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IAC Express 2011

Issue number 948: August 25, 2011

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Contents of this Issue
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  1. Read "Ask the Experts" Q&As about healthcare personnel vaccination
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
Issue 948: August 25, 2011
1.  Read "Ask the Experts" Q&As about healthcare personnel vaccination

Many readers of Needle Tips and Vaccinate Adults consistently rank "Ask the Experts" as their favorite feature in these publications. As a thank-you to our loyal IAC Express readers, we periodically publish Extra Editions with new "Ask the Experts" Q&As answered by CDC experts.

IAC thanks nurse educator Donna L. Weaver, RN, MN, and medical epidemiologists Andrew T. Kroger, MD, MPH, and William L. Atkinson, MD, MPH, National Center for Immunization and Respiratory Diseases, CDC, for answering the following questions.

All the Q&As in this edition of IAC Express deal with vaccination issues related to healthcare personnel.

We encourage you to reprint any of these Q&As in your own newsletters. Please credit the Immunization Action Coalition and the Centers for Disease Control and Prevention. Information about IAC's preferred citation style can be found at http://www.immunize.org/citeiac

You can access more "Ask the Experts" Q&As in our online archive at http://www.immunize.org/askexperts

Editor's note: Information about submitting a question to "Ask the Experts" is provided at the end of this Extra Edition.

Q: Which vaccines does ACIP specifically recommend that healthcare personnel (HCP) receive in order to work in a healthcare setting?

A: ACIP recommends that all HCP be vaccinated with 2 doses of MMR vaccine (or have evidence of measles, mumps, and rubella immunity), annual influenza vaccination, 1 dose of Tdap (especially to protect against pertussis), 3 doses of hepatitis B vaccine for those who might be exposed to blood or body fluids at work, and 2 doses of varicella vaccine (or have evidence of varicella immunity). For definitions of evidence of immunity to mumps measles, rubella, and varicella, please refer to here (for MMR) and http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf (page 26, for varicella).

Q: For which workers in healthcare settings does the Occupational Safety and Health Administration (OSHA) require that hepatitis B vaccine be provided?

A: OSHA requires that hepatitis B vaccine be provided free of charge to HCP who have reasonably anticipated contact with blood or body fluids on the job. This requirement does not include HCP who would not be expected to have occupational risk, such as billing staff and general office workers. Employers must ensure that workers who decline hepatitis B vaccination sign a declination form. For a fact sheet about this OSHA requirement, go to: http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf

Q: If an employee has 2 documented doses of MMR but has negative or equivocal titers for 1 or more of the antigens, what should we do? Same question if an employee has 2 documented doses of varicella vaccine but tests negative.

A: Actually, ACIP does not recommend testing for immunity in such situations. For measles, mumps, and rubella, ACIP considers 2 documented doses of MMR vaccine given on or after age 1 year and at least 28 days apart to be evidence of immunity for HCP. For varicella, ACIP considers 2 documented doses of vaccine to be evidence of immunity for HCP as long as doses are given no earlier than age 12 months, with at least 3 months between doses for children younger than age 13 years, or at least 4 weeks between doses for people age 13 years and older.

Because of the limitations of serologic testing, tests for even properly vaccinated individuals will often come back as negative or equivocal, putting the employee health service in the difficult position of having to do something (e.g., give additional doses, perform a follow-up titer).

If a healthcare worker does not have any documented doses of MMR and/or varicella vaccine, he or she can (1) be tested for immunity or (2) just be given 2 doses of MMR and/or varicella at least 4 weeks apart. ACIP does not recommend serologic testing after vaccination.

For more information on this topic, go to:

IAC's "Ask the Experts" web section on MMR vaccination

IAC's "Ask the Experts" web section on varicella vaccination

ACIP recommendations on the prevention of measles, mumps, and rubella
http://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf (pages 18-20)

ACIP recommendations on the prevention of varicella
http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf (page 26)

Q: How soon after a dose of Td can HCP receive a dose of Tdap?

