IAC Express 2011 |
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Issue number 948: August 25, 2011 |
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Contents
of this Issue
Select a title to jump to the article. |
- Read "Ask
the Experts" Q&As about healthcare personnel vaccination
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| Abbreviations |
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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. |
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Issue 948: August 25, 2011 |
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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
http://www.immunize.org/askexperts/experts_mmr.asp
IAC's "Ask the Experts" web section on varicella vaccination
http://www.immunize.org/askexperts/experts_var.asp
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:
http://www.cdc.gov/vaccines/recs/provisional
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
USEFUL RESOURCES
From CDC/ACIP
Immunization of Health-Care Workers: Recommendations of the
Advisory Committee on Immunization Practices and the
Hospital Infection Control Practices Advisory Committee
(1997)
http://www.cdc.gov/mmwr/PDF/rr/rr4618.pdf
Influenza Vaccination of Health-Care Personnel (2006)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm
ACIP recommendations for all vaccines, including MMR,
varicella, influenza, Tdap, and hepatitis B
http://www.cdc.gov/vaccines/pubs/ACIP-list.htm
From IAC
IAC provides links to all ACIP recommendations
chronologically and by disease at
http://www.immunize.org/acip
Healthcare Personnel Vaccination Recommendations
http://www.immunize.org/catg.d/p2017.pdf
Hepatitis B and the Healthcare Worker
http://www.immunize.org/catg.d/p2109.pdf
Screening Questionnaire for Injectable Influenza Vaccination
(English)
http://www.immunize.org/catg.d/p4066.pdf
Screening Questionnaire for Injectable Influenza Vaccination
(Spanish)
http://www.immunize.org/catg.d/p4066-01.pdf
Screening Questionnaire for Intranasal Influenza Vaccination
(English)
http://www.immunize.org/catg.d/p4067.pdf
Screening Questionnaire for Intranasal Influenza Vaccination
(Spanish)
http://www.immunize.org/catg.d/p4067-01.pdf
Declination of Influenza Vaccination (English)
http://www.immunize.org/catg.d/p4068.pdf
Declination of Influenza Vaccination (Spanish)
http://www.immunize.org/catg.d/p4068-01.pdf
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
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HOW TO SUBMIT A QUESTION TO "ASK THE EXPERTS"
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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