Are they protected? Immunity to vaccine‐preventable diseases in healthcare workers at an Australian hospital

Abstract

Objective: Australian guidelines for healthcare worker (HCW) vaccination were updated in 2010, and pre-employment assessment of new employees has previously been identified as a priority. We determined the vaccination status of a cohort of existing HCWs at a tertiary hospital in Melbourne, Victoria.Methods: Random sampling of HCWs employed prior to 2006 with unknown/incomplete immunisation status was conducted between April and August 2011. Immunity to vaccinepreventable diseases (VPDs) was determined serologically (hepatitis B, varicella, measles, mumps, rubella) and by questionnaire (diphtheria, tetanus and pertussis), with vaccination by a nurse immuniser.Results: Overall, 95 HCWs were evaluated. Mean age and duration of employment were 47.2 and 12.6 years, respectively. Forty-seven staff (49%) required vaccination to comply with Australian immunisation guidelines: 18% were non-immune to hepatitis B, 2% to varicella, 8% to measles, 19% to mumps and 13% to rubella. HCWs without serological hepatitis B immunity were all staff with clinical roles. Total costs were $7,527.34 (mean $222.79/HCW). Conclusions:Immunity to VPDs among existing HCWs was inadequate. About half assessed HCWs were non-immune to at least one VPD, and non-immunity to hepatitis B was high. A comprehensive assessment strategy for existing employees is required to enhance vaccination coverage and compliance with national guidelines. Implications:Adequately resourced 'look-back' immunisation assessment programs are required to reduce the risks of VPDs among existing staff and patients. Review of current approaches and national consensus regarding the need for mandatory strategies would assist this process.

Seroprotection to vaccine‐preventable diseases among workers at a Victorian tertiary hospital

“…Compared with the international literature, we found similar rates of seropositivity for measles, mumps, VZV and HBV. However, the rates of seropositivity for rubella were considerably lower in our studied population of HCWs (78%) than have been reported with other recent Australian 11,13 and international 7–10 studies (seropositivity rates range from 83% to 91%). Vagholkar and colleagues found 91% of HCWs were seropositive to measles, 89% for mumps, 91% for rubella, 89% to VZV and only 64% for HBV 11 .…”

“…Vagholkar and colleagues found 91% of HCWs were seropositive to measles, 89% for mumps, 91% for rubella, 89% to VZV and only 64% for HBV 11 . More recently, Leung and colleagues performed a smaller study and showed rates of seroprotection of 92% for measles, 80% for mumps, 86% for rubella, 98% for VZV and 82% for HBV 13 . The reasons for the discrepancies seen between our results and the other Australian studies are unclear, but could relate to the laboratory cut‐off used for positive versus equivocal serology results, smaller study size in previous studies, differences in populations included and demographic factors.…”

“…Previous studies both internationally and in Australia over the past decade have described the seroepidemiology of some or all of these VPDs among HCWs. Overall, the average seroprotection to measles has been shown to be 92% (range 54–100%); 88% for mumps (69–97%); 91% for rubella (83–98%); 92% for VZV (71–99%); and 80% for HBV (58–96%) 7–14 . However, the results of these studies are not necessarily generalisable to other contexts and only a minority included analysis of other potential predictive factors of immunity such as self‐reported disease and vaccination history or demographic factors such as year of birth and country of origin.…”

Factors affecting uptake of recommended immunizations among health care workers in South Australia

“…[1][2][3][4][5][6][7] Despite this, HCW uptake of recommended vaccines is low 2,[8][9][10][11][12][13][14][15][16] , particularly for seasonal influenza and pertussis. 13,[16][17][18][19] In Australia, both pertussis and seasonal influenza vaccines are recommended for all HCWs 17 however providing free influenza vaccine is a policy decision for each hospital or state and is not uniform across Australia. 20 Influenza virus infection causes a wide spectrum of disease, from no or minimal symptoms, to respiratory illness with systemic features, and/or multisystem complications and death from primary viral or secondary bacterial pneumonia.…”

“…22 HCWs have a higher risk of exposure to pertussis due to occupational contact and may be asymptomatic, acting as a reservoir to vulnerable patients in their care. [23][24][25] With low uptake of pertussis vaccine among HCWs 13,18,26 nosocomial outbreaks have been reported. 4,[27][28][29][30][31] In the workplace environment, it is plausible that vaccination recommendations and practices for some vaccinations may influence the uptake of other vaccines.…”