CDC urges better flu, pertussis vaccination
New guidelines a 14-year update
Hospitals should boost the pertussis vaccination rates of their employees, track and report their influenza vaccination rates, and review employees' immunity to measles, mumps and rubella (MMR), according to updated recommendations from the Centers for Disease Control and Prevention.
The agency issued an update to the 14-year-old guidelines on Immunization of Healthcare Personnel (http://1.usa.gov/ukOECq). The new document is a compilation of previous recommendations by the Advisory Committee on Immunization Practices (ACIP), a federal advisory panel to CDC.
The recommendations now will become a dynamic document, updated at least annually online, says Abigail Shefer, MD, FACP, associate director for science in CDC's National Center for Immunization and Respiratory Disease.
Among the changes since 1997: Stronger language urging pertussis and influenza vaccination of health care personnel, which includes employees who do not have direct patient care responsibilities as well as volunteers, students and contract workers.
In 2010, there were 27,555 cases of pertussis nationwide, the highest number in 63 years. More than 9,000 of those cases were in California, where 10 infants died. Hospital outbreaks have been associated with transmission to or from health care workers.1Yet in 2009, only 17% of health care workers had received a pertussis booster, which is the Tdap vaccine, according to the National Health Interview Survey.2
The guidelines emphasize that all health care workers should receive a single dose of Tdap, regardless of when they received their last tetanus booster. Tdap is a tetanus, diphtheria and acellular pertussis vaccine.
Meanwhile, CDC also stressed the need for all health care workers to receive the flu vaccine and said that flu vaccination should be a measure of quality of care. CDC did not comment on the use of mandates, but recommended a "comprehensive influenza vaccination strategy" tailored to the needs of health care organizations.
"It probably does take an aggressive approach for facilities to achieve [high vaccination rates] both for influenza and Tdap," says Shefer.
According to the guidelines, it is no longer adequate for health care workers to report that they previously had measles, mumps or varicella. They would need documentation from a health care provider regarding a history of varicella or herpes zoster. Measles, mumps and rubella would require laboratory confirmation of disease.
Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety at the Marshfield (WI) Clinic, would have liked CDC to go a step farther with its MMR recommendations. Cunha documents post-vaccination titers. If a new employee reports previous MMR vaccination but has no documentation of a post-vaccination titer, he tests. If the titer is negative, Cunha gives the employee a dose of vaccine and tests again. "We have very, very clear evidence of who is immune and who is a non-responder," he says.
In an outbreak, Cunha doesn't have to scramble to determine the immune status of employees. For example, during a mumps outbreak about five years ago, "we had no employees who had any issues with mumps because we know they're all immune by titer, not by vaccination history," he says.
"Immunization does not equate to immunity," he says. "You cannot say a person is immune just because they got immunized."
Health care facilities may go beyond the recommendations, notes Shefer. CDC did not recommend titer testing because it was not considered to be cost-effective, she says.
CDC also leaves some latitude for health care workers born before 1957. They are still presumed to be immune to mumps because they are likely to have had natural disease. However, CDC says health care facilities "should consider" vaccinating those employees with two doses of MMR if they don't have laboratory confirmation of immunity or disease. In the case of an outbreak, health care facilities "should recommend" two doses of MMR to those unvaccinated employees born before 1957 and without lab confirmation of immunity or disease.
References
1. Centers for Disease Control and Prevention. Outbreaks of pertussis associated with hospitals – Kentucky, Pennsylvania and Oregon, 2003. MMWR 2005; 54:67-71.
2. Centers for Disease Control and Prevention. 2009 Adult vaccination coverage, NHIS. (Updated March 2, 2011.): http://1.usa.gov/cPezDA
Hospitals should boost the pertussis vaccination rates of their employees, track and report their influenza vaccination rates, and review employees' immunity to measles, mumps and rubella (MMR), according to updated recommendations from the Centers for Disease Control and Prevention.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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