Hepatitis B Vaccines
Unvaccinated healthcare personnel (HCP) and/or those who cannot document previous vaccination should receive a 3-dose series of hepatitis B vaccine 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 #3 to document immunity.
- If anti-HBs are at least 10 mIU/mL (positive), the vaccine is immune. No further serologic testing or vaccination is recommended.
- If anti-HBs are less than 10 mIU/mL (negative), the vaccine is not protected from hepatitis B virus (HBV) infection, and should receive 3 additional doses of Hepatitis B vaccine on the routine schedule, followed by anti-HBs testing 1–2 months later. A vaccine whose anti-HBs remain less than 10 mIU/mL after 6 doses is considered a “non-responder.”
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 immune suppressed patients (e.g., stem cell transplant recipients) when they require protective isolation.
Measles, Mumps, Rubella (MMR) Vaccines
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 (chickenpox) Vaccines
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
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 boosters every 10 years thereafter.
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.