2. Introduction
• Immunity wanes with age in adults.
• Health care workers (HCW) have additional risk of
coming in contact with patients and infective
materials from patients.
• Vaccines can prevent hospital outbreaks.
• Vaccines can prevent development of severe health
conditions:
3. • Vaccination of HCW is an Essential part of Infection
prevention & control program.
• HCW should be provided a copy of their Vaccination
records & encouraged to keep it with them.
• Employers can review vaccination and immunity
status of employees at the time of hire & at regular
intervals.
4. • Vaccine record should include:
• Name of the vaccine
• Date of administration
• Site of administration
• Number of dose
• Any adverse reaction/allergic response
• Health conditions of HCW: H/o smoking, presence of
Liver disease, Spleen damage, Bone marrow transplant
etc.
5. All adults must receive:
COVID-19 vaccine.
Tetanus, Diphtheria,
Pertussis (TdaP) vaccine
single dose & then Td
booster doses every 10 years.
Influenza vaccine every year.
HCW:
Hepatitis B, MMR,
Meningococcal vaccine in
addition to other adult
vaccines.
Age 50 years & above:
Varicella/Chicken pox
vaccine & Pneumococcal
vaccine in addition to other
adult vaccines.
Aged 19-26 years:
HPV vaccine in addition
to other adult vaccines.
If age >26 years HPV
vaccines can be taken
after consulting
consultants.
Overview
6. • Diseases for which routine vaccination of
HCW is recommended: Hepatitis B, Seasonal
influenza, Measles, Mumps, Rubella, Pertussis,
Varicella vaccine.
• Diseases for which vaccination might be
indicated in certain circumstances:
Meningococcal, Typhoid & Polio vaccine etc..
7. Diseases for Which Vaccination Is
Recommended for HCW
• Hepatitis B
• Seasonal influenza
• Measles, Mumps, Rubella
• Pertussis
• Varicella vaccine
• Covid-19
8. Hepatitis B vaccine
• Recombinant vaccine.
• Dose: 0, 1 & 6 months.
• Route: IM in Deltoid region.
• Vaccine efectiveness: >90% after 3rd dose.
• Anti-HBsAg titres >10 mIU/ml after 1-2 months of 3rd
dose is protective dose.
• If titres <10 mIU/ml, 3 dose Revaccination schedule
is followed.
• Non-Responders: Those who fail to achieve >10
mIU/ml titres even after revaccination schedule.
9. • Post exposure prophylaxis (PEP):
• Non responders- Take Hepatits B immunoglobulin
(HBIG) within 24 hours post exposure.
• Unvaccinated, Incompletely vaccinated & HCW with
Anti-HBsAg titres <10 mIU/ml- Take single dose of
hepatits B immunoglobulin (HBIG) and single dose of
vaccine as early as possible.
• HCW with Anti-HBsAg titres >10 mIU/ml don’t need
anything.
• Adverse effects: Pain at the injection site &
Hypersensitivity reaction.
• Pregnancy is not a contraindication to receive the
vaccine.
10. Influenza (Flu) vaccine
• A single dose of inactivated flu vaccine of 0.5 ml is
given IM into the deltoid muscle for all who are aged >6
months.
• Live attenuated influenza vaccine can be intranasally
given to non-pregnant adults aged between 2-49 years.
• Infected HCW if continues to work can transmit the
infection to patients, many of whom can land up in severe
outcomes of the disease.
• Influenza can cause outbreaks of severe respiratory
illness among hospitalized persons and long-term-care
residents
11. • Annual vaccination is recommended because
predominant variant roaming in the community changes
every year.
• Oseltamivir or zanamivir are recommended currently
for both chemoprophylaxis and treatment of influenza
• Chemoprophylaxis: Antivirals are used often among
patients & unvaccinated HCW during outbreaks. It
consists of 1 dose (of either antiviral drug) daily for 10
days.
• Treatment: It consists of 1 dose twice daily for 5 days.
12. Measles
• Measles is a highly contagious rash illness that is
transmitted by respiratory droplets and airborne
spread.
• Severe complications, which might result in death,
include pneumonia and encephalitis.
• Before the national measles vaccination program was
implemented in 1963, almost every person acquired
measles before adulthood.
13. • Because of the greater opportunity for exposure, HCW
are at higher risk than the general population for
becoming infected with measles.
• MMR vaccine is highly effective in preventing measles
with a 1-dose vaccine effectiveness of 95% when
administered on or after age 12 months and a 2-dose
vaccine effectiveness of 99%.
• Dose: 0.5ml SC route single dose.
• Adverse effects: Anaphylactic reactions.
14. Mumps
• Mumps is an acute viral infection characterized by
fever and inflammation of the salivary glands.
• Although health-care–associated transmission of
mumps is infrequent, it might be underreported
because 20%–40% are asymptomatic.
• 2-dose vaccine effectiveness is 80%–95%.
• Dose: 0.5ml SC route single dose.
• Prevention of outbreak in the hospital:
• Placing patients in droplet precautions.