A: If they have not previously received Tdap, HCP in hospital, long-term care, and ambulatory care settings should receive a single dose of Tdap as soon as feasible and without regard to the dosing interval since the last Td dose. No minimum interval exists between receiving Td and Tdap.

Q: Can Tdap be given to pregnant HCP?

A: In June 2011, after studying new safety and efficacy data, ACIP voted to recommend that pregnant women who have never received the Tdap vaccine be vaccinated with Tdap during their third trimester or the second half of their second trimester (after 20 weeks gestation). ACIP made this recommendation in response to the continuing pertussis outbreak, with the goal of protecting newborns with maternal antibodies and decreasing the risk of transmission from mother to infant after birth. If the vaccine is not given during pregnancy, it should be given immediately post-partum.

To view ACIP's provisional recommendation for use of Tdap in pregnant women, go to:

Q: Can pregnant healthcare personnel administer live-virus vaccines?

A: A pregnant staff member may administer any vaccine except smallpox vaccine.

Q: Why is it so important to vaccinate HCP against influenza?

A: Because HCP provide care to patients at high risk for complications of influenza, achieving high rates of vaccination among HCP will reduce disease burden and healthcare costs.

Influenza is readily transmitted for 24 hours before a person develops influenza symptoms. That means symptom-free unvaccinated HCP can transmit influenza virus to patients before developing symptoms and electing to stay home as a way to prevent transmission.

Q: Why does CDC recommend that we consider obtaining a signed declination from HCP who refuse influenza vaccination?

A: Some studies have shown an increase in HCP influenza vaccine acceptance when decliners are required to sign such a statement. In addition, such statements can help a vaccination program assess the reasons for declination and plan future educational efforts.

You can find links to sample influenza vaccination declination forms in the resources section at the end of the Q&As.

Q: Please tell me which professional associations have endorsed mandatory influenza vaccination for healthcare workers and have created policy statements.

A: The following professional associations have issued policy statements supporting mandatory healthcare worker influenza vaccination:

You can find additional information about mandatory influenza vaccination for HCP including a list of more than 100 healthcare settings that have implemented mandatory vaccination programs. Access IAC's Honor Roll for Patient Safety web section at http://www.immunize.org/honor-roll



Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices and the Hospital Infection Control Practices Advisory Committee (1997)

Influenza Vaccination of Health-Care Personnel (2006)

ACIP recommendations for all vaccines, including MMR, varicella, influenza, Tdap, and hepatitis B

From IAC

IAC provides links to all ACIP recommendations chronologically and by disease at

Healthcare Personnel Vaccination Recommendations

Hepatitis B and the Healthcare Worker

Screening Questionnaire for Injectable Influenza Vaccination (English)

Screening Questionnaire for Injectable Influenza Vaccination (Spanish)

Screening Questionnaire for Intranasal Influenza Vaccination (English)

Screening Questionnaire for Intranasal Influenza Vaccination (Spanish)

Declination of Influenza Vaccination (English)

Declination of Influenza Vaccination (Spanish)

Sample standing orders for most vaccines, including all those recommended for HCP, can be accessed at http://www.immunize.org/standing-orders

Visit IAC's Honor Roll for Patient Safety to view stellar examples of influenza vaccination mandates in healthcare settings at http://www.immunize.org/honor-roll

IAC works with CDC to compile new "Ask the Experts" Q&As for our publications based on commonly asked questions. We also consider the need to provide information about new vaccines and recommendations. Most of the questions are thus a composite of several inquiries.

You can email your question about vaccines or immunization to IAC at admin@immunize.org As we receive hundreds of emails each month, we cannot guarantee that we will print your specific question in the "Ask the Experts" feature. However, you will get an answer. To see if your question has already been answered, you can first check the "Ask the Experts" online archive at http://www.immunize.org/askexperts

You can also email CDC's immunization experts directly at nipinfo@cdc.gov There is no charge for this service.

If you have a question about IAC materials or services, email admininfo@immunize.org

Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at http://www.immunize.org/subscribe

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