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Ask the Experts: Routine immunization of health care personnel

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All health care workers, including those not involved in direct patient care, are responsible for receiving all recommended vaccines.

The Advisory Committee on Immunization Practices (ACIP) recently updated its recommendations on immunizations for health care personnel (HCP).1 Despite these recommendations, immunization rates of HCP continue to be low. As of November 2011, CDC estimated an influenza vaccination rate of 63.4% for HCP.2 The agency's definition of HCP is all paid and unpaid individuals working in a health care setting who have the potential for exposure to patients or infectious materials.1 This includes all administrative and support staff. Table 1 provides a simplified description of the most common vaccines; however, the new recommendations should be read for a more detailed description. The following is a summary of the report appearing in MMWR Recommendations and Reports.1

Hepatitis B vaccination is recommended for all HCP who have the potential for exposure to blood or infectious materials.1 This vaccination, along with hepatitis immune globulin, also is recommended postexposure for nonvaccinated individuals. HCP should be tested for an immunological response 1 to 2 months after the last dose. Although antibody to hepatitis B surface antigen titers decrease over time (<10 mIU/mL), the patient remains protected due to immunological memory, which has been documented to last for 22 years.

Influenza is recommended yearly for all HCP. Mandatory influenza vaccination has been recommended by many health care systems and organizations.3 In 2011, APhA passed a resolution stating, “APhA supports an annual influenza vaccination as a condition of employment, training or volunteering, within an organization that provides pharmacy services or operates a pharmacy or pharmacy department (unless a valid medical or religious reason preludes vaccination).”4

Recent pertussis outbreaks led to the recommendation that all HCP should receive a dose of Tdap (tetanus–diphtheria–acellular pertussis) vaccine, regardless of the interval since receiving their last dose of Td (tetanus–diphtheria) vaccine.1 Adults, including HCP, are a reservoir for transmitting pertussis to infants and children, in which the disease is much more serious. Regardless of vaccination history, antibiotics should be taken following exposure to pertussis.

All HCP without evidence of immunity to varicella should receive two doses of the vaccine.1 Evidence of immunity is shown in Table 1. For individuals born in the United States, birth before 1980 is considered evidence of immunity; however, this does not include HCP.5 Laboratory testing is indicated for HCP born before 1980 unless vaccination is preferred.5 Laboratory testing for vaccine-induced immunity often lacks sensitivity; it is more accurate for disease-induced immunity.1

Although the general population born before 1957 is considered immune to measles and mumps, this does not apply to HCP.5 All HCP should provide documentation of vaccination with two doses of MMR (measles–mumps–rubella) vaccine or laboratory evidence of immunity.1 Provider-diagnosed rubella disease is not considered evidence of immunity.

Meningococcal vaccine is indicated for high-risk patients but not routinely for all HCP.1 HCP who travel internationally to work in high-risk areas and clinical microbiologists who may be exposed to Neisseria meningidites should receive a single dose of the vaccine if it has been more than 5 years since their last vaccination.1 If the potential for exposure persists, the vaccine should be repeated every 5 years.

The updated guidelines include the following recommendations for other vaccinations not discussed here: routine recommended vaccines based on age or medical conditions, vaccines based on occupational risk, and travel vaccines.1 All HCP, including those not involved in direct patient care, are responsible for receiving all recommended vaccines. In addition to protecting HCP, this also will ensure the safety of our patients.

 

Stephan L. Foster, PharmD, FAPhA

Professor and Vice Chair
College of Pharmacy
University of Tennessee Health Sciences Center
Memphis
APhA Liaison Representative to the Advisory Committee on Immunization Practices (ACIP)
CAPT (Ret) U.S. Public Health Service

 

Haley B. Armstrong

Student pharmacist
College of Pharmacy
University of Tennessee
Memphis
Member
2009–11 University of Tennessee APhA–ASP Executive Committee

References

  1. CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-7):1–45.
  2. Lindley MC, Zhang J, Euler GL. Health care personnel flu vaccination. Accessed at www.cdc.gov/flu/professionals/vaccination/health-care-personnel.htm, January 17, 2012.
  3. Immunization Action Coalition. Honor roll for patient safety. Accessed at www.immunize.org/honor-roll, January 17, 2012.
  4. APhA. 2011 actions of the APhA House of Delegates. Accessed at www.pharmacist.com/Content/ContentFolders3/AboutAPhA/HouseofDelegates/2011ActionsoftheAPhAHoD-Public.pdf, January 17, 2011.
  5. CDC. Recommended adult immunization schedule: United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(4):1–4.

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