MSNVA News

Despite significant and ongoing efforts by healthcare providers to strengthen community immunity, many vaccine preventable diseases remain endemic in Fairfax County.  During the last five years, an annual average of approximately 150 varicella, 40 pertussis, and 3 mumps cases were identified in our community.  Each of these cases visited at least one healthcare facility and the vast majority of these visits resulted in exposures to healthcare workers. 

Additionally, there has been a resurgence of measles in the National Capital Region during the last three years.  After a period of significantly decreased disease incidence in the early 2000s, 13 cases have been identified in the Region since 2008. Although none of these cases occurred among Fairfax residents, many of the infected individuals sought healthcare in our community.  This resulted in measles exposures to hundreds of healthcare workers at 24 Fairfax County healthcare facilities.

Given the possibility for airborne transmission of measles and the often delayed implementation of appropriate infection control measures, many of these 24 facilities faced a situation in which their entire staff, from physicians to office managers to custodians, was considered exposed.  To limit the spread of disease to other patients and community members, the Health Department required that these facilities provide documented evidence of immunity to measles (i.e. physician diagnosed measles, two doses of vaccine, or a positive IgG titer) for each exposed staff member.  Individuals without such documentation were excluded from work and all activities outside the home from day 5 through day 21 after exposure, or until a positive IgG titer was obtained.  Though necessary to protect the public’s health, this process caused significant disruptions to the operations of those facilities that had not maintained complete and readily-available employee immunization records. 

Airborne transmission makes measles the most extreme example; however, ensuring immunity against other vaccine preventable diseases is also critical.  Each varicella, mumps, and pertussis case has the potential to result in exposures to multiple healthcare workers, often requiring significant follow-up by the Health Department and the affected office or practice.  As with measles, healthcare workers exposed to varicella and mumps must have documented evidence of immunity or be excluded during the incubation period for the disease (up to 21 days after exposure for varicella and 25 days for mumps).  

At this time of the year, many of you are in the process of ensuring that your staff members are immunized against influenza.  As you complete this process, we recommend that you also ensure that your office or practice has a comprehensive, up-to-date healthcare worker immunization policy for all vaccine preventable diseases. This policy should not be limited to staff working in patient care roles, but should encompass all other employees and volunteers who are at risk of exposure to or possible transmission of vaccine preventable diseases (e.g. administrative and maintenance staff). To assist you in ensuring appropriate documentation of immunity, a one-page summary of the Advisory Committee on Immunization Practices (ACIP) recommendations for healthcare worker vaccination is available at http://www.immunize.org/catg.d/p2017.pdf.  The full 2011 ACIP recommendations can be accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm?s_cid=rr6007a1_w

Many healthcare workers have received vaccinations during their training or through previous employers.  However, assuming that new employees are adequately vaccinated when they begin work in your practice is not sufficient.  Immunization status should be reviewed and documented for each new employee as soon as possible, preferably prior to starting work.  Further, changes in immunization recommendations make it necessary to regularly assess and update employee immunization policies and records.  For example, ACIP revised the pertussis vaccination requirements for healthcare workers in February 2011 due to concerns over waning immunity. According to this new recommendation, all healthcare workers who have not received a dose of Tdap, or are unsure if they have previously received a dose, should receive a one-time dose as soon as feasible.  This dose should be given without regard to the interval since the previous dose of Td.  (For more information on Tdap, please visit http://www.cdc.gov/vaccines/recs/provisional/downloads/use-of-Tdap-in-hcp.pdf)

Ensuring that our healthcare workforce is adequately immunized is a critical strategy in the campaign to eradicate vaccine preventable diseases.  Protecting these individuals not only limits the spread of disease to patients, but also ensures healthcare workforce integrity. 

We thank you for your continued efforts to limit the spread of disease in the community.  Please feel free to contact the Fairfax County’s Health Department’s Communicable Disease Unit at 703-246-2433 if you need further information about vaccine preventable diseases or healthcare worker vaccination.  Information on specific vaccine preventable diseases in Fairfax County can also be found in the Health Department’s 2010 Communicable Disease Summary, available at http://www.fairfaxcounty.gov/hd/comdis/pdf/cd-summary-2010.pdf.