Appendix A

A

Appendix A-19

Hepatitis B

Unvaccinated healthcare personnel (HCP) and/

or those who cannot document previous vaccination should receive either a 2-dose series of 

Heplisav-B at 0 and 1 month or a 3-dose series 

of either Engerix-B or Recombivax HB at 0, 1, 

and 6 months. HCP who perform tasks that 

may involve exposure to blood or body fluids 

should be tested for hepatitis B surface antibody (anti-HBs) 1–2 months after dose #2 of 

Heplisav-B or dose #3 of Engerix-B or Recombivax HB to document immunity. 

• If anti-HBs is at least 10 mIU/mL (positive), 

the vaccinee is immune. No further serologic 

testing or vaccination is recommended. 

• If anti-HBs is less than 10 mIU/mL (negative), 

the vaccinee is not protected from hepatitis B 

virus (HBV) infection, and should receive 

another 2-dose or 3-dose series of HepB 

vaccine on the routine schedule, followed by 

anti-HBs testing 1–2 months later. A vaccinee 

whose anti-HBs remains less than 10 mIU/

mL after 2 complete series is considered a 

“non-responder.”

For non-responders: HCP who are non-responders 

should be considered susceptible to HBV and 

should be counseled regarding precautions to 

prevent HBV infection and the need to obtain 

HBIG prophylaxis for any known or probable 

parenteral exposure to hepatitis B surface antigen 

(HBsAg)-positive blood or blood with unknown 

HBsAg status. It is also possible that nonresponders are people who are HBsAg positive. 

HBsAg testing is recommended. HCP found 

to be HBsAg positive should be counseled and 

medically evaluated.

For HCP with documentation of a complete 

2-dose (Heplisav-B) or 3-dose (Engerix-B or Recombivax HB) vaccine series but no documentation of anti-HBs of at least 10 mIU/mL (e.g., 

those vaccinated in childhood): HCP who are at 

risk for occupational blood or body fluid exposure might undergo anti-HBs testing upon hire or 

matriculation. See references 2 and 3 for details.

Influenza 

All HCP, including physicians, nurses, paramedics, 

emergency medical technicians, employees 

of nursing homes and chronic care facilities, 

students in these professions, and volunteers, 

should receive annual vaccination against influenza. Live attenuated influenza vaccine (LAIV) 

may be given only to non-pregnant healthy HCP 

age 49 years and younger. Inactivated injectable 

influenza vaccine (IIV) is preferred over LAIV 

for HCP who are in close contact with severely 

immunosuppressed patients (e.g., stem cell 

transplant recipients) when they require protective isolation. 

Measles, Mumps, Rubella (MMR)

HCP who work in medical facilities should be 

immune to measles, mumps, and rubella. 

• HCP born in 1957 or later can be considered 

immune to measles, mumps, or rubella only 

if they have documentation of (a) laboratory 

confirmation of disease or immunity or 

(b) appropriate vaccination against measles, 

mumps, and rubella (i.e., 2 doses of live 

measles and mumps vaccines given on or after 

the first birthday and separated by 28 days or 

more, and at least 1 dose of live rubella 

vaccine). HCP with 2 documented doses of 

MMR are not recommended to be serologically 

tested for immunity; but if they are tested and 

results are negative or equivocal for measles, 

mumps, and/or rubella, these HCP should be 

considered to have presumptive evidence of 

immunity to measles, mumps, and/or rubella 

and are not in need of additional MMR doses.

• Although birth before 1957 generally is considered acceptable evidence of measles, 

mumps, and rubella immunity, 2 doses of MMR 

vaccine should be considered for unvaccinated HCP born before 1957 who do not have 

laboratory evidence of disease or immunity to 

measles and/or mumps. One dose of MMR 

vaccine should be considered for HCP with no 

laboratory evidence of disease or immunity 

to rubella. For these same HCP who do not 

have evidence of immunity, 2 doses of MMR 

vaccine are recommended during an outbreak 

of measles or mumps and 1 dose during an 

outbreak of rubella.

Varicella 

It is recommended that all HCP be immune to 

varicella. Evidence of immunity in HCP includes 

documentation of 2 doses of varicella vaccine 

given at least 28 days apart, laboratory evidence 

of immunity, laboratory confirmation of disease, 

or diagnosis or verification of a history of varicella or herpes zoster (shingles) by a healthcare 

provider.

Tetanus/Diphtheria/Pertussis (Td/Tdap)

All HCPs who have not or are unsure if they have 

previously received a dose of Tdap should 

receive a dose of Tdap as soon as feasible, without regard to the interval since the previous dose 

of Td. Pregnant HCP should be revaccinated 

during each pregnancy. All HCPs should then 

receive Td or Tdap boosters every 10 years 

thereafter. 

Meningococcal

Vaccination with MenACWY and MenB is 

recommended for microbiologists who are 

routinely exposed to isolates of N. meningitidis. 

The two vaccines may be given concomitantly 

but at different anatomic sites, if feasible.

references

1 CDC. Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization 

Practices (ACIP). MMWR, 2011; 60(RR-7).

2 CDC. Prevention of Hepatitis B Virus Infection in the United States. Recommendations of the Advisory Committee 

on Immunization Practices. MMWR, 2018; 67(RR1):1–30.

3 IAC. Pre-exposure Management for Healthcare Personnel 

with a Documented Hepatitis B Vaccine Series Who Have 

Not Had Post-vaccination Serologic Testing. Accessed at 

www.immunize.org/catg.d/p2108.pdf.

For additional specific ACIP recommendations, visit CDC’s 

website at www.cdc.gov/vaccines/hcp/acip-recs/vaccspecific/index.html or visit IAC’s website at 

www.immunize.org/acip.

Healthcare Personnel Vaccination Recommendations1

vaccines and recommendations in brief

Hepatitis B – If previously unvaccinated, give a 2-dose (Heplisav-B) or 3-dose (Engerix-B 

or Recombivax HB) series. Give intramuscularly (IM). For HCP who perform tasks 

that may involve exposure to blood or body fluids, obtain anti-HBs serologic testing 

1–2 months after dose #2 (for Heplisav-B) or dose #3 (for Engerix-B or Recombivax HB).

Influenza – Give 1 dose of influenza vaccine annually. Inactivated injectable vaccine is 

given IM. Live attenuated influenza vaccine (LAIV) is given intranasally.

MMR – For healthcare personnel (HCP) born in 1957 or later without serologic evidence 

of immunity or prior vaccination, give 2 doses of MMR, 4 weeks apart. For HCP 

born prior to 1957, see below. Give subcutaneously (Subcut).

Varicella (chickenpox) – For HCP who have no serologic proof of immunity, prior 

vaccination, or diagnosis or verification of a history of varicella or herpes zoster 

(shingles) by a healthcare provider, give 2 doses of varicella vaccine, 4 weeks apart. 

Give Subcut.

Tetanus, diphtheria, pertussis – Give 1 dose of Tdap as soon as feasible to all HCP 

who have not received Tdap previously and to pregnant HCP with each pregnancy 

(see below). Give Td or Tdap boosters every 10 years thereafter. Give IM.

Meningococcal – Give both MenACWY and MenB to microbiologists who are routinely exposed to isolates of Neisseria meningitidis. As long as risk continues: boost 

with MenB after 1 year, then every 2–3 years thereafter; boost with MenACWY every 

5 years. Give MenACWY and MenB IM.

Hepatitis A, typhoid, and polio vaccines are not routinely recommended for HCP who may have on-the-job exposure to fecal material.

Immunization Action Coalition Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org

www.immunize.org/catg.d/p2017.pdf • Item #P2017 (2/21)