Healthcare Worker Vaccinations PDF

VACCINATION FOR HEALTHCARE WORKERS  Introduction Immunity wanes with age in adults. Health care workers (HCW) have additional risk of coming in contact with patients and infective materials from patients. Vaccines can prevent hospital outbreaks. Vaccines can prevent deve...

VACCINATION FOR HEALTHCARE WORKERS  Introduction Immunity wanes with age in adults. Health care workers (HCW) have additional risk of coming in contact with patients and infective materials from patients. Vaccines can prevent hospital outbreaks. Vaccines can prevent development of severe health conditions:  Vaccination of HCW is an Essential part of Infection prevention & control program. HCW should be provided a copy of their Vaccination records & encouraged to keep it with them. Employers can review vaccination and immunity status of employees at the time of hire & at regular intervals.  Vaccine record should include: Name of the vaccine Date of administration Site of administration Number of dose Any adverse reaction/allergic response Health conditions of HCW: H/o smoking, presence of Liver disease, Spleen damage, Bone marrow transplant etc.  Overview All adults must receive: Aged 19-26 years: COVID-19 vaccine. HPV vaccine in addition Tetanus, Diphtheria, to other adult vaccines. Pertussis (TdaP) vaccine If age >26 years HPV single dose & then Td vaccines can be taken booster doses every 10 years. after consulting Influenza vaccine every year. consultants. Age 50 years & above: HCW: Varicella/Chicken pox Hepatitis B, MMR, vaccine & Pneumococcal Meningococcal vaccine in vaccine in addition to other addition to other adult adult vaccines. vaccines.  Diseases for which routine vaccination of HCW is recommended: Hepatitis B, Seasonal influenza, Measles, Mumps, Rubella, Pertussis, Varicella vaccine. Diseases for which vaccination might be indicated in certain circumstances: Meningococcal, Typhoid & Polio vaccine etc..  Diseases for Which Vaccination Is Recommended for HCW Hepatitis B Seasonal influenza Measles, Mumps, Rubella Pertussis Varicella vaccine Covid-19  Hepatitis B vaccine Recombinant vaccine. Dose: 0, 1 & 6 months. Route: IM in Deltoid region. Vaccine efectiveness: >90% after 3rd dose. Anti-HBsAg titres >10 mIU/ml after 1-2 months of 3rd dose is protective dose. If titres 10 mIU/ml titres even after revaccination schedule.  Post exposure prophylaxis (PEP): Non responders- Take Hepatits B immunoglobulin (HBIG) within 24 hours post exposure. Unvaccinated, Incompletely vaccinated & HCW with Anti-HBsAg titres 10 mIU/ml don’t need anything. Adverse effects: Pain at the injection site & Hypersensitivity reaction. Pregnancy is not a contraindication to receive the vaccine.  Influenza (Flu) vaccine A single dose of inactivated flu vaccine of 0.5 ml is given IM into the deltoid muscle for all who are aged >6 months. Live attenuated influenza vaccine can be intranasally given to non-pregnant adults aged between 2-49 years. Infected HCW if continues to work can transmit the infection to patients, many of whom can land up in severe outcomes of the disease. Influenza can cause outbreaks of severe respiratory illness among hospitalized persons and long-term-care residents  Annual vaccination is recommended because predominant variant roaming in the community changes every year. Oseltamivir or zanamivir are recommended currently for both chemoprophylaxis and treatment of influenza Chemoprophylaxis: Antivirals are used often among patients & unvaccinated HCW during outbreaks. It consists of 1 dose (of either antiviral drug) daily for 10 days. Treatment: It consists of 1 dose twice daily for 5 days.  Measles Measles is a highly contagious rash illness that is transmitted by respiratory droplets and airborne spread. Severe complications, which might result in death, include pneumonia and encephalitis. Before the national measles vaccination program was implemented in 1963, almost every person acquired measles before adulthood.  Because of the greater opportunity for exposure, HCW are at higher risk than the general population for becoming infected with measles. MMR vaccine is highly effective in preventing measles with a 1-dose vaccine effectiveness of 95% when administered on or after age 12 months and a 2-dose vaccine effectiveness of 99%. Dose: 0.5ml SC route single dose. Adverse effects: Anaphylactic reactions.  