Immunization of health care workers

Introduction

Active immunization of healthcare workers (HCWs) constitutes an essential infection prevention measure in order to control and reduce transmission of infectious diseases in healthcare settings.

Risks and benefits

Healthcare personnel working in hospitals, health departments, private clinician offices, nursing homes and laboratories are exposed to various infectious agents and may be in contact with infective material from patients. They are therefore at risk for acquisition of vaccine preventable diseases and may at the same time represent a source of infection for vulnerable patients, HCWs relatives and colleagues.

The benefits of vaccination in healthcare settings have been shown in different studies and high vaccination coverage among healthcare personnel interrupt outbreaks in healthcare settings and finally reduce disease burden and costs.

Recommendations

HCWs immunization should be based upon their risk of exposure. All new employees by healthcare providers should receive a prompt review of their immunization status prior to starting to care for patients. An annual review of the HCWs immunization status is advisable.

Policies and barriers

A considerable country-to-country variation exists in policies regarding vaccination of HCWs as well as in the uptake HCWs’ vaccination rates in Europe state members. Different studies showed how the most relevant factors involved in a low vaccination uptake are both individual barriers as concerns regarding side effects or failure to recognize risk, and of inadequate enforcement of immunization policies.

Vaccines

When no contraindication to vaccine administration is present, immunization to the following vaccines should be administrated:

• Hepatitis B: a three-dose series of hepatitis B vaccine at month 0,1 and 6 should be administrated for unvaccinated HCWs or those who cannot document previous hepatitis B vaccination. Non-responders HCW´s (hepatitis B surface antibody ≤10mlU/mL) should be considered as susceptible of hepatitis B infection.

• Polio: all HCWs should have completed a full course of primary vaccination against polio. Unvaccinated HCWs should receive a three-dose Inactivated Polio Vaccine (IPV) at month 0, 1 and 6.

• Tetanus/Diphtheria/Pertussis (Tdap): all HCWs should receive Tdap boosters every 10 years. Unvaccinated HCWs or those who are unsure about previous Tdap vaccination should be vaccinated as soon as feasible.

• Measles: all HCWs with no proof evidence of immunity or immunization should receive a two-dose Measles vaccine 28 days apart.

• Rubella: HCWs with no documentation of immunity or immunization to Rubella should receive a one-dose Rubella vaccine.

• Meningococcal: one booster dose 3-5 years after the primary dose should be administrated to HCWs of microbiology departments if routinely exposed to Neisseria meningitidis isolates.

• Influenza: annual immunization with a single dose is recommended. Live attenuated influenza vaccine (LAIV) may be given only to non-pregnant healthy HCWs younger than 50 years old. Inactivated injectable Influenza vaccine (IIV) is preferred over LAIV for HCWs who are in close contact with severely immunosuppressed patients.

• Varicella: unvaccinated HCWs and with no history of varicella or herpes zoster should receive 2 doses of varicella vaccine given at least 4 weeks apart.

Evidence of immunity or immunization

Evidence of immunity or immunization in HCWs includes:

• vaccine documentation;
• laboratory evidence;
• laboratory confirmation of disease;
• diagnosis or verification of history of disease.

References

• Maltezoua HC, Poland GA. Vaccination policies for healthcare workers in Europe. Vaccine 32 (2014) 4876–4880.
• Burls A, Jordan R, Barton P, Olowokure B, Wake B, Albon E, et al. Vaccinating healthcare workers against influenza to protect the vulnerable. Is it a good use of healthcare resources? A systematic review of the evidence and an economic evaluation. Vaccine. 2006;24(19):4212-21.
• World Health Organization. Immunization, Vaccines and Biological. WHO Policy recommendations. Recommendations for Routine Immunization (Updated 27/02/2015)

Available material

• Centres for Disease Control and Prevention, Morbidity and Mortality Weekly Report. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Recommendations and Reports. November 25, 2011 / 60(RR07);1-45. Available from:
• http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm [accessed 5th April 2016].

FEM PAGE CONTRIBUTORS 2007

Original authors

Elisabeth Presterl, Clinic for Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna General Hospital, Austria.

Other FEM Contributors

Presterl Elisabeth

Vladimir Prikazsky