Vaccine-Preventable Diseases: Protecting Healthcare Workers and Patients

1. Educational lecture template (general)Vaccine preventable diseases at Insert HHS/facility name Presenter: Insert presenter name

2. What are vaccine-preventable diseases? • A vaccine preventable disease (VPD) is an infectious disease for which an effective vaccine is available.

3. What are vaccine-preventable diseases? • VPDs may cause: • Serious, life threatening illness and even death • Chronic (long lasting) impacts with ongoing health problems • Adverse pregnancy outcomes such as miscarriage, stillbirth and birth defects

4. Vaccination • A vaccine is a product often made from parts of killed viruses or bacteria, or from live weakened strains of viruses or bacteria. • Vaccines usually induce an immune response to mimic the body’s response to natural infection, but without the harmful consequences of the infection itself. • Immunity following vaccination generally lasts for months to many years depending on the nature of the vaccine and individual factors. • Some vaccine courses require more than one dose.

5. Transmission of VPDs VPDs can be spread in a variety of ways depending on the disease, such as: • inhaling droplets expelled from an infected person when they cough, sneeze, laugh or speak • inhaling respiratory particles carried on air currents • contact with infected blood and body fluids • contact with fluid from vesicles (blisters) • touching a surface that someone has contaminated and then touching your own mucous membranes • contact with something contaminated with faeces that is transferred to another person’s mouth (faecal-oral route)

6. Why is vaccination important for staff? Working in healthcare: • ↑ risk of exposure to VPDs • ↑ risk of transmitting a VPD to people at risk

7. Why is vaccination important for staff? Vaccination protects you, your family, and patients you have contact with. Health professionals have a duty of care to protect their patients.

8. VPDs in healthcare • All healthcare workers in direct or indirect contact with patients are recommended to be vaccinated against the following: • Measles • Mumps • Rubella • Pertussis (whooping cough) • Influenza • Varicella (chickenpox) • In addition, healthcare workers who have contact with blood or body fluids are recommended to be vaccinated against: • Hepatitis B

9. VPDs in healthcare • Apart from the standard group of vaccinations, there are additional vaccination recommendations for some healthcare worker categories: • Hepatitis A • Japanese encephalitis • Screening for tuberculosis should also be undertaken for all healthcare workers working in clinical areas

10. Queensland Health Policy • There is a requirement for prospective workers for roles with VPD requirements to provide evidence that they are not susceptible to the specific conditions. • Evidence may include immunisation records or blood test results. • Evidence must be provided prior to offer of employment / prior to execution of contract. • While this requirement does not apply to existing workers unless they apply for a role in another Queensland Health entity, vaccination against the listed VPD’s is strongly recommended.

11. The VPDs in detail

12. Hepatitis B Infectious agent • Hepatitis B virus (HBV) Transmission • Blood borne virus (skin puncture and mucous membrane exposure) Signs and symptoms • Asymptomatic in 30-50% of adults • Symptoms may include lack of appetite, abdominal discomfort, nausea, vomiting, joint pains, rash, and jaundice.

13. Hepatitis B Complications and serious consequences • 1-10% of adults develop chronic infection (up to 90% of children) • 15-25% of those with chronic HBV die prematurely of cirrhosis or liver cancer • Approximately 50% of liver cancers globally are attributable to chronic HBV infection

14. Hepatitis B Vaccination • Vaccination requires 2-4 doses depending on the individual’s age and the timing of the doses. Booster doses are not routinely required. • If not vaccinated, adults will require a 3 dose schedule at times 0, 1 and 6 months. • Hepatitis B antibody levels can be tested from 1-2 months after the last vaccine, and this is recommended for those at high occupational risk of exposure. A hepatitis B antibody level ≥ 10mIU/mL is evidence of protection.

15. Measles Infectious agent • Measles virus Transmission • Highly infectious. Airborne transmission. Signs and symptoms • Fever and malaise, cough and conjunctivitis, maculopapular rash (flat red area on the skin covered with bumps). Image: CDC, 1963. ID# 1150. Retrieved October 20, 2016, from https://phil.cdc.gov/phil/details.asp

16. Measles Complications and serious consequences • Often a severe disease. Frequently complicated by middle ear infection, pneumonia and diarrhoea. • 1 in 15 children with measles develops pneumonia • 1 in 1000 develops encephalitis. For every 10 children who develop measles encephalitis, 1 dies and many have permanent brain damage. • About 1 in 100,000 will develop subacute sclerosing panencephalitis (SSPE) (progressive brain degeneration) up to several years after an apparent full recovery from a measles infection; it is always fatal. Image: Measles & Rubella Initiative, Date unknown. #Spotted, child with measles. Retrieved October 20, 2016, from http://measlesrubellainitiative.org/photoalbums/spotted-2/

17. Mumps Infectious agent • Mumps virus Transmission • Exposure to respiratory droplets and direct contact with saliva and possibly urine. Signs and symptoms • Acute viral illness. • Fever, swelling and tenderness of one or more salivary glands. Muscle pain, loss of appetite, body weakness or discomfort, headache. Image: CDC, 1975. ID#14488. Retrieved October 20, 2016, from https://phil.cdc.gov/phil/details.asp

