Essential Vaccines for Healthcare Providers

People who work in health care settings are frequently exposed to germs while being with or around patients. Vaccinating healthcare personnel (HCP), like physicians and nurses, helps protect them from potentially dangerous diseases like flu and whooping cough, as well as protects the patients they care for. All adults should make sure they are up-to-date on all routinely recommended vaccines. But if you're an HCP or work in a health care setting, there are six shots in particular that are recommended by the Advisory Committee on Immunization Practices (ACIP).

1
Influenza

Male doctor giving female patient an injection in clinic examination room
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An estimated 12,000 to 56,000 people die each year in the United States from influenza, making it one of the deadliest vaccine-preventable diseases in the country today.

The populations most vulnerable to hospitalization or death as a result of the flu are also those who are already likely to come into frequent contact with HCP. This group includes those with underlying medical conditions, young children, pregnant women, and the elderly—some of whom can't be vaccinated safely due to age or medical reasons.

You can get the flu by breathing in or coming into contact with respiratory droplets that spray as a result of coughs or sneezes or through touching contaminated objects like doorknobs. That means you can become infected and spread influenza even if you don't come into direct contact with patients.

The ACIP recommends everyone over the age of six months receive the annual flu vaccine, including—and especially—HCP and other kinds of caregivers. According to the CDC, an estimated 88 percent of health care workers in the United States got the flu vaccine during the 2016-2017 flu season, though those numbers range based on the individual environment.

Hospital settings tend to have higher vaccination rates than long-term care facilities like nursing homes, and employees are much more likely to receive the flu vaccine if it is required by their employers. In facilities where the vaccine is mandatory, 97 percent of HCP get vaccinated, compared to just 46 percent of those who work in settings where it isn't required, promoted, or offered on-site.

2
Hepatitis B

Hepatitis B spreads through bodily fluids like blood and saliva. More than 1 million people are believed to be currently infected in the United States. Because many of these individuals don't feel sick, they often don't realize they have the virus, but they can still spread it to other people. If left untreated, the hepatitis B virus can lead to potentially serious conditions, including cirrhosis and liver cancer. This is especially true for very young children who become infected.

For HCP at risk for contracting hepatitis B, vaccination is an important part of infection control. When the recommendation to vaccinate HCP against hepatitis B first came out in 1982, an estimated 10,000 infections occurred among workers in the medical and dental fields. In 2004, there were just 304. In 2015, 74 percent of HCP with direct patient contact had been vaccinated against the virus. While higher than the general adult population, this rate is far below the 90 percent objective outlined in Healthy People 2020, a set of national goals to be accomplished by the year 2020 to improve the health of the U.S. population.

All HCP who have yet to be vaccinated against hepatitis b should receive the full three-dose series, and those who may come into contact with bodily fluids should be tested 1-2 months after the final dose to verify that their bodies responded well to the vaccine.

3
Measles, Mumps, and Rubella (MMR)

Measles was declared eliminated from the United States in 2000, but the disease remains common in many parts of the world, and sporadic outbreaks still occur here at home. It's one of the most contagious viruses known to mankind and capable of staying in the air for up to two hours after an infected individual has already left the room.

Because measles is no longer prevalent in the United States, young parents might not know the signs of the disease and so don't take precautions before bringing infected children into healthcare settings. And that can spark outbreaks, like one that occurred in 2008. An unvaccinated, 7-year-old boy with measles visited his pediatrician's office and inadvertently passed on the virus to four other children—three of whom were too young to receive the MMR vaccine at the time. One of the infants had to be hospitalized. The boy visited multiple healthcare settings before being diagnosed with measles, with no isolation protocols implemented to protect other patients or vulnerable HCP.

Even in technologically advanced countries like the United States, roughly one in four people with measles needs to be hospitalized. Worldwide, roughly 100,000 people die from the disease every year, mostly children. Vaccination is by far the most effective way at preventing death and disability from measles. According to the World Health Organization, the vaccine prevented an estimated 20 million deaths between 2000 and 2016.

While rubella and mumps tend to be less serious than measles, unvaccinated HCP can still become infected after being exposed to patients with these diseases, and subsequently pass the viruses on to medically fragile patients, like pregnant women.

