Vaccination recommendations

Vaccination recommendations for specific work activities

Activity	Immunisation	Status	Comment	Booster doses required
Undergraduate Medical courses Biomedical Science courses involving patient contact Clinical work (NHS Honorary Contract or equivalent)	Hepatitis B	Mandatory	Series of 3 vaccinations & blood test necessary to complete schedule. This can take up to 7 months to complete. Accelerated courses are administered to lab workers. Annual Hepatitis B Surface Antigen (HBSAg)screening required for non-responders undertaking Exposure Prone Procedures (Medical Students and NHS Honorary Contract holders)	Accelerated courses and “poor” responders in line with PHE guidance, DOH Green Book
	MMR (Measles, Mumps Rubella)	Mandatory	Evidence of two vaccinations or positive serology required as proof of immunity to measles & rubella. Some clinical settings require evidence of Mumps Immunity if evidence of 2 MMR not available.
	Tuberculosis (BCG)	Recommended	Testing for pre-existing immunity from earlier vaccination or exposure to mycobacteria required before vaccination.	No
	Chickenpox	Mandatory	Only if no past history of infection and a negative blood test	No
Other patient contact (Social)	As for clinical work		Exact requirements can vary between NHS Trusts Hepatitis B not usually required – Risk Assessment	No
Laboratory work with human blood, serum or unfixed tissue	Hepatitis B	Recommended	Usually recommended unless samples actively screened for hepatitis or sourced from a screened population or an individual's involvement in the work lasts for less than eight weeks. Vaccination is not required if not directly involved in handling or for short-term use of blood in practical classes. Accelerated course is completed within a month	No
Deliberate work with Hepatitis B cultures	Hepatitis B	Mandatory		No
Deliberate work with N. Meningitides cultures	Meningitis	Mandatory	Vaccine choice (ACWY, B or C- conjugate) will be dependent on strains in use. The risk assessment for the work should specify	5 years depending on level of risk (risk assessment should specify)
Other laboratory work with human pathogens	Relevant vaccine	Recommended	Vaccination usually recommended if available. Decision will be based on risk assessment. Risk assessment for the work should be passed to the Occupational Health Physician for decision
Overseas travel	Variable	Variable	Recommendations will be based on risk assessment which considers destination, duration of stay & activities undertaken. Vaccination is likely for fieldwork or stays of more than a few days in countries other than Northern and Central Europe and North America. Recommendations will be made in line with those from UK reference authorities (NATHNAC)	Variable
Maintenance work	Tetanus, Hepatitis A	Recommended	Only maintenance staff whose work may involve regular contact with sewage.	Hepatitis A: single booster at one year
Early Years Educators	As for clinical work	Recommended	Hepatitis B not required
Grounds maintenance	Tetanus	Recommended	Most adults have lasting immunity from childhood vaccinations
Cleaning	None	Not applicable	Risk assessment may dictate urgent Hep B vaccination if inoculation accident with discarded needle
Welding	Pneumococcus	Recommended	Recommended for anyone carrying out welding more than once per week. Anyone welding for >4 hours per month, on average, may be vaccinated on request.	No

Additional control measures for individuals who decline or do not respond to vaccinations or where individual vaccination is contra-indicated on health grounds

Immunisation	Comment
Hepatitis B	Restrict from direct handling of cultures or blood or tissue samples known to contain viable virus urgent OH assessment for consideration of post exposure prophylaxis after any significant exposure (inoculation or splash onto mucosa/broken skin) non-responders who undertake exposure prone procedures as part of their clinical work (NHS honorary contract holders and medical students ) will require annual hepatitis B surface antigen screening in line with the Public Health England Document : Integrated Guidance on Health Clearance of Healthcare Workers and the Management of Healthcare Workers Infected with Bloodborne Viruses (Hepatitis B, Hepatitis C And HIV), October 2017.
MMR	Non-immune students or clinical staff may need to be restricted from contact with vulnerable patient groups e.g. infants, immuno- suppressed patients each case will be considered individually in conjunction with local NHS Infection Control teams.
TB	Non-immune students or staff may need to be restricted from working in clinical areas at high risk for TB exposure e.g. infectious disease wards. Non-immune individuals should be informed of the symptoms of TB and advised to report suspicious symptoms to the Occupational Health.
N. Meningitides (research work)	Restrict from direct handling of pathogenic cultures.

Revision History

August 2018: Reviewed (Claire O'Brien, Director of Occupational Health)