St Vincent's Hospital
HEALTH CARE WORKER VACCINATION AND IMMUNITY ASSESSMENT
GUIDELINES
NSW Health is committed to ensuring the health and safety of all patients in the health care setting and providing
a safe and healthy working environment for all health care workers (HCWs). This commitment includes
adopting a screening, education and vaccination policy that minimises the risk to patients and HCWs from
infectious diseases.
Employee adherence to Standard and Transmission Based Precautions remains the first line of protection for
HCWs and patients to infectious diseases.
The following guidelines summarise the NSW Health infectious diseases screening and vaccination
recommendations. They do not replace individual risk assessment, education and interview by a HCW
vaccination provider.
HEPATITIS B VACCINATION
Hepatitis B is one of several viruses that may be transmitted by significant exposure to blood or other body
substances. Fortunately, there is a very effective vaccination that provides protection against hepatitis B.
Hepatitis B vaccination is recommended for all HCWs and is essential for workers whose work may involve
activities with the potential for contact with blood or other body substances. For adults, a full course of hepatitis
B vaccine consists of three doses. There should be an interval of one month between the first and second dose
with a third dose at five months after the second dose. This induces protective levels of antibody against
hepatitis B virus (anti-HBs) in over 90% of young adults. All HCWs should have a blood test for anti-HBs 3
months after the third dose of vaccine. If the post-vaccination anti-HBs is positive no further testing or boosters
are required. If however, the result is negative a double booster will be given and a blood test for anti-HBs
attended 3 months after.
EXPOSURE PRONE PROCEDURES (EPPS) are those procedures characterized by the potential for direct
contact between the skin of the HCW and sharp surgical instruments, needles or sharp tissues (spicules of bone
or teeth) in body cavities or in poorly visualized or confined body sites (including the mouth).
HCWs must not perform EPPs if they are HB e Ag and/or HBV DNA positive, HCV PCR positive or HIV
antibody positive.
HCWs who perform EPPs as part of their employment must provide documented evidence of their hepatitis B
status. Where the HCW is non-immune the HCW must agree to regular screening, at least annually and after any
exposure.
HEPATITIS C & HIV
There is no vaccine available for these diseases.
Annual screening for hepatitis C and HIV is only required for HCWs who perform EPPs.
TUBERCULOSIS
Tuberculosis (TB) is a curable disease that most commonly affects a person’s lungs. It is spread by people, who
have active TB germs in their lungs or throat, coughing and sending their germs into the air. Most people who
are infection with TB get the germs from someone they spend a lot of time with, such as a family member, friend
or co-worker. The incidence of TB disease in Australia is low. Furthermore, the rate of TB disease in the
Northern Rivers Area is lower than the Australian rate.
Having TB infection means the TB germs are in the body but they are inactive. The germs can stay in the body
for years in an inactive state. While the germs are inactive they can’t do any damage and they can’t spread to
other people. For most people the germs will always be inactive. People with TB infection will react to the
tuberculin skin test (TST), also called a Mantoux test. It is recommended that all medical, nursing, pathology,
radiology, dental, mortuary and allied health staff have a TST on the commencement of employment. This
baseline information assists with management if the HCW ahs contact with a person with TB disease. A chest
xray is required if the TST is positive. Due to the low incidence of TB disease, routine repeated TST is generally
not recommended for HCWs in the Northern Rivers Area.
Tuberculosis disease is caused by active TB germs. It is possible of inactive TB germs to become active when
the body defences are weakened. This may be due to aging or a serious illness. It sis important that all HCWs
are aware of the symptoms of TB – cough, fever, night sweats, weight loss, lethargy and haemoptysis (coughing
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blood) are common symptoms. If it is suspected a person has TB the local doctor or Chest Clinic should be
contacted immediately.
INFLUENZA VACCINATION
Influenza is a viral respiratory disease causing abrupt fever, myalgia, headache, sore throat, acute cough and can
cause extreme malaise lasting several days. The elderly are at increased risk of influenza-related complications
such as pneumonia and exacerbation of chronic diseases. Influenza vaccination provides approximately 70%
protection against infection for 1 year. Annual influenza vaccination in autumn is recommended for all HCWs,
especially staff who have contact with patients at high risk for complications from influenza infection.
MEASLES, MUMPS, RUBELLA
These diseases are highly infectious and are spread by respiratory droplets. All HCWs should ensure they are
immune to these diseases.
Measles
HCWs can be considered immune to measles if they are born before 1970; or can show evidence of 2 doses of a
measles containing vaccines; or serological evidence of immunity to measles. Vaccination (2 doses of measlesmumps-rubella (MMR) vaccine) is recommended for those without evidence of immunity. HCWs who are not
immune must not care for patients with measles.
Rubella
HCWs can be considered immune to rubella if they are born before 1960; or can show evidence of rubella
vaccination; or serological evidence of immunity to rubella. Vaccination (with MMR vaccine) is recommended
for those without evidence of immunity. This is especially important for females of childbearing age and young
adult males. HCWs who are not immune must not care for patients with rubella.
CHICKENPOX (Varicella)
Chickenpox is highly infectious and is spread by respiratory droplets and contact with chickenpox/shingles
lesions. HCWs should be aware of whether they are immune to varicella. A history of chickenpox or shingles
correlates with immunity. HCWs who do not have a reliable history of chickenpox illness should be tested for
varicella antibodies.
Varicella vaccination is strongly recommended for non-immune HCWs working in maternity, neonatal or
pediatric units or with immuno-compromised patients. HCWs who are not immune must not care for patients
with chickenpox or shingles. Vaccine recipients who develop a rash in the 6 weeks following vaccination should
be reassigned to duties that require no contact with susceptible patients or staff, or placed on sick leave for the
duration of the rash.
HEPATITIS A VACCINATION
Hepatitis A virus is predominantly transmitted by the faecal-oral route. In Australia, large slowly evolving
community-wide outbreaks tend to affect low socioeconomic areas and young children play a substantial role in
the spread of the virus. The NHMRC recommend Hepatitis A vaccine for nursing and medical staff in pediatric
wards, emergency departments and intensive care units that provide for substantial populations of indigenous
communities; staff of residential facilities for the intellectually disabled; and nursing and medical staff on remote
indigenous communities. Hepatitis A vaccine is also recommended for sewerage workers.
Pre-vaccination screening for hepatitis A is recommended for those born prior to 1950; those who spent their
early childhood endemic areas, including indigenous Australian communities; and those with an unexplained
previous episode of hepatitis or jaundice. If upon screening, a person has either total hepatitis A antibodies or
anti-hepatitis A IgG, he/she has presumably had prior, perhaps unrecognized Hepatitis A infection and can be
assumed to be immune, therefore not needing hepatitis A vaccination.
TETANUS & DIPTHERIA VACCINATION
All adults should ensure they have had primary vaccination against these diseases. A primary course of
tetanus/diphtheria vaccination is 5 doses of the vaccine. A booster dose is recommended:
 At the time of a tetanus-prone injury, if 5 or more years have elapsed since the previous dose
 At 50 years of age, if 10 or more years have elapsed since the last dose.
POLIO VACCINATION
All adults should ensure they have had primary vaccination against polio. The primary course of polio
vaccination is 4 doses of oral polio vaccine or inactivated polio vaccine. Booster doses of polio vaccine are not
recommended as part of the standard HCW vaccination program.
Acknowledgement: Taken from the ‘Health Care Worker Vaccination and Immunity Assessment Guidelines’
written by Sue Devlin, Communicable Diseases CNC, NRAHS. October 2001.
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