People who work in healthcare settings are frequently exposed to germs while seeing or caring for patients, but direct contact isn’t always necessary to contract an infection.
Vaccination of healthcare personnel—from doctors and nurses to admissions clerks and ambulance drivers—protects from potentially dangerous diseases like flu and COVID-19, and protects patients and the community at large as well.
Influenza Vaccine
An estimated 12,000 to 61,000 people die from influenza each year in the United States, making it one of the deadliest vaccine-preventable diseases in the country.
Healthcare workers are exposed to this infection from patients who have the flu. According to the Centers for Disease Control and Prevention (CDC), between 140,000 to 810,000 people are hospitalized each year for influenza, depending on the severity of the variant circulating that year.
The groups most vulnerable to hospitalization and death are young children, pregnant women, adults 65 and older, and people with underlying medical conditions—some of whom cannot get the flu vaccine.
Because flu is spread by droplets from coughing or sneezing and by fomite transmission (touching contaminated objects or surfaces), healthcare workers can be exposed even if they don’t come in direct contact with patients.
Hospitals tend to have higher vaccination rates than long-term care facilities like nursing homes, and employees are much more likely to receive the flu vaccine if it is mandated by the state or their employer.
Recommendations
The ACIP recommends that everyone over the age of six months receive the annual flu vaccine, including—and most especially—healthcare workers.
There are nine flu vaccine options, including three specifically recommended for adults 65 and over (Fluzone High-Dose Quadrivalent, Flublok Quadrivalent, and Fluad Quadrivalent).
Hepatitis B Vaccine
Hepatitis B is a chronic viral infection that spreads through blood and other bodily fluids. Over 850,000 people are believed to be infected in the United States, with around 21,000 new infections occurring every year.
Because many people with hepatitis B don’t feel sick, they can spread the virus without even knowing it. If left untreated, hepatitis B can lead to potentially serious conditions, including cirrhosis and liver cancer.
Healthcare workers who are regularly exposed to blood and other bodily fluids are at constant risk of hepatitis B. Vaccination is central to preventing infection, as well as maintaining infection control in healthcare settings.
Prior to routine hepatitis B vaccinations of healthcare workers, a staggering 18% of those working in the medical and dental fields were believed to have been infected. Within 10 years thereafter, the rate dropped to 6%.
Recommendations
The ACIP recommends a two- or three-dose hepatitis B vaccination series for healthcare workers, depending on the vaccine. There are three hepatitis B vaccines approved for use by the U.S. Food and Drug Administration (FDA).
MMR Vaccine
Measles was declared eliminated from the United States in 2000, but the disease has made a huge comeback due, in large part, to the rise of anti-vaccination campaigns. As a result, sporadic outbreaks still occur in the United States, including the 2019 outbreak that affected over 1,200 people in 31 states.
Measles is easily transmitted among children in pediatric offices and care units. Although measles vaccinations in schools have largely reduced such incidents, anti-vaccination sentiments are feared to reverse many of those gains.
In 2008, an unvaccinated 7-year-old boy with measles visited a pediatrician’s office in San Diego and inadvertently passed on the virus to four other children—three of whom were too young to receive the measles, mumps, and rubella (MMR) vaccine. One was hospitalized with severe measles complications.
While rubella and mumps tend to be less serious than measles, unvaccinated healthcare workers can pass the viruses to medically vulnerable patients, like pregnant women, who are at greater risk of harm.
Vaccination is by far the most effective way to prevent these potentially serious diseases.
Recommendations
According to the ACIP, unvaccinated healthcare workers born in 1957 or after should get two doses of the MMR vaccine at least 28 days apart. Vaccination should be considered for unvaccinated healthcare workers born before 1957.
MMR vaccine recommendation:
One dose if lacking proof of immunity against rubella onlyTwo doses if lacking proof of mumps and/or measles
There are two MMR vaccines approved for use in the United States (MMR 2, Priorix). Both are delivered by subcutaneous injection, under the skin.
Considerations
Many people who were vaccinated with MMR don’t recall getting the vaccine or have a record of their childhood vaccinations. If you have evidence, you won’t need to get vaccinated.
Healthcare workers can get tested for immunity using a DNA-based PCR test instead of automatically getting revaccinated if they don’t have vaccine records.
Tdap Vaccine
There are several kinds of tetanus vaccines: Tdap (tetanus, diphtheria, and acellular pertussis) and Td (tetanus and diphtheria), Dtap, and DT. It is recommended to have at least one dose.
Although they can all be used as tetanus booster shots for adults, only Tdap protects against pertussis (whooping cough). In a healthcare setting, this is a very important distinction.
Pertussis, a respiratory disease mainly spread through coughing and sneezing, can be particularly dangerous for young infants. Because the early symptoms of pertussis can seem like the common cold, many adults with pertussis don’t even realize they have been infected and can pass it to others.
This makes pertussis particularly dangerous in neonatal intensive care units (NICUs) where transmission of the bacteria to newborns can be fatal. Despite these hazards, less than half of all healthcare workers receive the vaccine, according to a 2017 study in the American Journal of Preventive Medicine.
Recommendations
According to the ACIP, healthcare workers who haven’t been or are unsure if they’ve been vaccinated against pertussis should get a dose of Tdap. This is true even if they recently received the Td vaccine as part of the recommended vaccine schedule for all adults (in which a Td booster is given every 10 years).
There are two Tdap vaccines approved for use by the FDA.
Varicella Vaccine
Varicella, also known as chickenpox, is no longer commonplace in the United States thanks to widespread vaccination. But outbreaks still occur throughout the country, and cases can spread quickly in healthcare settings. The disease can be particularly dangerous for medically vulnerable patients, such as pregnant women.
People who have varicella infection can be contagious a day or two prior to getting the telltale rash. If you’re a healthcare worker in frequent contact with patients, the effects of an unrecognized infection can be costly.
Studies have shown that a single provider with varicella can expose more than 30 patients to chickenpox, as well as dozens of coworkers. Adults also tend to be more seriously affected by chickenpox, with some experiencing pneumonia, bacterial skin infections, encephalitis (brain inflammation), and sepsis (blood infection).
Recommendations
According to the ACIP, unvaccinated healthcare workers with no laboratory evidence of immunity or documented proof of diagnosis with chickenpox should get two doses of the vaccine, spaced four to eight weeks apart.
There is only one varicella vaccine, called Varivax, approved for use in adults in the United States. It is delivered by subcutaneous injection.
There may be an added benefit of getting Varivax. Studies in children have shown that varicella vaccination reduces the risk of shingles in later life because the virus that causes chickenpox is the same one that causes shingles. The same may apply, at least in part, if you receive Varivax as an adult.
Meningococcal Vaccine
Meningococcal disease is a bacterial infection that can cause meningitis, a condition in which the protective lining of the brain and spinal cord (called the meninges) becomes inflamed.
Meningococcal meningitis is relatively rare but can be serious, resulting in seizures, deafness, shock, multi-organ failure, and death within a matter of hours. Adolescents and young adults are particularly vulnerable.
It is not common for healthcare workers to become infected with meningococcal disease from patients, but it can occur if there is direct exposure to saliva or respiratory secretions (whether from contact with patients or saliva or sputum samples obtained for the lab).
This is especially true during outbreaks at universities or colleges where the disease can spread rapidly through residence halls.
Recommendations
Microbiologists who are routinely exposed to Neisseria meningitidis should get a meningococcal conjugate vaccine and serogroup B meningococcal vaccine.
There are five meningococcal vaccines approved for use by the FDA.
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