Immunization of Health-Care Personnel

Immunization of Health-Care Personnel
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Recommendations and Reports
November 25, 2011 / 60(RR07);1-45

Prepared by
Abigail Shefer, MD1
William Atkinson, MD1
Carole Friedman, DO1*
David T. Kuhar, MD2
Gina Mootrey, DO1
Stephanie R. Bialek, MD1
Amanda Cohn, MD1
Anthony Fiore, MD3
Lisa Grohskopf, MD1
Jennifer L. Liang, DVM1
Suchita A. Lorick, DO1
Mona Marin, MD1
Eric Mintz, MD2
Trudy V. Murphy, MD4
Anna Newton, MPH2
Amy Parker Fiebelkorn, MSN, MPH1
Jane Seward, MBBS1
Gregory Wallace, MD1

1National Center for Immunization and Respiratory Diseases
2National Center for Emerging and Zoonotic Infectious Diseases
3Center for Global Health
4National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
*Deceased.

The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director.

Corresponding preparer: Abigail Shefer, MD, National Center for Immunization and Respiratory Diseases, 1600 Clifton Rd., MS A-19, Atlanta, GA 30333. Telephone: 404-639-8233; Fax: 404-417-0791; E-mail: ams7@cdc.gov.

Summary
This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee.

These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies.

The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term--care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services.

Introduction
This report updates the previously published summary of recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee (HICPAC) for vaccinating health-care personnel (HCP) in the United States (1). The report, which was reviewed by and includes input from HICPAC, summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies that have not been published previously. These recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs.

HCP are defined as all paid and unpaid persons working in health-care settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, laundry, security, maintenance, administrative, billing, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP and patients (2).

Because of their contact with patients or infective material from patients, many HCP are at risk for exposure to (and possible transmission of) vaccine-preventable diseases. Employers and HCP have a shared responsibility to prevent occupationally acquired infections and avoid causing harm to patients by taking reasonable precautions to prevent transmission of vaccine-preventable diseases. Vaccination programs are therefore an essential part of infection prevention and control for HCP. Optimal use of recommended vaccines helps maintain immunity and safeguard HCP from infection, thereby helping protect patients from becoming infected; pertinent ACIP statements on various individual vaccines and diseases have been published (Table 1). Nationwide, ongoing implementation of these vaccine recommendations through well-managed vaccination programs could substantially reduce both the number of susceptible HCP in any setting in which they interact with patients and their risks for transmitting vaccine-preventable diseases to patients, other HCP, and other contacts (3).

HICPAC and CDC have recommended that secure, preferably computerized, systems should be used to manage vaccination records for HCP so records can be retrieved easily as needed (3). Each record should reflect immunity status for indicated vaccine-preventable diseases (i.e., documented disease, vaccination history, or serology results) as well as vaccinations administered during employment and any documented episodes of adverse events after vaccination (4). For each vaccine, the record should include date of vaccine administration (including for those vaccines that might have been received prior to employment), vaccine manufacturer and lot number, edition and distribution date of the language-appropriate Vaccine Information Statement (VIS) provided to the vaccinee at the time of vaccination, and the name, address, and title of the person administering the vaccine (4). Accurate vaccination records can help to rapidly identify susceptible HCP (i.e., those with no history of vaccination or lack of documentation of immunity) during an outbreak situation and can help reduce costs and disruptions to health-care operations (5--7). HCP should be provided a copy of their vaccination records and encouraged to keep it with their personal health records so they can readily be made available to future employers.

HICPAC has encouraged any facility or organization that provides direct patient care to formulate a comprehensive vaccination policy for all HCP (3). The American Hospital Association has endorsed the concept of vaccination programs for both hospital personnel and patients (8). To ensure that all HCP are up to date with respect to recommended vaccines, facilities should review HCP vaccination and immunity status at the time of hire and on a regular basis (i.e., at least annually) with consideration of offering needed vaccines, if necessary, in conjunction with routine annual disease-prevention measures (e.g., influenza vaccination or tuberculin testing). These recommendations (Tables 2 and 3) should be considered during policy development. Several states and health-care facilities have established requirements relating to assessment of vaccination status and/or administration of one or more vaccines for HCP (9,10). Disease-specific outbreak control measures are described in this report and elsewhere (3,11,12). All HCP should adhere to all other recommended infection-control guidelines, whether or not they are individually determined to have immunity to a vaccine-preventable disease.

Methods
In 2008, the ACIP Immunization of Health-Care Personnel Work Group (the Work Group) was formed as a subgroup of the ACIP Adult Immunization Work Group to update the previously published recommendations for immunization of HCP. The Work Group comprised professionals from academic medicine (pediatrics, family medicine, internal medicine, occupational and environmental medicine, and infectious disease); federal and state public health professionals; and liaisons from the Society for Healthcare Epidemiology of America and HICPAC. The Work Group met monthly, developed an outline for the report, worked closely with subject matter experts at CDC (who developed, revised, and updated sections of the report), and provided subsequent critical review of the draft documents. The approach of the Work Group was to summarize previously published ACIP recommendations and not to make new recommendations or policies; a comprehensive list of publications containing the various vaccine-specific recommendations is provided (Table 1). In February 2011, the updated report was presented to ACIP, which voted to approve it.

The recommendations for vaccination of HCP are presented below by disease in two categories: 1) those diseases for which routine vaccination or documentation of immunity is recommended for HCP because of risks to HCP in their work settings and, should HCP become infected, to the patients they serve and 2) those diseases for which vaccination of HCP might be indicated in certain circumstances. Vaccines recommended in the first category are hepatitis B, seasonal influenza, measles, mumps, and rubella, pertussis, and varicella vaccines. Vaccines in the second category are meningococcal, typhoid, and polio vaccines. Except for influenza, all of the diseases prevented by these vaccines are notifiable at the national level (13). Main changes from the 1997 ACIP recommendations have been summarized (Box).

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Immunization of Health-Care Personnel