Immunisation policies are drawn up by the Occupational Health Services in liaison with Infection Control Teams based upon Department of Health guidance.

Diseases of special concern for healthcare workers are tuberculosis, polio, rubella and hepatitis B. A vaccination history taken at pre-employment requests information on:

• tetanus
• poliomyelitis
• rubella (german measles)
• chickenpox
• TB heaf test
• BCG
• diphtheria
• hepatitis A
• hepatitis B.

Immunisation is now recommended for non-immune health care workers (HCWs), who work in primary care and in hospitals (both in the NHS and privately) and who have direct patient contact against chickenpox.
PL CMO (2003)8: Chickenpox (varicella) immunisation for health care workers

Seronegative women of child-bearing age and healthcare workers who need to be protected against rubella are now offered the combined measles-mumps-rubella (MMR) vaccine in place of the rubella vaccine which is no longer available.
PL CMO (2003)7: Protecting women against rubella: switch from rubella vaccine to MMR

Up-to-date information and knowledge on tuberculosis can be found at: www.hpa.org.uk/tbknowledge/default.htm

Specific guidance for laboratory workers is given in the Green Book; immunisation is indicated to protect:

1. The individual from an occupational risk.
2. Against a laboratory-acquired infection being transmitted to others (e.g. family members).
3. Staff who have not received generally recommended vaccines.
   
   The following vaccines are indicated for laboratory staff:

• anthrax: not given routinely but may be indicated for those who work with the organism, or for those who have direct contact with imported animal products likely to have been in contact with the organism
• BCG: anyone likely to be in contact with material containing tubercle bacilli should be checked for evidence of BCG scar, or written evidence of vaccination and immune status to TB
• cholera: routine immunisation of laboratory staff is not indicated
• diphtheria: a risk assessment is taken to identify those who may be considered for a booster or for primary immunisation (if they handle clinical material, work with the organism, or come into contact with infected patients)
• hepatitis A: offered to those attempting to culture the virus and to those who travel regularly to endemic areas in the course of their work
• hepatitis B: for all staff who handle material that may contain the virus (blood, blood-stained body fluids and patients’ tissues)
• influenza: for laboratory staff working with the virus
• Japanese encephalitis: indicated for those working with the virus and for those travelling to infected areas in the course of their work
• meningococcal disease: vaccination is not routinely recommended
• poliomyelitis: all staff should have their polio immunisation history checked and be offered primary vaccination if required. Those exposed to polio viruses should be offered a booster every ten years
• rabies: pre-exposure is indicated for those who work with the virus, with recently imported primates, or with other animals that may be infected, in addition to those working in rural areas of countries where the disease is endemic. At risk workers include voluntary staff working with bats, and vets, for further information, www.hpa.org.uk
• rubella: documented evidence of rubella status is required at pre-employment and immunisation offered if non-immune
• smallpox: where a Laboratory Director thinks there is a special case for vaccination, this should be discussed with the Director, Virus Reference Division at Colindale (020 8200 4400) or SCIEH (0141 300 1100)
• tetanus: all staff should have their immunisation status checked and be offered a primary course if required
• tick borne encephalitis: this is indicated for those who work with the virus and for those travelling in the course of their work to infected areas
• typhoid: recommended for staff who may handle faeces, or who work with the organism
• yellow fever: recommended for those who work with the virus or handle material from suspected cases, and for those travelling in the course of their work to infected areas.

Those working in nurseries with young children are exposed to common childhood infections. As these can be prevented through vaccination, a full vaccination history should be obtained at pre-employment on the following:

• polio
• diphtheria
• tetanus
• MMR
• Men C.

Advice should be given on what is considered good practice covering general health and personal hygiene, plus advice on contact with body fluids and the importance of contact tracing (should an individual be identified with an infectious disease).

Health Service Circular HSC(98)064, The Management of Health, Safety and Welfare Issues for NHS Staff (follow link to ‘H’ – HSC – 1998 – 1998/064)
www.info.doh.gov.uk/doh/coin4.nsf/Circulars?ReadForm

Management of Health, Safety and Welfare Issues for NHS Staff (full document) (follow link to subject – ‘O’ – Occupational Health Services)
www.info.doh.gov.uk/doh/point.nsf/Publications?ReadForm

Immunisation against Infectious Disease (1996), on-line version of the Green Book.
www.dh.gov.uk/PolicyAndGuidance/

PL CMO (2003)8: Chickenpox (varicella) immunisation for health care workers

PL CMO (2003)7: Protecting women against rubella: switch from rubella vaccine to MMR