Mumps Mumps is an acute viral infection characterized by fever and inflammation of the salivary glands. Although health-care–associated transmission of mumps is infrequent, it might be underreported because 20%–40% are asymptomatic. 2-dose vaccine effectiveness is 80%–95%. Dose: 0.5ml SC route single dose. Prevention of outbreak in the hospital: Placing patients in droplet precautions. HCW with mumps should be excluded from work for 5 days from the onset of parotitis.  Rubella Rubella (German measles) is a viral disease characterized by rash, low-grade fever, lymphadenopathy, and malaise. Infection is asymptomatic in 25%–50% of cases. When a pregnant woman becomes infected, especially during the first trimester, it can result in miscarriages, stillbirths, therapeutic abortions, and congenital rubella syndrome (CRS). Postnatal rubella is transmitted through direct or droplet contact from nasopharyngeal secretions. Because of the potential for contact with pregnant women in health-care facility, all HCW should have documented presumptive evidence of immunity to rubella.  Hospital outbreaks can result in serious consequences, including pregnancy terminations, disruption of hospital routine, absenteeism from work, expensive containment measures, negative publicity, and the threat of litigation. In the outbreaks, transmission occurs from HCW to patients, and from patients to HCW. Dose: 0.5ml SC route single dose Vaccine effectiveness is 99% after single dose of MMR vaccine. The only reliable evidence of previous rubella infection is the presence of serum rubella IgG antibody. Adverse effects: Anaphylaxis, thrombocytopenia, acute arthritis.  Pertussis Pertussis is a highly contagious bacterial infection. Secondary attack rates among susceptible household contacts exceed 80%. Transmission occurs by direct contact with respiratory secretions. Infants too young to be vaccinated are at greatest risk for severe pertussis, including hospitalization and death. In hospital settings, transmission of pertussis has occurred from hospital visitors to patients, from HCW to patients, and from patients to HCW. Vaccine schedule: Single dose of Tdap vaccine followed by Td boosters every 10 years.  Vaccine effectiveness: 92%. The cost of infection control would be $388,000 without Tdap vaccination of HCW compared with $69,000 with Tdap vaccination(Calugar A et al). Postexposure antimicrobial prophylaxis is recommended for all HCW who have unprotected exposure to pertussis and are likely to expose themselves to risk groups such as hospitalized neonates and pregnant women. Recommended Postexposure prophylaxis: Antibiotics for HCW exposed to pertussis include azithromycin, clarithroymycin, or erythromycin. Exclude from work.  Varicella Varicella vaccine is a live attenuated vaccine. All HCW who have never had chickenpox should receive 2 doses 0.5 ml subcutaneously 4-6 weeks apart. The vaccine is contraindicated in pregnant woman, persons on corticosteroids & other immunosuppressive drugs. It is also contraindicated in HIV patients with CD4 count 60 years of age can be given precaution dose of Covid vaccine if they have finished 9 months from 2nd dose. Other Covid vaccines: Pfizer-BioNTech: It is a m-RNA vaccine. Can be given to people above 5 years of age. 2 doses given 3 weeks apart. Moderna: It is a m-RNA vaccine. Can be given to people above 18 years of age. 2 doses given 4 weeks apart. Sputnik vaccine: It is a Adeno virus based viral vector vaccine.  Diseases for Which Vaccination Might Be Indicated in Certain Circumstances Meningitis: Nosocomial transmission of Meningitis is rare, but HCW have become infected after direct contact with respiratory secretions of infected persons (e.g., during resuscitation) and in a laboratory setting. 2 Vaccines are available: Quadrivalent (A, C, W-135, Y) Meningococcal conjugate vaccine (MCV4) is available for persons aged through 55 years of age. Quadrivalent (A, C, W-135, Y) Meningococcal polysaccharide vaccine (MPSV4) is available for use in persons aged >55 years. Vaccines are not recommended routinely for all HCW.  