• HCW with mumps should be excluded from work for
5 days from the onset of parotitis.
15. Rubella
• Rubella (German measles) is a viral disease characterized
by rash, low-grade fever, lymphadenopathy, and malaise.
• Infection is asymptomatic in 25%–50% of cases.
• When a pregnant woman becomes infected, especially
during the first trimester, it can result in miscarriages,
stillbirths, therapeutic abortions, and congenital rubella
syndrome (CRS).
• Postnatal rubella is transmitted through direct or droplet
contact from nasopharyngeal secretions.
• Because of the potential for contact with pregnant women
in health-care facility, all HCW should have documented
presumptive evidence of immunity to rubella.
16. • Hospital outbreaks can result in serious consequences,
including pregnancy terminations, disruption of
hospital routine, absenteeism from work, expensive
containment measures, negative publicity, and the
threat of litigation.
• In the outbreaks, transmission occurs from HCW to
patients, and from patients to HCW.
• Dose: 0.5ml SC route single dose
• Vaccine effectiveness is 99% after single dose of MMR
vaccine.
• The only reliable evidence of previous rubella infection
is the presence of serum rubella IgG antibody.
• Adverse effects: Anaphylaxis, thrombocytopenia, acute
arthritis.
17. Pertussis
• Pertussis is a highly contagious bacterial infection.
Secondary attack rates among susceptible household
contacts exceed 80%.
• Transmission occurs by direct contact with respiratory
secretions.
• Infants too young to be vaccinated are at greatest risk
for severe pertussis, including hospitalization and
death.
• In hospital settings, transmission of pertussis has
occurred from hospital visitors to patients, from HCW to
patients, and from patients to HCW.
• Vaccine schedule: Single dose of Tdap vaccine followed
by Td boosters every 10 years.
18. • Vaccine effectiveness: 92%.
• The cost of infection control would be $388,000 without
Tdap vaccination of HCW compared with $69,000 with
Tdap vaccination(Calugar A et al).
• Postexposure antimicrobial prophylaxis is recommended
for all HCW who have unprotected exposure to pertussis
and are likely to expose themselves to risk groups such
as hospitalized neonates and pregnant women.
• Recommended Postexposure prophylaxis:
• Antibiotics for HCW exposed to pertussis include
azithromycin, clarithroymycin, or erythromycin.
Exclude from work.
19. Varicella
• Varicella vaccine is a live attenuated vaccine.
• All HCW who have never had chickenpox should receive
2 doses 0.5 ml subcutaneously 4-6 weeks apart.
• The vaccine is contraindicated in pregnant woman,
persons on corticosteroids & other immunosuppressive
drugs. It is also contraindicated in HIV patients with CD4
count <200. Such people should receive varicella zoster
immunoglobulin (VZIG).
• Secondary attack rate is 90%.
• Mode of transmission is direct contact & aerosols.
20. • Prevention of hospital outbreak:
• Isolation room/ Negative pressure room for the patient.
• Airborne precautions and contact precautions.
• Treating HCW & restriction from work.
• Post exposure prophylaxis (PEP):
• For the vaccinated HCW: Observed for symptoms for 8-
21 days following exposure.
• For Unvaccinated HCW: Vaccination should be given
within 3-5 days of exposure. Observed for symptoms.
• For pregnant and immunocompromised HCW: Vaccine is
avoided. VZIG should be given. Observed for symptoms.
21. Zoster vaccine
• Zoster vaccine contains the same live attenuated
varicella zoster virus as varicella vaccine but at a
higher concentration (approximately 14 times
more vaccine virus per dose).
• Zoster vaccine is recommended for the prevention
of HZ (shingles) in HCW aged ≥60 years.
22. COVID-19
• Covishield & Covaxin are mainly used in India.
• Covishield: It is a viral vector based vaccine which
contains inactivated Adenovirus containing components
of Corona virus. Two vaccines are given 12-16 weeks
apart.
• Covaxin: It is whole cell inactivated vaccine. Two
vaccines are given 4-6 weeks apart.
• Age limit: Above 18 years of age.
• Vaccination for Children of age 15-18 years started
recently with Covaxin.
23. • For HCW, front line workers & people >60 years of
age can be given precaution dose of Covid vaccine if
they have finished 9 months from 2nd dose.
• Other Covid vaccines:
• Pfizer-BioNTech: It is a m-RNA vaccine. Can be given
to people above 5 years of age. 2 doses given 3 weeks
apart.
• Moderna: It is a m-RNA vaccine. Can be given to
people above 18 years of age. 2 doses given 4 weeks
apart.
• Sputnik vaccine: It is a Adeno virus based viral vector
vaccine.
24. Diseases for Which Vaccination Might
Be Indicated in Certain Circumstances
• Meningitis: Nosocomial transmission of Meningitis is
rare, but HCW have become infected after direct contact
with respiratory secretions of infected persons (e.g., during
resuscitation) and in a laboratory setting.
