My Nanny has HEP B

[marthawashington]

I just found out my nanny tested positive for Hep B. Should I quickly vaccinate my 10 month old, let go the nanny, etc? Even if it's spread by bodily fluids, can't she still catch it through some means I'm not thinking clearly right now? I'm so worried because I didn't think to test the nanny for TB, Hep a,b,c, and HIV until after 3 months of working for us. I asked her not to cut anything because I want to be extra safe. I know I might sound over-protective, but I don't know what to believe these days so I'm going to play it safe!!! Any advice?

[poppan]

I think I would want to find out if she's "immune", "acutely infected" or "chronically infected" and go from there.
http://www.cdc.gov/hepatitis/HBV/PDF...gicChartv8.pdf

If your LOs are already infected, getting the vax won't help, so personally I would not vax -- instead, I would prevent future transmission by letting go the nanny if she's acute or chronic. (If acute I suppose you could entertain the possibility of hiring her back when she's gotten rid of the virus -- but the range is weeks to months so that may not be practical.) I know it's only spread by blood or sexual contact but "household contacts of a Hep B infected person" are identified as a high risk group, so I would not want to risk it. Especially as exposure as a child is at much higher risk for developing a chronic infection which leads to shorter life expectancy.

http://www.hepb.org/patients/adults_and_hepatitis_b.htm

[carriebft]

If she is a full time nanny, at your house 9 hours a day or whatever, then that is as much contact as many family members have and would be intensive contact since it's not at night when the child is sleeping.

So I would proceed to think about it as how you would if someone in the family was positive. Would that worry you? or would you just take extra precautions? would that make you want the vaccine?.

PP has good info as well and definitely good to know these things before getting too worried.

[My3guys]

Legally, can you let the nanny go due to an illness? Wouldn't that get you in trouble, if she opted to fight you on it? Just something to think about.

Good luck.

[Lollicup]

Simply let the nanny go. Either you vax for Hep B or let her go.

[JBaxter]

You can fire an employee for any reason. I would NOT have a caregiver who is HepB positive caring for an unvaxed child. FOR ME there is to much a risk.

[Marnica]

Originally Posted by JBaxter

You can fire an employee for any reason. I would NOT have a caregiver who is HepB positive caring for an unvaxed child. FOR ME there is to much a risk.

I agree here. I wouoldn't risk it. One could not fire her is she was employed by a company or coorporation simply for having an illness, but this is a nanny working for a family, proably being paid cash.

[AislinCarys]

Remember if you chose to vaccinate your child now it will take many months before he has full immunity, as it takes several doses.

[Gitti]

Originally Posted by AislinCarys

Remember if you chose to vaccinate your child now it will take many months before he has full immunity, as it takes several doses.

And there is no 100% guarantee that it will work. Plus there are too many possible side effects from it.

[Gitti]

Originally Posted by marthawashington

I'm so worried because I didn't think to test the nanny for TB, Hep a,b,c, and HIV

I also meant to say that Hep A, B, and C are all different disease and from what I have read, the only one to worry about is Hep B.

HIV in connection with AIDS is very controversial and I have read that some people test HIV positive after certain drugs, esp. chemo therapy, or doing strenuous sports such as running a marathon.

Anyone who has had the TB vaccine will also test positive for TB.

[katiesk]

yeah - i would make the decision based on your feeling around a hep b positive person being around your children whether vaccinated or not. the vaccine does not guarantee immunity.

[not now]

Originally Posted by Gitti

I also meant to say that Hep A, B, and C are all different disease and from what I have read, the only one to worry about is Hep B.

What not Hep C? It's chronic much more often than Hep B, no vax, typically asymptomatic so by the time someone realizes they have it the liver is already shot to hell and TX's like interferon are less likely to work. I worry more about Hep C than B and I work around infected folks all the time.

If the nanny has/had acute Hep B then it's self limiting and I wouldn't let her work while active but I'd bring her back after it ran it's course after she's been medically cleared. But then, there is the tiny risk of Hep D associated with Hep B.

[FertileMertel]

Originally Posted by CottontailKate

Legally, can you let the nanny go due to an illness? Wouldn't that get you in trouble, if she opted to fight you on it? Just something to think about.

Good luck.

Absolutely not! That would be ludicrous to have to keep someone to care for your child that has a contagious disease. In fact, I think it is actaully irresponsible to do so. Let the nanny go for your child's sake and peace of mind.

[zylph]

I would tread very carefully if I were you. Hepatitis B infection status is covered under the Americans with Disabilities Act. If it's not a completely mutual decision for your nanny to leave, you could have a fairly serious lawsuit on your hands.

Hepatitis B and C are both fairly serious diseases - B a little more so than C, as there is no treatment to clear the virus in a chronically infected person. HBV is also more transmissible - the minimum infectious dose is about 10 viral particles (the typical rule for the bloodborne pathogens is 0.2, 2, 20 for HIV, HCV, HBV - meaning that 0.2% of people exposed to HIV+ blood will be infected and 20% of people exposed to HBV blood will). However, most people will clear HBV spontaneously and develop immunity - 95% of adults clear HBV, as opposed to 20% for HCV.

There is really nothing to worry about as long as your nanny is well acquainted with universal precautions (she really should be). People with HCV/HBV/HIV are not lepers and should not be treated as such. The risk to your child is infinitesimally small as long as your nanny is careful (if she's not, that's a firable offense). I would urge you to get your child vaccinated anyway, but that's less to do with your nanny than other situations that might crop up later.

[ammiga]

Originally Posted by zylph

I would tread very carefully if I were you. Hepatitis B infection status is covered under the Americans with Disabilities Act. If it's not a completely mutual decision for your nanny to leave, you could have a fairly serious lawsuit on your hands.

Hepatitis B and C are both fairly serious diseases - B a little more so than C, as there is no treatment to clear the virus in a chronically infected person. HBV is also more transmissible - the minimum infectious dose is about 10 viral particles (the typical rule for the bloodborne pathogens is 0.2, 2, 20 for HIV, HCV, HBV - meaning that 0.2% of people exposed to HIV+ blood will be infected and 20% of people exposed to HBV blood will). However, most people will clear HBV spontaneously and develop immunity - 95% of adults clear HBV, as opposed to 20% for HCV.

There is really nothing to worry about as long as your nanny is well acquainted with universal precautions (she really should be). People with HCV/HBV/HIV are not lepers and should not be treated as such. The risk to your child is infinitesimally small as long as your nanny is careful (if she's not, that's a firable offense). I would urge you to get your child vaccinated anyway, but that's less to do with your nanny than other situations that might crop up later.

ADA applies to employers with 15 or more employees. So unless you have a whole slew of nannies working with dd, you should be fine in that regard.

I wouldn't treat someone as a leper. They would be welcome in my home and I would treat them with respect. However, I would not leave them unattended with my child every day. Yes, we would hope that the nanny would be careful, but there is no guarantee that she will be. Even if she can be fired for not being careful, that will serve as little solace if something happens. Plus, accidents happen.

And I would not vax my 10 month old for a disease that is primarily transmitted through IV drug use and sexual contact with an infected person.

[Hopesmommy]

I've read that Hep B can be transmitted via dried blood, not just fresh blood. So what happens if your tot grabs nanny's toothbrush, or razor?

I don't think I'd be comfortable keeping her in my employment, personally.