The following may be documented by your primary care physician, or on clinic or hospital letterhead:
1. Positive tetanus toxin antibody titers (or proof of vaccination), AND
2. Positive HBsAB titers (or proof of vaccination), AND
3. Positive varicella antibody titers (or proof of vaccination), AND
4. Positive triple antibody titers to Mumps & Measles & Rubella (or proof of vaccination), AND
5. (Only Required by Some Sites & Seasonal) Influenza (flu shot): some clinical sites require a single dose of a flu shot (U.S. strands) for the current flu season (typically August to March), so you may be asked to repeat your flu vaccines if you’re in a new flu season in that same year. Ask your AmeriClerkships Residency Enrollment Consultant if this applies to any of your Clinical Blocks.
*PLEASE NOTE: Clinical sites may require additional health-related documentation. Please inquire with your residency enrollment strategist if this applies to you. Results must be valid for full duration of all clinical rotations.
Establishing Immunity to MMR Immunity:
- Titers frequency: 1x (can be anytime in lifetime)
- If positive: Do nothing
- If negative + 2 documented doses of MMR: Presumed immune
- Note: Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. Because rapid vaccination is necessary to halt disease transmission, during outbreaks of measles, serologic screening before vaccination is not recommended.
- Reference: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm
Do my titers expire? How long are they valid for rotations at ACMedical?
- Most vaccines/immunity do last a long time, however, there are also cases where the immunity decreases or goes away over time. It is especially important to know that:
- Most people don’t need to have their titers checked routinely if they are not in one of the high-risk groups such as pregnant women, healthcare workers, students in nursing and medical schools, children and adults exposed in an outbreak or after a needlestick injury;
- A healthcare provider with a negative measles titer after two doses of the MMR vaccine does not need another dose of vaccine, but a titer may be requested without proof of vaccination;
- A healthcare provider who has anti-HBs <10 mIU/mL (negative titer) should get another dose of a vaccine and repeat titers again in 1 to 2 months, even if they have had three doses of the hepatitis B vaccine administered, so the only way to know this is by doing updated titers (up to a total of 6 doses may be required, with repeat titer testing);
- Vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses, and should not be tested again (again, a repeat titer is needed to assess for this);
- Postvaccination titer testing is not recommended after the chickenpox vaccine in addition to not being able to test titers for pertussis and Hib immunity, it is becoming difficult to test poliovirus type 2 titers, as the test uses a live virus that isn’t routinely available anymore (type 2 polio has been eradicated)
What if I cannot repeat titers?
- If you do not want to repeat titers, we can accept your official documented proof of vaccination for all communicable diseases in English instead.