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Immunization Recommendations for Health-Care Workers

Centers for Disease Control, Division of Immunization, National Center for Prevention Services, Division of Viral, Division of Bacterial Diseases, Hospital Infections Program, National Center for Infectious Diseases

Publication date: 04/01/1989


Table of Contents

Immunization Recommendations for Health-Care Workers
Hepatitis B
Influenza
Measles
Mumps
Rubella
Tetanus and Diphtheria
Pneumococcal Disease
Other Issues
Vaccines Primarily Indicated for Foreign Travel

Selected References

Additional Information

POINT OF CONTACT FOR THIS DOCUMENT:


Immunization Recommendations for Health-Care Workers

Because of their contact with patients or infective material from patients with infections, many health-care workers (including physicians, nurses, dental professionals, medical and nursing students, laboratory technicians, administrative staff, etc.) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is therefore an essential part of prevention and infection control programs for health-care workers. Optimal use of immunizing agents will not only safeguard the health of workers but also protect patients from becoming infected. A consistent program of immunizations could eliminate the problem of having susceptible health-care workers in hospitals and health departments and the attendant risks to others workers and patients.

Administrative staff in any medical facility or health department providing direct patient care or contact are encouraged to formulate a comprehensive policy for all health-care workers. The following recommendations* should be considered during policy development.

* Consult current Advisory Committee Immunization Practices (ACIP) recommendations for a deatiled discussion of the rationale for each recommendation.

Hepatitis B

HBV Infection is the major infectious occupational hazard for health care and public safety workers. The risk of acquiring HBV Infection from occupational exposures is dependent on the frequency of percutaneous and permucosal exposures to blood or blood products. Any health care or public safety worker may be at high risk for HBV exposure depending on the tasks that he or she performs. Workers performing tasks involving exposure to blood or blood-contaminated body fluids should be vaccinated.

Risks among health care professionals vary during the training and working career of each individual but are often highest during the professional training period. For this reason, vaccination should be completed during training in schools of medicine, dentistry, nursing,laboratory technology, and other allied health professions before trainees have their contact with blood.
a. Persons at risk for hepatitis B virus infection who are demonstrated or judged likely to be susceptible should be vaccinated. Health-care workers who have contact with blood or blood products are at increased risk. These groups include (but are not limited to) physicians, nursing staff, dental professionals, and laboratory technicians.
b. Before immunizing, serologic screening for hepatitis B need not be done unless the provider considers it cost-effective or the potential vaccine requests it.
c. Prophylaxis with Hepatitis B immune globulin (passive immunization) and vaccine (active immunization) should be used when indicated, such as following needle-stick or percutaneous exposure to blood that is known to be at high risk for being HVsAG-positive. (See MMWR 1991;40:RR-13:15-17 for more details on post exposure prophylaxis.) Any needlestick exposure in an unvaccinated person should lead to initiation of the HB vaccine series.
d. Immune globulins should not be used as a substitute when active immunization is indicated.

Influenza

To reduce staff illnesses and absenteeism during the influenza season and to reduce the spread of influenza from workers to patients, any health care workers who attend patients having high-risk chronic medical conditions in health-care facilities or in the home setting should be immunized in the fall of each year. In addition, health-care workers with chronic medical conditions are at high risk for influenza-related complications, if infected, and should be vaccinated against influenza. Included in this category are:
a. Those with chronic disorders of the cardiovascular or pulmonary systems requiring medical follow-up or hospitalization within the preceding year;
b. Those with chronic metabolic disease (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression. c. Any other health-care worker 65 years of age or older.

Measles

All health-care workers who have contact with patients should have documented immunization to measles.*

Most persons born before 1957 have probably been infected naturally. However, serologic studies of hospital workers indicate that up to 9.3% of those born before 1957 were not immune to measles. Between 1985 and 1989, 29% of all measles cases among health-care workers occurred in persons born before 1957. Therefore, health facilities should consider requiring at least one dose of measles vaccine for older employees who are at risk of occupational exposure to measles and do not have proof of immunity to this disease. Younger persons can be considered immune only if they have documentation of:
a. Physician-diagnosed measles

b. Laboratory evidence of measles immunity

c. Two doses of live measles vaccine on or after the first birthday, separated by at least one month.

Consideration should be given to administering measles vaccine in combination with rubella and mumps vaccines (measles-mumps-rubella (MMR) trivalent vaccine).

* Consult current Advisory Committee Immunization Practices (ACIP) recommendations for a deatiled discussion of the rationale for each recommendation.

Mumps

All persons thought to be susceptible should be vaccinated unless otherwise contraindicated.* Most persons born before 1957 are likely to have been infected naturally and generally need not be considered susceptible. Younger persons can be considered immune only if they have documentation of:

a. Physician-diagnosed mumps

b. Laboratory evidence of mumps immunity

c. Adequate immunization with live mumps vaccine on or after the first birthday.

