Hospitals should provide pertussis vaccines to their health care workers free of charge, but should still treat employees with antibiotics if they have unprotected exposure to patients with pertussis and work with patients at high risk, such as young infants, a federal vaccine advisory panel says.
This recommendation represents a re-emphasis of the importance of immunization with the Tdap vaccine and post-exposure prophylaxis of health care workers.
“I think the big message to hospitals is to get your health care personnel vaccinated against pertussis. It’s a very effective vaccine,” says Alexis Elward, MD, assistant professor of pediatrics at the Washington University School of Medicine in St. Louis and a representative of the Healthcare Infection Control Practices Advisory Committee (HICPAC) to the Advisory Committee on Immunization Practices (ACIP). ACIP made the pertussis recommendation to the Centers for Disease Control and Prevention.
A study of two outbreaks in Minnesota found that health care workers are at risk. In one outbreak, only 12% of cases were among health care personnel, but many of the exposed employees had received prophylaxis. In another outbreak, 52% of cases were among health care workers, who contracted the disease from co-workers or patients. There were no cases identified of transmission from health care workers to patients.1
Pertussis epidemics are cyclical, and the disease is particularly dangerous for neonates who have not yet had their first pertussis vaccine. The CDC warned about the “continued resurgence of pertussis” in a February “Health Alert,” advising health care providers on using PCR tests to confirm the diagnosis. In 2010, there were 8,383 cases in California alone, including 10 deaths of infants. There also were significant outbreaks in Michigan and Ohio. ACIP expanded the recommendation for pertussis vaccination to include people 65 and older, so it encompasses all health care workers. Vaccination should include volunteers, especially those working in pediatric hospitals or with pediatric patients, says Elward.
Yet even vaccinated health care workers need to be evaluated for post-exposure prophylaxis, ACIP decided. An exposure is defined as being within six feet of coughing patients with pertussis for five minutes without wearing a mask.
Special update from our sister publication, Hospital Employee Health
1. Leekha S, Thompson RL, and Sampathkumar P. Epidemiology and control of pertussis outbreaks in a tertiary care center and the resource consumption associated with these outbreaks. Infect Control Hosp Epidemiol 2009; 30:467-473.
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