March 2018

1. PD 2018_009 Occupational Assessment Screening and Vaccination against Specified Infectious Diseases March 2018

2. What’s New in PD2018_009? • Category A High Risk & annual mandatory influenza vaccination • Compliance requirements for all Category A employees and management of non-compliant staff • Compliance deadline for students • Hepatitis B statutory declaration • Clinical evidence for varicella compliance removed • 10-yearly dTpa booster requirement • TB assessment requirements

3. Background PD 2011_005 has now been replaced by PD2018_009 Released March 2018 with advice to CEs 8 March 2018 Implementation is mandatory in all LHDs and other NSW Health agencies immediately FAQ’s are available on website

4. What are the infectious diseases that are included in compliance requirements?

5. What is Category A High Risk? Category A High Risk Positions: • Antenatal, perinatal and postnatal wards including labour wards and recovery rooms and antenatal outreach programs • Neonatal intensive care units, special care units, any home visiting health service provided to neonates • Paediatric intensive care units • Transplant and oncology wards • Intensive care units

6. Annual mandatory Influenza vaccination Mandatory annual influenza vaccination for workers employed in a Category A High Risk position: • must be vaccinated by 1 June each influenza season • unprotected staff must wear a surgical/procedural mask for influenza season (1 June to 30 September annually) or longer if season extended by Chief Health Officer • LHD Chief Executives will be required to report annually to the Ministry of Health on staff compliance

7. Refusal or contraindication to specific vaccines • Existing employees in Category A positions must comply with screening and vaccination requirements – if they decline or are unable to participate then they must be risk managed (Sections 9, 11 and 12) • Attachment 4 denotes the evidence that is required • Medical Contraindication • Assess on case by case basis • Permanent: anaphylaxis to a vaccine component • time limited or temporary: for example pregnancy, certain immunosuppressive medications

8. Risk Management – unprotected employees - Attachment 2 Measles - after return from overseas an unprotected worker must be excluded from the high risk area for 14 days Mumps – a worker with mumps must be excluded from clinical duties for 9 days Rubella – unprotected worker excluded from clinical areas for 21 days following exposure to a rubella case

9. Risk Management – Attachment 2 cont’d Varicella – following contact with varicella/shingles case – offered varicella vaccine as soon as possible and within 5 days of exposure or VZIG within 96 hours (4days) OR if unable to be vaccinated exclude from clinical duties for 21 days Pertussis – following exposure to a pertussis case unprotected worker must be excluded from clinical duties until they have 5 days of an appropriate antibiotic OR 14 days if they are unable to have or refuse antibiotics

10. Student requirements • Students must be assessed for compliance in their first year of enrolment (except for TB assessment which is to occur within 4 months prior to the first placement) • All students including secondary school students are required to comply • Cost of vaccination (including annual influenza if required) and screening is at the student’s own cost • Temporary compliance may be granted once only for 6 months in relation to hepatitis B and/or TB assessment provided certain criteria are met (section 2.5)

11. Hepatitis B Statutory Declaration • Those who have had positive serology and have awareness of being previously vaccinated but no record is available • Complete Attachment 9 • Signed in presence of appropriately trained assessor

12. Varicella compliance • Verbal history of disease is no longer accepted as evidence of compliance* • Must show evidence of: • 2 doses of varicella vaccine at least 1 month apart (1 dose in those vaccinated before 14 years of age); OR • Positive serology; OR • 1 dose of Zostavax in those aged 50 years or over *Workers employed in existing positions who have been previously assessed as compliant under previous policy (history of varicella disease) do not need to be re-assessed if they apply for a new position

13. 10 yearly boosters for dTpa (Boostrix) • all Category A workers are required to have a 10 yearly booster for dTpa • must be vaccinated within one month of the due date • must be reviewed for compliance when dTpa booster being provided • LHD is responsible to meet the cost of dTpa boosters

14. Changes - TB Assessment and screening • TB Assessment Tool (Attachment 7) needs to be completed and submitted no more than 4 months prior to first clinical placement to assess recent potential exposure • Screening is required if: • Born in a high incidence country (≥ 40/100,000) • Resided/travelled for ≥ 3 months cumulative time in high incidence country or countries (≥ 40/100,000) • Interferon Gamma Release Assay (IGRA) or Tuberculin Skin Test (TST/mantoux) are acceptable screening tests • TST results will only be accepted from accredited nurses/clinicians practicing with a NSW TB Service

15. Changes - TB Assessment and screening • TB clinical review at a designated TB Services (Chest Clinic) is required if the person: • Answers “yes” to any part A questions, or; • Has a positive test on either a TST and/or IGRA • Any further tests to investigate TB infection or disease (e.g. CXR) need to be provided free of charge (as per PD2014_050 Principles for the Management of Tuberculosis in New South Wales)

16. FAQ’s Frequently asked questions are available at: http://www.health.nsw.gov.au/immunisation/Pages/oasv-FAQ.aspx Policy document can be accessed at: http://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2018_009 Please contact your local public health unit on 1300 055 066 for any queries