TABLE 5

Immunizations for Ambulatory Care Staff

All staff members should receive the following immunizations:
 • Meningococcal vaccines
  Generally not indicated for HCP.
  Standard recommendation for all who are asplenic (functional or anatomic) or have complement deficiency.
 • MMR vaccine
  All HCP born after 1956 should have documentation of 2 doses of an MMR vaccine. Because birth before 1957 is only presumptive evidence of immunity to measles, mumps, and rubella, 1 dose of MMR vaccine for unimmunized workers born before 1957 who do not have laboratory evidence of immunity to these viruses is recommended. Some experts recommend serologic screening for all employees to ensure immunity to measles, mumps, and rubella.
 • Hepatitis B vaccine
  Hepatitis B vaccine should be strongly recommended for any employee who may come in contact with blood. OSHA requires that a hepatitis B vaccine must be offered to all employees who may be at risk for bloodborne exposures on the basis of the job categories determined by the organization’s bloodborne pathogen exposure control plan. If the employee refuses immunization, this should be documented in the employee’s file; the OSHA declination form is useful for this purpose.
 • Varicella vaccine
  Proof of varicella immunity is recommended. This may include either verified history of varicella or herpes zoster, laboratory confirmation of immunity, or documentation of 2 doses of varicella vaccine.
  If the employee has a medical contraindication to varicella vaccine or refuses immunization, this information should be placed in the employee’s file.
 • Influenza vaccine
  Vaccine use should be mandated and offered free of charge yearly to all employees.
 • Adolescent-adult Tdap
  This vaccine is recommended by the CDC to be given once to all HCP with direct patient contact.
  • Adapted from American Academy of Pediatrics Committee on Infectious Diseases. Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Pediatrics. 2006;117(3):965–978; Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13–15; American Academy of Pediatrics, Committee on Infectious Diseases. Influenza immunization for all health care personnel: keep it mandatory. Pediatrics. 2015;136(4):809–819; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America; Pediatric Infectious Diseases Society. Joint policy statement on mandatory immunization of health care personnel according to the ACIP-recommended vaccine schedule. 2013. Available at: https://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/Current_Topics_and_Issues/Immunizations_and_Vaccines/Health_Care_Worker_Immunization/Statements/IDSA_SHEA_PIDS%20Policy%20on%20Mandatory%20Immunization%20of%20HCP.pdf. Accessed March 6, 2017; and Dheda K, Udwadia ZF, Huggett JF, Johnson MA, Rook GA. Utility of the antigen-specific interferon-gamma assay for the management of tuberculosis. Curr Opin Pulm Med. 2005;11(3):195–202. MMR, measles-mumps-rubella; Tdap, tetanus, diphtheria toxoid, and acellular pertussis vaccine.