There are some jobs that may require an employee to have occupational health vaccinations, to help protect them against certain diseases, their clients or patients and prevent disease outbreaks. An employers’ occupational health department should be able to advise if any vaccinations are required. Alternatively, private clinics can provide a risk assessment and advise what vaccinations are required for occupational health reasons. Below, we outline which vaccinations are sometimes required for occupational health reasons.
This vaccination helps protect against the bacterial disease Mycobacterium tuberculosis (TB) disease. The rates of infection in developed countries have declined to very low levels. However, infections can still occur in some patients, such as migrant patients who are from a country with more than 40 cases in 100,000. In the UK, the vaccination is still available on the NHS for such high-risk groups. However, for occupational reasons, the risk of exposure would have to be carefully assessed and the vaccination is provided on a private basis. The Department of Health guidance states the following:-
‘People in the following occupational groups, with direct TB patient contact or contact with infectious materials, should be vaccinated with BCG.
- Healthcare worker or laboratory worker, who has either direct contact with TB patients or with potentially infectious clinical materials or derived isolates.
- Veterinary and staff such as abattoir workers who handle animals or animal materials, which could be infected with TB.’
Prior to providing the BCG vaccination, a Mantoux test should be done to determine a persons’ TB status and if they have antibodies to a BCG vaccination, which may have been administered previously. If this is positive, a TB Quantiferon Test or IGRA test should be done to ensure the patient does not have latent or active TB. Only if the tests are negative, can the BCG vaccination be given safely.
Studies have shown that immunity to the BCG vaccination can last a minimum of 15years and up to 60 years. However, there are no studies in patients who have received this over the age of 35 years and the vaccine diminishes in efficacy in older patients.
Administration of the BCG vaccination requires special training as this needs to be given via the intradermal route. Furthermore, the Mantoux test needs to be read accurately to determine the current BCG and TB status. This, along with intermittent supply issues, has made the BCG vaccination a rare but nevertheless, an important occupational health vaccination.
Most people have been exposed to the chickenpox disease in childhood so have natural antibodies which can be identified through a simple blood test. Most healthcare workers have this done as part of the usual screening procedures. If they have not previously been exposed to chickenpox, then it is important for them to have the vaccination as this will protect them against patients who may have chickenpox and also protect patients against potential exposure from the healthcare professional. Chickenpox can have more serious complications in adults, whereas in children, it is most often a mild and self-limiting disease.
The vaccination consists of 2 doses given at least 4 weeks apart, depending on the brand used. It is a well-tolerated vaccine with minimal adverse effects. However, it is a live vaccine so there are clear contraindications to providing this in some groups of patients e.g. immunocompromised patients. Two doses are predicted to provide 77 years immunity.
The incidence of measles, mumps and rubella has decreased dramatically over the past few decades due to a successful vaccination programme. There have been some localised outbreaks of measles and mumps in parts of the UK, which can be explained through the poor uptake of the vaccination for various reasons.
The combined MMR vaccine was licensed in 1988 and the licensed schedule is two doses given a minimum of 4 weeks apart. Patients born before then may only have received a single measles and rubella vaccination, which does not provide long-term immunity to measles and no immunity to mumps. There were also parents who were reluctant to have their children vaccinated with the combined vaccine due to the false links with autism that occurred in the 1990s. The vaccine has a weaker mumps antigen and so two does are needed to help provide a higher level of immunity that will also last longer.
Some measles outbreaks have occurred in areas with migrant populations, where there is a lack of education and understanding of the need for vaccinations. Further education is needed within this group of patients.
Healthcare workers need to be protected against these diseases due to the contagious nature and potential for serious consequences. If vaccination records are missing, then the MMR vaccine should still be given as there are no reports of increased adverse effects from additional doses and the balance clearly outweighs the risk.
Hepatitis B Vaccine
Hepatitis B is a blood-borne virus (BBV) that can cause acute symptoms in a patient or they can remain chronically infected. The incidence of hepatitis B has increased in the UK with this being higher in certain groups e.g. Men who have sex with men. These groups can have the vaccination provided on the NHS if they visit a sexual health clinic. However, for occupational health reasons, the vaccination is the responsibility of the employer.
The Department of Health has identified the following occupational groups to be at an increased risk of exposure to BBV and recommends that they be may be immunised against hepatitis B:
- laboratory staff handling biological material that may be contaminated with BBV;
- staff of residential and other accommodation for those with learning difficulties;
- those handling cadavers and other human remains, such as anatomical pathology technologists (APTs), funeral directors, embalmers and pathologists;
- prison service staff in regular contact with inmates; and
- certain members of the emergency frontline services, such as the police, ambulance and fire and rescue services, may require corporate vaccination, but only if local risk assessment indicates a need, and only if occupational health advice supports this requirement.
A course of 3 vaccinations is usually required over a period of 3 months or 6 months. All patients who have completed a course of hepatitis B vaccinations for occupational health reasons should have a hepatitis B surface antibody test done 1-4 months after completing the course of vaccinations. This is to check they have responded to the vaccination course and produced the adequate amount of antibodies.
If antibodies have not developed, the hepatitis B vaccination course should be repeated. If the employee still does not respond, then they should be classed as a ‘non-responder’. The occupational health department must be made aware of this so the employee can be treated with an immunoglobulin, should they become infected with hepatitis B.
The immunity will last for a minimum of 20 years if the employee responds to the course. Previously, a booster was recommended at 5 years but this is in the process of being phased out. Overall, it is a well-tolerated vaccine that will help protect the employee and patient.