Vaccination for people at occupational risk

Certain occupations are associated with an increased risk of some vaccine-preventable diseases:^1,2 

• healthcare workers
• people who work in childhood education and care
• carers
• emergency and essential services workers
• laboratory workers
• people who work with specific communities
• people who work with animals
• other people exposed to human tissue, blood, body fluids or sewage

Infected workers, especially healthcare workers and people working in childhood education and care, may transmit infections to susceptible people, although the risk of onward transmission in most settings is very low. This does however have the potential for serious health outcomes. These infections may include:

• influenza
• rubella
• measles
• mumps
• varicella 
• pertussis

Many infectious diseases are highly infectious several days before symptoms appear. Vaccination can protect the worker who is at risk of acquiring the disease, and also reduce the risk of disease transmission to people who the worker is in contact with.

See:

• Infographic. Vaccination for people who care for others
• Infographic. Vaccination for people who have regular contact with animals and
• Infographic. Vaccination for people at occupational risk

If workers have a significant occupational risk of acquiring a vaccine-preventable disease, the employer should implement a comprehensive occupational vaccination program. Such a program includes:

• a vaccination policy
• current staff vaccination records
• information about relevant vaccine-preventable diseases
• a policy for managing vaccine refusal — for example, to reduce the risk of an unvaccinated healthcare worker transmitting disease to vulnerable people

Employers should take all reasonable steps to encourage non-immune workers to receive the recommended vaccines.

Adopt standard precautions if there is a risk of occupational exposure to blood and body fluids. Preventive measures include:

• appropriately handling and disposing of sharps
• wearing gloves when handling body fluids
• using goggles or face shields when splashes are likely

If a non-immune person is exposed to a vaccine-preventable disease, give post-exposure prophylaxis where indicated. See the relevant disease-specific chapters in this Handbook.

Consider the work activities, rather than the job title, for each person to ensure that they are appropriately protected.

Healthcare workers

Healthcare workers employed within the public health system should check:

• which vaccines their state or territory guidelines require them to have
• what documentation they need to support this

Contact your state or territory health authority for more details.

Healthcare workers should be up to date with routinely recommended vaccines for adults, such as dT (diphtheria-tetanus)–containing and MMR (measles-mumps-rubella) vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

All healthcare workers, including all workers and students directly caring for patients, or handling human tissue, blood or body fluids, are recommended to receive vaccines against:

• hepatitis B
• influenza
• MMR (if non-immune — see Measles)
• pertussis (dTpa [diphtheria-tetanus-acellular pertussis])
• varicella (if non-immune — see Varicella)

In addition to the vaccines for all healthcare workers, hepatitis A vaccine is recommended for:

• healthcare workers who work in remote Aboriginal and Torres Strait Islander communities
• healthcare workers who work with Aboriginal and Torres Strait Islander children in the Northern Territory, Queensland, South Australia or Western Australia
• other specified healthcare workers in some states or territories

In addition to the vaccines for all healthcare workers, consider BCG (bacille Calmette–Guérin) vaccine for healthcare workers who may be at high risk of exposure to drug-resistant cases of tuberculosis (depending on state or territory guidelines).

Primary preventive vaccination (PPV) with mpox vaccine may be considered for healthcare workers at risk of exposure to patients with mpox, based on local risk assessment. This may include workers in primary care, sexual health clinics, hospital staff and others.

See Infographic. Vaccination for people who care for others.

People who work in childhood education and care

People who work in childhood education and care include:

• staff and students working in early childhood education and care
• correctional staff working where infants and children live with mothers
• school teachers (including student teachers)
• outside-school-hours carers
• child counselling services workers
• youth services workers

People who work with children should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

All people who work with children are recommended to receive vaccines against:

• influenza
• MMR (if non-immune — see Measles)
• pertussis (dTpa)
• varicella (if non-immune — see Varicella)

In addition to the vaccines for all people who work with children, hepatitis A vaccine is recommended for staff working in early childhood education and care.

See Infographic. Vaccination for people who care for others.

Carers

Carers should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

Carers of infants <6 months of age are recommended to receive pertussis-containing vaccine (dTpa; see Pertussis).

