2.3 Groups with special vaccination requirements
Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.
Certain occupations, particularly those associated with healthcare, are associated with an increased risk of some vaccine-preventable diseases.67,68 Furthermore, some infected workers, particularly healthcare workers and childcare workers, may transmit infections such as influenza, rubella, measles, mumps, varicella and pertussis to susceptible contacts with the potential for serious health outcomes. Many infectious diseases, measles in particular, are highly infectious several days before symptoms become apparent.
Where workers are at significant occupational risk of acquiring a vaccine-preventable disease, the employer should implement a comprehensive occupational vaccination program which includes a vaccination policy, current staff vaccination records, provision of information about the relevant vaccine-preventable diseases, and the management of vaccine refusal (which should, for example, include reducing the risk of a healthcare worker (HCW) transmitting disease to a vulnerable patient). Employers should take all reasonable steps to encourage non-immune workers to be vaccinated.
Current recommended vaccinations for people at risk of occupationally acquired vaccine-preventable diseases are listed in Table 2.3.6.
Standard precautions should be adopted where there is risk of occupational exposure to blood and body fluids. Preventive measures include the appropriate handling and disposal of sharps, and the donning of gloves, when handling body fluids, and goggles/face shields, when splashes are likely.
If a non-immune person is exposed to a vaccine-preventable disease, post-exposure prophylaxis should be administered where indicated.
Table 2.3.6: Recommended vaccinations for those at risk of occupationally acquired vaccine-preventable diseases*
OCCUPATION |
DISEASE/VACCINE |
|---|---|
HEALTHCARE WORKERS (HCW) |
|
All HCW: |
Hepatitis B Influenza Pertussis (dTpa, provided dTpa has not been given previously) MMR (if non-immune) † Varicella (if seronegative) |
HCW who work with remote Indigenous communities in NT, QLD, SA and WA; medical, dental and nursing undergraduate students (in some jurisdictions) |
Vaccines listed for ‘All HCW', plus hepatitis A |
HCW who may be at high risk of exposure to drug-resistant cases of tuberculosis |
Vaccines listed for ‘All HCW', plus BCG |
THOSE WHO WORK WITH CHILDREN |
|
All those working with children including: Childcare and preschool staff (including childcare students) Correctional staff working where infants/children cohabitate with mothers School teachers (including student teachers) Outside school hours carers Child counselling services workers Youth services workers |
Pertussis (dTpa, provided dTpa has not been given previously) MMR (if non-immune) † Varicella (if seronegative) |
Childcare and preschool staff |
Vaccines listed for ‘All those working with children' plus hepatitis A vaccine |
CARERS |
|
Carers of people with intellectual disabilities |
Hepatitis A Hepatitis B |
Staff of nursing homes and long-term care facilities |
Influenza |
Providers of home care to people at risk of high influenza morbidity |
Influenza |
EMERGENCY AND ESSENTIAL SERVICE WORKERS |
|
Police and Emergency Workers |
Hepatitis B, influenza |
Armed Forces personnel |
Hepatitis B, influenza (and other vaccines relevant to deployment) |
Staff of correctional facilities |
Hepatitis B, influenza |
LABORATORY PERSONNEL |
|
Laboratory personnel handling veterinary specimens or working with Q fever organism ( Coxiella burnetii ) |
Q fever |
Laboratory personnel handling either bat tissues or ABL or rabies virus |
Australian bat lyssavirus (ABL) and rabies |
Laboratory personnel routinely working with other infectious agents |
Anthrax ‡ Vaccinia poxviruses Poliomyelitis Typhoid Yellow fever Meningococcal disease Japanese encephalitis |
WORKING WITH SPECIFIC COMMUNITIES |
|
Workers who live with or make frequent visits to remote Indigenous communities in NT, QLD, SA and WA |
Hepatitis A |
Workers assigned to the outer Torres Strait Islands for a month or more during the wet season |
Japanese encephalitis |
WORKING WITH ANIMALS |
|
Veterinarians, veterinary students, veterinary nurses |
Q fever Australian bat lyssavirus (ABL) and rabies |
Agricultural college staff and students exposed to high-risk animals |
Q fever |
Abattoir workers and contract workers in abattoirs (excluding pig abattoirs) Livestock transporters Sheep shearers and cattle, sheep and dairy farmers Those culling/processing kangaroos or camels Tanning and hide workers Goat farmers Livestock saleyard workers Those handling animal products of conception |
Q fever |
Those who come into regular contact with bats (both flying foxes and microbats), bat-handlers, bat scientists, wildlife officers, zoo curators |
Australian bat lyssavirus (ABL) and rabies |
Poultry workers, and others handling poultry, including those who may be involved in culling during an outbreak of avian influenza |
Influenza |
OTHERS EXPOSED TO HUMAN TISSUE, BLOOD, BODY FLUIDS OR SEWAGE |
|
Embalmers |
Hepatitis B, BCG |
Sex industry workers |
Hepatitis A Hepatitis B |
Workers who perform skin penetration procedures, eg. tattooists, body-piercers |
Hepatitis B |
Funeral workers and other workers who have regular contact with human tissue, blood or body fluids and/or used needles or syringes |
Hepatitis B |
Plumbers or other workers in regular contact with untreated sewage |
Hepatitis A |
* Work activities, rather than job title, should be considered on an individual basis to ensure an appropriate level of protection is afforded to each worker.
† All adults born during or since 1966 should have evidence of either receiving 2 doses of MMR vaccine or immunity. Adults born before 1966 are considered to be immune due to extensive measles circulating widely in the community during this period of time (see Chapter 3.11, Measles).
‡ People with a repeated risk of exposure or working with large quantities or concentrations of Bacillus anthracis cultures. For information regarding anthrax vaccination, please contact the Office of Health Protection, Canberra.
References
67. Sepkowitz KA. Occupationally acquired infections in health care workers. Part II. [erratum appears in Ann Intern Med 1997 Apr 1;126(7):588]. Annals of Internal Medicine 1996;125:917-28.
68. Centers for Disease Control and Prevention (CDC). Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR - Morbidity & Mortality Weekly Report 1997;46(RR-18):1-42.