Unvaccinated HCP who were born in 1957 or after should get two doses of the MMR, at least 28 days apart. HCP born prior to 1957 are generally presumed to be immune to measles, mumps, and rubella, but unless they can show proof that they either had the diseases or tested positive for immunity, they should still be vaccinated with the MMR with either 1 dose (if lacking proof of immunity against rubella only) or 2 doses (if lacking proof of mumps and/or measles). Unvaccinated women working in healthcare settings who could become pregnant (but not yet are) should also receive at least one dose of the MMR to protect against rubella.

4
Tetanus, Diphtheria, and Pertussis (Tdap)

Two kinds of tetanus vaccines exist: Tdap and Td. Both include components to protect against toxins made by tetanus and diphtheria bacteria, but only the Tdap includes the pertussis component.

Pertussis, also known as whooping cough, is a respiratory disease that can be particularly dangerous for young infants. Like influenza, it is spread through coughing and sneezing, as well as close contact like kissing. Because early symptoms of pertussis can come across looking like the common cold, many adults don't even realize they are infected. HCP working in pediatric settings appear to be most at risk for both contracting and spreading pertussis. And those who work in neonatal intensive care units in hospital settings should be extremely cautious of pertussis, as it could prove fatal for premature infants if they become infected.

All HCP who haven't been or aren't sure they've been vaccinated against pertussis should get at least one dose of Tdap—regardless of how long it's been since they last received a Td—and be re-vaccinated against tetanus with or without the pertussis component at least once every 10 years. HCP who are pregnant should also receive a Tdap during the third trimester of each pregnancy.

Despite these recommendations, however, only about half of HCP were vaccinated with Tdap in 2015.

5
Varicella

Varicella, or chickenpox, is no longer commonplace in the United States, thanks to widespread vaccination. But outbreaks still occur throughout the country, and cases can spread quickly in healthcare settings. The disease can be particularly dangerous for medically fragile adult patients, including pregnant women.

Like with many other diseases, people infected with varicella can be contagious a day or two prior to getting the telltale rash. If you're a healthcare provider with frequent contact with patients, the effects of an unrecognized infection can be costly. Studies have shown that a single provider with varicella can expose more than 30 patients to the virus, and dozens more other employees. In addition to being wholly unpleasant, adults tend to have more serious cases of varicella, and the disease can be particularly dangerous for pregnant staff and patients.

Unvaccinated HCP with no laboratory evidence of immunity or documented proof of diagnosis with varicella should get two doses of the vaccine, spaced four weeks apart.

6
Meningococcal

Meningococcal disease is a bacterial infection that can cause meningitis, a condition where the lining of the brain has become swollen. The disease is rare but can be serious, resulting in limb loss, deafness, or death in only a matter of hours. Adolescents and young adults are particularly at risk.

It's not common for HCP to become infected with meningococcal disease from their patients, but it is possible, especially for those who have direct contact with either the respiratory secretions of an infected individual—while managing the airway during a resuscitation, for example—or with the bacteria itself in a laboratory setting.

If you're an HCP who frequently comes into direct contact with patients, or if you handle specimens in a lab, you should get one dose of the meningococcal vaccine.

A Word From Verywell

Physicians, nurses, medical assistants, and other HCP play a vital role in protecting the health of communities. You care for the most vulnerable among us, and as a result, put yourself at risk, too, for the dangerous diseases you treat. Vaccination is one of the most important steps you as a healthcare provider can take to protect not just yourself, but also the patients you care for.

Sources: 

Centers for Disease Control and Prevention. Recommended Vaccines for Healthcare Workers

Immunization Action Coalition. Healthcare Personnel Vaccination Recommendations. 2016. 

McLean H, Fiebelkorn A, Temte J. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP)Morbidity and Mortality Weekly Report. 2013; 62(RR04):1-34.  

Shefer A, Atkinson W, Friedman C, et al; Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)Morbidity and Mortality Weekly Report. 2011; 60(RR07):1-45.

Williams WW, Lu P, O’Halloran A, et al; Surveillance of vaccination coverage among adult populations — United States, 2015. Morbidity and Mortality Weekly Report. 2017; 66(011):1-28.

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