18. Mumps Complications and serious consequences • Orchitis (inflammation of the testes) occurs in 20-30% of adult and adolescent males, meningitis (inflammation of the lining of the brain) occurs in up to 10% of cases. • Occasionally, mumps causes infertility or permanent deafness. Image: CDC (1976). ID#130. Retrieved October 20, 2016 from https://phil.cdc.gov/phil/details.asp

19. Rubella Infectious agent • Rubella virus Transmission • Contact with nasopharyngeal secretions of infected people either by droplet spread or direct contact. Signs and symptoms • Generally mild self-limiting, often a mild febrile viral illness with a maculopapular rash (flat red area on the skin covered with bumps). • Symptoms include mild fever, punctate (small red points) and maculopapular rash, headache, body weakness or discomfort and conjunctivitis. Image: Sitzmann, F.C. (2005), Rash on the back. Retrieved October 20, 2016, from https://commons.wikimedia.org/wiki/Rubella#/media/File:Rubella_Dgk_kind_mitroeteln.jpg

20. Rubella Complications and serious consequences • Rubella during pregnancy can result in foetal infection causing congenital rubella syndrome. Rubella infection during pregnancy can also cause miscarriage and stillbirth. • Congenital rubella syndrome occurs in up to 90% of infants born to women who had rubella in the first trimester of pregnancy and results in congenital abnormalities including deafness, blindness or heart defects. Image: CDC (1976). ID#4284. Retrieved October 20, 2016, from https://phil.cdc.gov/phil/details.asp

21. Measles, mumps, rubella Vaccination • MMR (measles, mumps and rubella) vaccine is a live attenuated virus vaccine. • TheAustralian Immunisation Handbook recommends Measles, Mumps, Rubella (MMR) vaccination for healthcare workers. • All healthcare workers should ensure that they have received 2 doses of MMR. • MMR vaccine is contraindicated in pregnant women and pregnancy should be avoided for 28 days after vaccination. • The vaccine course involves two doses, at least a month apart. This vaccine is available funded (free) for anyone born after 1 January 1966 who does not have two doses documented.

22. Varicella (chickenpox) Infectious agent • Varicella zoster virus (VZV) Transmission • Highly infectious. Transmitted by respiratory secretions, including airborne transmission, or from the vesicle (blister) fluid of the skin lesions of varicella (chickenpox) or zoster (shingles) infection. • The disease is able to be transmitted 1-2 days before onset of the rash. Signs and symptoms • Acute viral disease, sudden onset of fever, constitutional symptoms and a red and raised rash that is raised for a few hours, fluid-filled blisters (vesicles) for 3-4 days and leaves a scab.

23. Varicella (chickenpox) Complications and serious consequences • Secondary bacterial infection of the vesicles (blisters) may lead to scarring, serious tissue infection, or bloodstream infection. • Varicella infection in people with immunocompromise (conditions that cause the immune system to function abnormally) can cause serious and even fatal illness. • Varicella infection in pregnancy may lead to foetal abnormalities, such as limb abnormalities, skin scarring, ocular anomalies and neurologic malformations (risk is approximately 1.4% in the first trimester versus 0.55% in the second) .

24. Varicella (chickenpox) Vaccination • Adults require 2 doses of varicella vaccine at least 4 weeks apart (one dose is sufficient if the person was vaccinated before 14 years of age) or a single dose of Zoster vaccine (for those aged 60 years or over). • Testing to check for immunity after varicella vaccination is not recommended. • Varicella containing vaccines are contraindicated in pregnant women and pregnancy should be avoided for 28 days after vaccination.

25. Pertussis (whooping cough) Infectious agent • Bordetella pertussis (bacteria) Transmission • Direct contact with discharges from respiratory mucous membranes of infected persons. Disease signs and symptoms • Acute bacterial infection of the respiratory tract. Characterised by paroxysmal cough (violent fits of coughing) and inspiratory “whoop”. Other symptoms may include runny nose, sneezing, and low grade fever.

26. Pertussis (whooping cough) Complications and serious consequences • Approximately 1 in 125 babies under the age of 6 months with pertussis die from pneumonia or brain damage. Vaccination • Unvaccinated adults should receive one dose of pertussis-containing vaccine for a primary course of vaccination. • For healthcare workers, a booster dose is recommended if 10 years has elapsed since previous dose. • The vaccine is available in Australia only in combination with diphtheria and tetanus.

27. Questions about vaccination?

28. Questions about vaccination? • Answers to common questions about vaccination and responses to commonly held misconceptions can be found in “Myths and Realities: Responding to arguments against vaccination” • Web search for “immunisation myths”

29. What you can do

30. What you can do • Know your vaccination status • Provide your vaccination records to your infection control team / workforce vaccination program if possible • You may be required to be excluded from contact with patients that have a VPD if you have no history of immunity or vaccination to that VPD.

31. Get your vaccinations up to date • Visit insert facility / HHS staff vaccination service Where: Place of clinic When: Time of clinic Appointments / Drop in clinic: Book appointment by calling xxxxxxxxxx or emailing xxxxxxx@health.qld.gov.au

32. Further information Information about vaccines and VPDs can be found: • Queensland Health Immunisation https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/default.asp • Immunise Australia Program http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/home • The Australian Immunisation Handbook http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home • National Centre for Immunisation Research & Surveillance webpage http://www.ncirs.edu.au/ • World Health Organization (WHO) http://www.who.int/topics/immunization/en/ • Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/vaccines/index.html