification, or correction. It could also be affected by subsequent rulemaking; past interpretations may no longer be applicable. In the future, should you wish to verify that the guidance provided herein remains current, you may consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the [Office of Health Enforcement] at (202) 693-2190.

Sincerely,


Richard E. Fairfax, Director
[Directorate of Enforcement Programs]

[Corrected 6/2/2005]