6 Essential Vaccines for Healthcare Providers

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All adults should ensure that they are up-to-date with all of their recommended vaccines. If you're a healthcare worker, there are six shots in particular that are recommended by the Advisory Committee on Immunization Practices (ACIP).

People who work in healthcare settings are frequently exposed to germs while seeing or caring for patients, but direct contact isn't always necessary to contract an infection.

Vaccinating healthcare personnel—from doctors and nurses to admissions clerks and ambulance drivers—not only protects them from potentially dangerous diseases like flu and COVID-19, but patients and the community at large as well.

Doctor giving patient an injection in clinic examination room

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Influenza Vaccine

An estimated 12,000 to 61,000 people die from influenza each year in the United States, making it one of the deadliest vaccine-preventable diseases in the country.

Healthcare workers are particularly vulnerable to infection from those who seek treatment or are hospitalized for flu. According to the Centers for Disease Control and Prevention (CDC), anywhere from 140,000 to 810,000 people are hospitalized each year for influenza, depending on the severity of the variant circulating that year.

The groups most vulnerable to hospitalization and death are young children, pregnant women, adults 65 and older, and people with underlying medical conditions—some of whom cannot get the flu vaccine.

Because flu is spread not only by airborne transmission (from coughing or sneezing) but also by fomite transmission (touching contaminated objects or surfaces), healthcare workers can be exposed even if they don't come in direct contact with patients.

According to the CDC, around 80% of healthcare workers in the United States received the flu vaccine during the 2019-2020 flu season, meaning that a good number were unprotected from the virus.

Hospitals 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 mandated by the state or their employer.

Recommendations

The ACIP recommends that everyone over the age of six months receive the annual flu vaccine, including—and most especially—healthcare workers.

There are nine flu vaccine options, including two specifically used in adults 65 and over (Fluad and Fluzone High-Dose).

Vaccine Name Doses Ages Route
Adacel 1 10 years and over Intramuscular injection
Boosterix 1 10 years to 64 years only Intramuscular injection

Hepatitis B Vaccine

Hepatitis B is a chronic viral infection that spreads through bodily fluids like blood and saliva. Over 850,000 people are believed to be infected in the United States, with around 21,000 new infections occurring every year.

Because many people with hepatitis B don't feel sick, they can spread the virus without even knowing it. If left untreated, hepatitis B can lead to potentially serious conditions, including cirrhosis and liver cancer.

Healthcare workers who are regularly exposed to blood and other bodily fluids are at constant risk of hepatitis B. Vaccination is central to preventing infection as well as maintaining infection control in healthcare settings.

Prior to routine hepatitis B vaccinations of healthcare workers, a staggering 18% of those working in the medical and dental fields were believed to have been infected. Within 10 years thereafter, the rate dropped to 6%.

Recommendations

The ACIP recommends a two- or three-dose hepatitis B vaccination series for healthcare workers, depending on the vaccine. There are three hepatitis B vaccines approved for use by the U.S. Food and Drug Administration (FDA).

Vaccine Name Doses/Schedule Route
Engerix-B 3 delivered at 0, 1, and 5 months Intramuscular injection
Heplisav-B 2 delivered at 0 and 4 weeks Intramuscular injection
Recombivax HB 3 delivered at 0, 1, and 5 months Intramuscular injection

Healthcare workers should be tested one to two months after their final dose to verify that they have achieved the desired immune response (as measured by hepatitis B-specific antibodies).

Considerations

People born after 1986 (the year that Engerix was approved by the FDA) may very well have been vaccinated in infancy. Even so, the duration of efficacy of these vaccines is around 30 years, and it does no harm to get revaccinated if you are a healthcare worker. Unless you have evidence of recent immunization, hepatitis B vaccination should be pursued.

If you complete the vaccine series and are among the 5% to 15% who are non-responders (meaning that your antibody response was inadequate), the CDC recommends that you undergo a second complete vaccine series. If you still fail to respond, two doses of hepatitis B immunoglobulin (HBIG)—hepatitis B antibodies harvested from donated blood—may help "kickstart" your immune response.

MMR Vaccine

Measles was declared eliminated from the United States in 2000, but the disease has made a huge comeback due, in large part, to the rise of anti-vaccination campaigns. As a result, sporadic outbreaks still occur in the United States, including the 2019 outbreak that affected over 1,200 people in 22 states.

Measles is easily transmitted among children in pediatric offices and care units. Although measles vaccinations in schools have largely reduced such incidents, anti-vaccination sentiments are feared to reverse many of those gains.

In 2008, an unvaccinated 7-year-old boy with measles visited a pediatrician's office in San Diego and inadvertently passed on the virus to four other children—three of whom were too young to receive the MMR (measles, mumps, and rubella) vaccine. One was hospitalized with severe measles complications.

Even in developed countries like the United States, roughly one in five people with measles needs to be hospitalized.

While rubella and mumps tend to be less serious than measles, unvaccinated healthcare workers can still pass the viruses to medically vulnerable patients, like pregnant women, who are at greater risk of harm.

Vaccination is by far the most effective way to prevent these potentially serious diseases.

Recommendations

According to the ACIP, unvaccinated healthcare workers born in 1957 or after should get two doses of the MMR vaccine at least 28 days apart. 