• 2 Vaccines are available:
• Quadrivalent (A, C, W-135, Y) Meningococcal conjugate
vaccine (MCV4) is available for persons aged through 55
years of age.
• Quadrivalent (A, C, W-135, Y) Meningococcal
polysaccharide vaccine (MPSV4) is available for use in
persons aged >55 years.
• Vaccines are not recommended routinely for all HCW.
25. • A 2-dose MCV4 series is recommended for HCW with
known Asplenia or persistent complement component
deficiencies & who are active/passive smokers.
• Microbiologists who might be exposed routinely to isolates
of N. meningitides should receive a single dose of MCV4 and
receive a booster dose every 5 years if they remain at
increased risk.
• Health-care personnel aged >55 years who have any of the
above risk factors for meningococcal disease should be
vaccinated with MPSV4.
• Postexposure prophylaxis (PEP):
• Rifampin, ciprofloxacin, and ceftriaxone are effective in
eradicating nasopharyngeal carriage of N. meningitidis.
• PEP should be given preferably within 24 hours of exposure.
26. Typhoid
• Endemic in South Asian & southeast Asian countries.
• Available vaccines: Oral live-attenuated Ty21a
vaccine (one enteric-coated capsule taken on alternate
days for a total of four capsules) and the capsular
polysaccharide parenteral vaccine 0.5 mL
intramuscular dose.
• Protective efficacy: 50%–80%.
• To maintain immunity, booster doses of the oral vaccine
are required every 5 years, and booster doses of the
injected vaccine are required every 2 years.
27. • Microbiologists and others who work frequently with
S. Typhi should be vaccinated with either of the two
licensed vaccines.
• Prevention of outbreak:
• Personal hygiene, particularly hand hygiene before
and after all patient contacts.
• HCW who contract an acute diarrheal illness
accompanied by fever, cramps, or bloody stools should
be excluded from work until the condition has been
evaluated & treated.
28. POLIO
• Poliovirus can be recovered from infected persons, including
pharyngeal specimens, feces, urine, and (rarely)
cerebrospinal fluid.
• HCW and laboratory workers might be exposed if they come
into close contact with infected persons (e.g., travelers
returning from areas where polio is endemic) or with
specimens that contain poliovirus.
• Unvaccinated HCW should receive a 3-dose series of
IPV, with dose 2 administered 4–8 weeks after dose 1, and
dose 3 administered 6–12 months after dose 2.
• HCW who have previously completed a routine series of
poliovirus vaccine and who are at increased risk can receive
single lifetime booster dose.
29. Pneumococcal vaccines
• There are two vaccines available for Pneumococci.
• Pneumococcal polysaccharide vaccine (PPSV23):
Contains 23 serotypes, covers mainly serotypes of
adults, promotes herd immunity, doesn’t provide
mucosal immunity.
• Pneumococcal conjugate vaccine (PCV13):
Contains 13 serotypes, more immunogenic, doesn’t
provide herd immunity but provides mucosal
immunity.
30. • HCW (19-64 years):
• Immunocompetent: 1 dose of PPSV23.
• Immunocompromised: 1 dose of PCV13 followed by 1
dose of PPSV23 given at >8 weeks gap.
• HCW (>65 years):
• Immunocompetent: 1 dose of PCV13 followed by 1
dose of PPSV23 given given at a gap of 1 year.
• Immunocompromised: 1 dose of PCV13 followed by 1
dose of PPSV23 given at >8 weeks gap.
• Immunocompromised conditions: H/o smoking,
alcoholism, lung/liver/heart/kidney disease, spleen
disease, sickle cell disease, with Cochlear/CSF implants.
31. Tetanus and diphtheria toxoids (Td)
• Vaccine schedule: Single dose of Tdap vaccine followed
by Td boosters every 10 years.
• Td boosters are to be given every 10 years.
• Tdap/Td vaccines are contraindicated in person with h/o
anaphylaxis to vaccine components.
• Tdap vaccine is contraindicated in adults with a history
of encephalopathy. These persons should receive Td
vaccine.
32. Human Papilloma Virus
• In age group 9-14 years, 2doses are recommended at an
interval of 6 months.
• For >15 years, 3 doses are recommended at 0,1, and 6
months.
• The dose is 0.5 ml intramuscularly
• After 26 years of age HPV vaccination can be given
after consulting the treating doctor.
33. Hepatits A (HAV)
• 2 or 3 doses of the vaccine is needed for HCW with
additional risk factors such as:
• HCW who work with HAV in the lab, who are
suffering from chronic liver disease, who are
travelling to HAV endemic countries, who have
received clotting factors, who have received liver
transplant, homosexual men, who work in hospital
canteen.
34. Steps for successful implementation of
vaccination for HCW
• Education about vaccine preventable infections.
• Easy access to vaccines.
• Organized campaigns.
• Implementing vaccination records for every HCW.
• Reviewing vaccination records of HCW every year.
• Making vaccines free for HCW.
• Conducting vaccine workshops.
