Nursing

IMMUNIZATION REQUIREMENTS

2-Step Testing for TB

The booster phenomenon occurs during TB skin testing when an individual who is tested many years after becoming infected with tuberculosis has a falsely negative (non-reactive) skin test initially, followed by a positive reaction to a second TB skin test given from one week up to a year later. This occurs because the first test boosts the immune response.

Two-step testing is used in screening programs in order to tell the difference between a boosted reaction and a reaction due to a recent infection. Typically, the second test follows the first by one to three weeks. If the first is negative and the second is positive, it is felt that this most likely represents a past infection with a booster phenomenon rather than a recent infection.

The difference between a recent infection and a booster phenomenon is important for understanding the risk of developing active tuberculosis disease. Individuals infected with tuberculosis have a 10% lifetime risk of developing active disease. About one-half of that lifetime risk occurs in the first 2 years following infection. Individuals with a recent infection are strongly advised to have INH therapy (assuming that their chest x-ray is normal). If INH is refused or contraindicated, the individual needs to be followed with a repeat chest x-ray at least every 6 months for two years, along with chest x-rays during any prolonged respiratory illness.

Henry J. Kahn, M.D.

Director, UCSF Student Health Service

IMMUNIZATION & TB TESTING (all documents including immunization records and lab sheets with titer values are required)

REQUIREMENTS	DESCRIPTION
Hepatitis B	Evidence of the first 2 (of 3) shots, or positive Hep B surface antibody, or evidence of prior infection.
Varicella	2 doses of vaccine or positive titer
Measles	2 doses of vaccine (measles or MMR) or positive titer
Mumps	2 doses of vaccine (mumps or MMR) or positive titer
Rubella	2 doses of vaccine (rubella or MMR) or positive titer
TB Skin Testing	2 PPD (tuberculosis skin testing) skin tests administered one week apart within the three months preceding entry into school OR For people who have had annual TB tests Documentation of one TB skin test completed within three months prior to starting school *and* documentation of an additional skin test completed within one year of the more recent test For people with a positive skin test history submit chest x-ray report from time of conversion along with any INH therapy history *and* TB Symptoms Review Form OR a new chest x-ray report taking within 3 months of entering school if no INH therapy is taken *and* TB Symptoms Review Form
TB Symptoms Review Form	If you have a history of position TB Test the form has to be filled out by your doctor the first year and by student their second year.
Flu Shot	Verification of the annual Flu shot or refusal to have the shot is required by all hospitals.

This information was taken from the USCF Student Health Services Immunization Requirements and adapted to fit Chabot College Requirements.

Chabot Health Care Center offers the following services:

General Appointments to see a Nurse Practitioner
Treatment for Minor Injuries or Illnesses
TB Skin Test
Pregnancy Test
Referrals to Community Resources
Low Cost Medical Clinics
HIV (AIDS) Testing Sites
Self-Help Groups
Blood Pressure & Weight Checks

6/27/2005