A 2-dose MCV4 series is recommended for HCW with known Asplenia or persistent complement component deficiencies & who are active/passive smokers. Microbiologists who might be exposed routinely to isolates of N. meningitides should receive a single dose of MCV4 and receive a booster dose every 5 years if they remain at increased risk. Health-care personnel aged >55 years who have any of the above risk factors for meningococcal disease should be vaccinated with MPSV4. Postexposure prophylaxis (PEP): Rifampin, ciprofloxacin, and ceftriaxone are effective in eradicating nasopharyngeal carriage of N. meningitidis. PEP should be given preferably within 24 hours of exposure.  Typhoid Endemic in South Asian & southeast Asian countries. Available vaccines: Oral live-attenuated Ty21a vaccine (one enteric-coated capsule taken on alternate days for a total of four capsules) and the capsular polysaccharide parenteral vaccine 0.5 mL intramuscular dose. Protective efficacy: 50%–80%. To maintain immunity, booster doses of the oral vaccine are required every 5 years, and booster doses of the injected vaccine are required every 2 years.  Microbiologists and others who work frequently with S. Typhi should be vaccinated with either of the two licensed vaccines. Prevention of outbreak: Personal hygiene, particularly hand hygiene before and after all patient contacts. HCW who contract an acute diarrheal illness accompanied by fever, cramps, or bloody stools should be excluded from work until the condition has been evaluated & treated.  POLIO Poliovirus can be recovered from infected persons, including pharyngeal specimens, feces, urine, and (rarely) cerebrospinal fluid. HCW and laboratory workers might be exposed if they come into close contact with infected persons (e.g., travelers returning from areas where polio is endemic) or with specimens that contain poliovirus. Unvaccinated HCW should receive a 3-dose series of IPV, with dose 2 administered 4–8 weeks after dose 1, and dose 3 administered 6–12 months after dose 2. HCW who have previously completed a routine series of poliovirus vaccine and who are at increased risk can receive single lifetime booster dose.  Pneumococcal vaccines There are two vaccines available for Pneumococci. Pneumococcal polysaccharide vaccine (PPSV23): Contains 23 serotypes, covers mainly serotypes of adults, promotes herd immunity, doesn’t provide mucosal immunity. Pneumococcal conjugate vaccine (PCV13): Contains 13 serotypes, more immunogenic, doesn’t provide herd immunity but provides mucosal immunity.  HCW (19-64 years): Immunocompetent: 1 dose of PPSV23. Immunocompromised: 1 dose of PCV13 followed by 1 dose of PPSV23 given at >8 weeks gap. HCW (>65 years): Immunocompetent: 1 dose of PCV13 followed by 1 dose of PPSV23 given given at a gap of 1 year. Immunocompromised: 1 dose of PCV13 followed by 1 dose of PPSV23 given at >8 weeks gap. Immunocompromised conditions: H/o smoking, alcoholism, lung/liver/heart/kidney disease, spleen disease, sickle cell disease, with Cochlear/CSF implants.  Tetanus and diphtheria toxoids (Td) Vaccine schedule: Single dose of Tdap vaccine followed by Td boosters every 10 years. Td boosters are to be given every 10 years. Tdap/Td vaccines are contraindicated in person with h/o anaphylaxis to vaccine components. Tdap vaccine is contraindicated in adults with a history of encephalopathy. These persons should receive Td vaccine.  Human Papilloma Virus In age group 9-14 years, 2doses are recommended at an interval of 6 months. For >15 years, 3 doses are recommended at 0,1, and 6 months. The dose is 0.5 ml intramuscularly After 26 years of age HPV vaccination can be given after consulting the treating doctor.  Hepatits A (HAV) 2 or 3 doses of the vaccine is needed for HCW with additional risk factors such as: HCW who work with HAV in the lab, who are suffering from chronic liver disease, who are travelling to HAV endemic countries, who have received clotting factors, who have received liver transplant, homosexual men, who work in hospital canteen.  Steps for successful implementation of vaccination for HCW Education about vaccine preventable infections. Easy access to vaccines. Organized campaigns. Implementing vaccination records for every HCW. Reviewing vaccination records of HCW every year. Making vaccines free for HCW. Conducting vaccine workshops. THANK YOU