Those born prior to 1957 are generally presumed to be immune. But, unless they can show proof that they either had the diseases or tested positive for immunity, they should be vaccinated with the MMR vaccine as follows:

  • One dose if lacking proof of immunity against rubella only
  • Two doses if lacking proof of mumps and/or measles

Unvaccinated women working in healthcare settings who could become pregnant should also receive at least one dose of the MMR to protect against rubella.

There is only one MMR vaccine licensed for use in the United States (MMR 2). It is delivered by subcutaneous injection, meaning under the skin.

Considerations

The fact is that many people who were vaccinated with MMR don't recall getting the vaccine or have a record of their childhood vaccinations. If you do have evidence, you won't need to get vaccinated.

For everyone else, it won't harm you to get it again. Sure, you can undergo tests to prove that you have immunity to measles (using a measles antibody test) or have previously been exposed to measles (using a DNA-based test called a PCR), but it simpler to get vaccinated. This is especially important if you are in direct contact with patients.

Tdap Vaccine

There are two kinds of tetanus vaccines: Tdap (tetanus, diphtheria, and acellular pertussis) and Td (tetanus and diphtheria). Although both can be used as booster shots in adults, only Tdap protects against pertussis (whooping cough). In a healthcare setting, this is a very important distinction.

Pertussis, a respiratory disease mainly spread through coughing and sneezing, can be particularly dangerous for young infants. Because the early symptoms of pertussis can come across like the common cold, many adults with pertussis don't even realize they have been infected and can pass it to others.

This makes pertussis particularly dangerous in neonatal intensive care units (NICUs) where transmission of the bacteria to newborns can be fatal. Despite these hazards, less than half of all healthcare workers receive the vaccine, according to a 2017 study in the American Journal of Preventive Medicine.

Recommendations

According to the ACIP, healthcare workers who haven't been or are unsure if they've been vaccinated against pertussis should get a dose of Tdap. This is true even if they recently received the Td vaccine as part of the recommended vaccine schedule for all adults (in which a Td booster is given every 10 years). Getting the Tdap vaccine again won't hurt you.

There are two Tdap vaccines approved for use by the FDA.

Vaccine Name Doses Ages Route
Adacel 1 10 years and over Intramuscular injection
Boosterix 1 10 years to 64 years only Intramuscular injection

Healthcare workers who are pregnant should also receive a Tdap during the third trimester of each pregnancy to prevent transmission to their newborn.

Varicella Vaccine

Varicella, also known as 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 vulnerable patients such as pregnant women.

Like with many other infectious diseases, people with varicella can be contagious a day or two prior to getting the telltale rash. If you're a healthcare worker in 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 chickenpox, as well as dozens of coworkers. Adults also tend to be more seriously affected by chickenpox, with some experiencing pneumonia, bacterial skin infections, encephalitis (brain inflammation), and sepsis (blood infection).

Recommendations

According to the ACIP, unvaccinated healthcare workers with no laboratory evidence of immunity or documented proof of diagnosis with chickenpox should get two doses of the vaccine, spaced four weeks apart.

There is only one varicella vaccine, called Varivax, approved for use in the United States. It is delivered by subcutaneous injection.

There may be an added benefit of getting Varivax. Studies in children have shown that varicella vaccination reduces the risk of shingles in later life given that the virus that causes chickenpox is the same one that causes shingles. The same may apply, at least in part, if you receive Varivax as an adult.

Varivax is not a substitute for the shingles vaccine Shingrix. Even if you receive Varivax as a healthcare worker, you will still need to be vaccinated against shingles if you are 50 or older.

Meningococcal Vaccine

Meningococcal disease is a bacterial infection that can cause meningitis, a condition in which the protective lining of the brain and spinal cord (called the meninges) becomes inflamed.

Meningococcal meningitis is relatively rare but can be serious, resulting in seizures, deafness, shock, multi-organ failure, and death within a matter of hours. Adolescents and young adults are particularly vulnerable.

It is not common for healthcare workers to become infected with meningococcal disease from patients, but it can occur if there is direct exposure to saliva or respiratory secretions (whether from contact with patients or saliva or sputum samples obtained for the lab).

This is especially true during outbreaks at universities or colleges where the disease can spread rapidly through residence halls.

Recommendations

According to ACIP, if you are a healthcare worker who frequently comes into direct contact with patients or handles lab specimens, you should get vaccinated with two different meningococcal vaccines—one that protects against meningococcal serogroups (species) A, C, W, and Y, and another that protects against serogroup B.

There are five meningococcal vaccines approved for use by the FDA.

Vaccine Name Doses/Schedule Serogroups Route
Bexsero 2 delivered at 0 and 6 months B Intramuscular injection
Menactra 1 A, C, W, Y Intramuscular injection
MedQuadfi 1 A, C, W, Y Intramuscular injection
Menveo 1 A, C, W, Y Intramuscular injection
Trumenba 2 delivered at 0 and 6 months B Intramuscular injection

A Word From Verywell

Although guidelines have not been established, it is likely that ongoing COVID-19 vaccination may be needed both for the general public and healthcare workers alike.

This is especially crucial in hospitals given that an estimated 114,000 healthcare workers were infected with COVID-19 in 2020, according to data published in the International Journal of Infectious Diseases.

By ensuring that all frontline healthcare personnel are properly vaccinated from infectious diseases, from flu to COVID-19, patients can be protected as well.

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