Consideration should be given to administering mumps vaccine in combination with measles and rubella vaccines (measles-mumps-rubella (MMR) trivalent vaccine).

* Consult current Advisory Committee Immunization Practices (ACIP) recommendations for a deatiled discussion of the rationale for each recommendation.

Rubella

a. All health care workers (male or female) who might transmit rubella to pregnant patients or other personnel should be immune to rubella.*

*Pregnancy is contraindication to vaccination against measles, mumps, and/or rubella. Vaccine should not be given to pregnant women or those who may become pregnant within 3 months of vaccination.

b. Before immunizing, serologic screening for rubella need not be done unless the health facility considers it cost-effective or the potential vaccinee requests it.
c. Persons can be considered susceptible unless they have laboratory evidence of immunity or documented immunization with live virus vaccine on or after their first birthday.

Consideration should be given to giving rubella vaccine in combination with measles and mumps vaccines (measles-mumps-rubella (MMR) trivalent vaccine).

Although health-care workers are not at substantially higher risk than the general population for acquiring diphtheria, pneumococcal disease, or tetanus, they should seek these immunizations from their primary care provider, according to the recommendations of the ACIP for adults.

Tetanus and Diphtheria

After primary immunization, a tetanus-diphtheria booster is recommended for all persons every 10 years. Primary immunization of adults consists of three doses of adult tetanus-diphtheria toxoid (Td): 4-6 weeks should separate the first and second doses, with the third dose given 6-12 months after the second.

Pneumococcal Disease

Personnel for whom pneumococcal vaccine is recommended include:
a. Those with chronic illnesses, especially cardiovascular disease, chronic pulmonary disease, and diabetes mellitus.
b. Those with splenic dysfunction or anatomic asplenia, Hodgkins disease, lymphoma, multiple myeloma, cirrhosis, alcoholism, chronic renal failure, nephrotic syndrome, cerebral spinal fluid leaks, and other conditions, such as organ transplantation, associated with immunosuppression.
c. All otherwise healthy adults 65 years of age and older.
d. Persons living in special environments or social settings with an identified increased risk for pneumococcal disease or its complications (e.g. certain native-American populations).

Other Issues

An immunization record should be maintained for all health-care workers reflecting both documented histories and immunizations administered at the provider site. At each immunization encounter, the record should be updated and the health-care workers encouraged to maintain the record as appropriate.

In addition to informing new health-care workers of any existing immunization policy, health facility administrative staff should be encouraged to consider catch-up programs for health-care workers already employed. Since educational components will enhance the success of any immunization program, reference materials should be available to assist in answering questions regarding the diseases, vaccines and toxoids, and the program or policy being implemented. To help ensure acceptance of the program goals, it may be necessary to conduct educational workshops or seminars several weeks prior to the initiation of the program.

Vaccines Primarily Indicated for Foreign Travel

Research and health care work in foreign countries by hospital and other health care workers may put them at greater risk of certain diseases. Vaccination against diseases such as polio, cholera, Japanese encephalitis, meningococcal disease, plague, rabies, typhoid, or yellow fever should be considered when indicated for foreign travel.


Selected References

  1. Immunization Practices Advisory Committee. Recommendations for protection against viral hepatitis. MMWR 1990;39(No. RR-2):2-21.
  2. Immunization Practices Advisory Committee. Hepatitis B virus: A comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination. MMWR 1991;40(No. RR-13):1-25.
  3. Immunization Practices Advisory Committee. Prevention and control of influenza. MMWR 1993;42(No. RR-6):1-14.
  4. Immunization Practices Advisory Committee. Measles prevention. MMWR 1989;(No. S-9):1-18.
  5. Immunization Practices Advisory Committee. Mumps prevention. MMWR 1989;38:388-92,397-400.
  6. Immunization Practices Advisory Committee. Rubella prevention. MMWR 1990;39(No. RR-15):1-13.
  7. Immunization Practices Advisory Committee. Pneumococcal polysaccharide vaccine. MMWR 1989;38:64-68,73-76.
  8. Immunization Practices Advisory Committee. Update on adult immunization. MMWR 1991;40(No. RR-12):1-94.
  9. Williams WW: CDC guideline for infection control in hospital personnel. Infect Control 1983;4(Suppl):326-349.


Additional Information

First Printed:
January 1987

Revised:
April 1989

Prepared by:

The National Immunization Program, the Division of Viral and Rickettsial Diseases, the Division of Bacterial and Mycotic Diseases, and the Hospital Infections Program, National Center for Infectious Diseases, CDC.

For copies please write:

Information Services, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, Georgia 30333

For information regarding content:

Raymond A. Strikas, National Immunization Program, National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, Georgia 30333


POINT OF CONTACT FOR THIS DOCUMENT:

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NATIONAL IMMUNIZATION PROGRAM
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Atlanta, GA 30333



This page last reviewed: Wednesday, January 27, 2016
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