Immunization for vaccine-preventable diseases: why aren't we protecting our students?

Affiliations: 1. Department of Medicine, University of North Carolina, Chapel Hill, North Carolina; 2. Department of Hospital Epidemiology, UNC Health Care, Chapel Hill, North Carolina; 3. Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Received June 29, 2011; accepted July 1, 2011; electronically published July 22, 2011. 2011 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2011/3209-0012$15.00. DOI: 10.1086/661791 Despite major advances in the prevention and treatment of infectious diseases, infections still remain a common reason for admission to US hospitals. Healthcare personnel (HCP) are at risk for acquiring infections from patients and, if they are infected, transmitting infections to patients. The risk of acquisition of an infectious disease during the care of a patient is a major reason physicians have been held in such high regard by the public. While this risk can be minimized by adherence to infection control guidelines, it cannot be entirely eliminated. For example, more than 20% of persons who acquired severe acute respiratory syndrome (SARS) were healthcare workers. In Vietnam, Canada, and Singapore, healthcare workers accounted for 57%, 43%, and 41% of SARS patients, respectively. Protection of HCP from acquisition of infectious diseases can be achieved by adherence to established infection control guidelines to include the following: (1) assuring that HCP are immune to vaccine-preventable diseases; (2) strict adherence to standard precautions when providing patient care, especially the performance of hand hygiene before and after patient care; (3) rapid evaluation and appropriate isolation of patients with potentially communicable diseases; (4) proper use of personal protective equipment, such as masks, N-95 respirators, eye protection, and gowns, for patients with potentially communicable diseases; and (5) evaluation of personnel with exposure to communicable diseases for receipt of postexposure prophylaxis (eg, pertussis). Immunity to vaccine-preventable diseases for which transmission has been shown in healthcare facilities is recommended by the Centers for Disease Control and Prevention (CDC), the Healthcare Infection Control Practices Advisory Committee, the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics. Failure to assure immunity to vaccine-preventable diseases had led to large institutional outbreaks in healthcare facilities, morbidity and mortality among hospitalized patients, and even morbidity and mortality among HCP. HCP not only have become infected with vaccine-preventable diseases through patient care but also have served to initiate or propagate hospital outbreaks. The CDC and ACIP in recent publications have replaced the term “healthcare workers” with “healthcare personnel” specifically to indicate that all persons providing patient care should be immunized, including healthcare facility employees (eg, nurses and environmental service workers), physicians (who are often independent contractors), students, volunteers, and contract workers. All HCP should be immune to measles, mumps, rubella, varicella, pertussis, and influenza. Immunity should be demonstrated by all HCP providing service in the medical facility, not just those providing direct patient care, as all of the diseases just listed are transmitted by the droplet or airborne routes and hence unimmunized HCP, if infected, could transmit infection to their colleagues or patients via close contact or in common areas (eg, cafeteria or gift shop). HCP with potential exposure to blood or contaminated fluids must be offered hepatitis B vaccine per regulations from the US Occupational Health and Safety Administration. Healthcare facilities should screen HCP prior to providing service in the healthcare facility for immunity by using current recommendations (Table 1). Unimmunized HCP should be immunized with the appropriate vaccines unless there is a medical contraindication. Religious and personal objections to vaccines should be accepted only if required by local and state regulations or laws, as susceptible HCP pose a substantial risk to the well-being of their patients. HCP should be provided vaccines that are recommended for adults, such as human papilloma virus, herpes zoster, and pneumococcal vaccines, or referred to their local medical provider. In special circumstances, HCP or laboratory personnel should be offered immunization with other vaccines, includ-