Carers of people with developmental disabilities are recommended to receive vaccines against:

• hepatitis A
• hepatitis B
• influenza

Staff of nursing homes and long-term care facilities for people of any age are recommended to receive vaccines against:

• influenza
• MMR (if non-immune — see Measles)
• varicella (if non-immune — see Varicella)

People who provide home care to people at risk of high influenza morbidity are recommended to receive influenza vaccine.

See Infographic. Vaccination for people who care for others.

Emergency and essential services workers

Emergency and essential services workers should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

Police and emergency workers are recommended to receive vaccines against:

• hepatitis B
• influenza
• tetanus (dT or dTpa)

Armed forces personnel are recommended to receive vaccines against:

• hepatitis B
• influenza
• meningococcal disease (MenACWY [quadrivalent meningococcal conjugate] and MenB [meningococcal B])
• MMR (if non-immune — see Measles) 
• tetanus (dT or dTpa)
• other vaccine-preventable diseases relevant to deployment

People who work in correctional facilities, and detention and immigration centres are recommended to receive vaccines against:

• hepatitis B
• influenza
• MMR (if non-immune — see Measles)
• tetanus (dT or dTpa)

See Infographic. Vaccination for people at occupational risk.

Laboratory workers

Laboratory workers should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

Also see Table. Recommended vaccines for laboratory workers who routinely work with specific organisms.

See Infographic. Vaccination for people at occupational risk.

People who work with specific communities

People who work with specific communities should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

Workers who live in, or make frequent visits to, remote Aboriginal and Torres Strait Islander communities in the Northern Territory, Queensland, South Australia and Western Australia are recommended to receive hepatitis A vaccine.

Workers assigned to the outer Torres Strait Islands for a total of 30 days or more during the wet season are recommended to receive Japanese encephalitis vaccine.

People who work with animals

People who work with animals should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

Veterinarians, veterinary students and veterinary nurses are recommended to receive vaccines against:

• influenza
• Q fever
• rabies

The following people are recommended to receive Q fever vaccine (see Q fever):

• abattoir workers
• farmers
• stockyard workers
• shearers
• animal transporters (of high-risk animals such as cattle, camels, sheep, goats and kangaroos)
• veterinarians, veterinary nurses and veterinary students
• professional dog and cat breeders
• pet food manufacturing workers
• agricultural college staff and students
• wildlife and zoo workers who work with high-risk animals, including kangaroos and bandicoots
• animal refuge workers (including those working in animal shelters and boarding facilities)
• people who cull or process kangaroos or camels
• laboratory workers who handle veterinary specimens or work with C. burnetii
• other people exposed to high-risk animals, particularly cattle, camels, sheep, goats and kangaroos (including their products of conception, such as placental tissue and birth fluids)

People who come into regular contact with bats (flying foxes and microbats) are recommended to receive rabies vaccine. This includes:

• bat handlers
• bat scientists
• wildlife officers
• zoo curators

The following people are recommended to receive influenza vaccine:

• poultry workers and other people who handle poultry
• people who may be involved in culling during an outbreak of avian influenza
• swine industry workers

See Infographic. Vaccination for people who have regular contact with animals

Other people exposed to human tissue, blood, body fluids or sewage

People who are exposed to human tissue, blood, body fluids or sewage should be up to date with routinely recommended vaccines for adults, such as dT-containing and MMR vaccines. See also Table. Catch-up schedule for people ≥10 years of age (for vaccines recommended on a population level) in Catch-up vaccination.

The following people are recommended to receive hepatitis B vaccine:

• embalmers
• workers who perform skin penetration procedures (such as tattooists and body-piercers)
• funeral workers
• other workers who have regular contact with human tissue, blood or body fluids
• other workers who have regular contact with used needles or syringes

Plumbers and other workers in regular contact with untreated sewage are recommended to receive vaccines against:

• hepatitis A
• tetanus (dT or dTpa)

See Infographic. Vaccination for people at occupational risk.

1. Maltezou HC, Wicker S, Borg M, et al. Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine 2011;29:9557-62.
2. Centers for Disease Control and Prevention (CDC), Shefer A, Atkinson W, et al. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports 2011;60(RR-7):1-45.