Immunisation of health professionals during whooping cough outbreaks.
Immunisation of health professionals during whooping cough outbreaks
Immunisation of health professionals was considered by the Joint Committee on Vaccination and Immunisation (JCVI) as part of a range of control options during the 2012 whooping cough outbreak. The committee agreed that the first priority was to optimise protection in children too young to be vaccinated by offering a pertussis containing booster to pregnant women (between 28 to 38 weeks) as an outbreak response measure.
The committee agreed that certain healthcare workers could become infected with pertussis and pass the infection on to neonates and young infants. Post exposure vaccination of healthcare workers in high risk settings is recommended as part of the control of a known outbreak. See ‘HPA Guidelines for the Public Health Management of Pertussis Incidents in Healthcare Settings (October 2012)’.
Due to limited supplies, current Department of Health stocks of dTaP/IPV vaccine should be prioritised for the temporary maternal immunisation programme (currently Boostrix-IPV) and the routine childhood vaccination programme (pre-school booster, currently Infanrix-IPV or Repevax) and should not be used for local outbreak control. In the event of such incidents, any NHS or non NHS organisation advising post exposure vaccination for their healthcare staff will have to procure vaccine directly from manufacturer.
Currently, proactive vaccination of health professionals is not advocated due to the limited supplies of the vaccine.
Information for healthcare workers exposed to whooping cough
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Definition of significant exposure in a healthcare setting
The current definition of a significant exposure is unprotected direct face-to-face contact less than 2 metres and for a cumulative period of 1 hour of exposure with an infectious case. This is based on the evidence that the dispersal of droplets can occur for up to a distance of 2 metres. The cumulative time period of up to 1 hour is based on the consensus reached by the pertussis expert working group given the lower risk to transient contacts. However, a lower threshold may be applied in certain settings, eg paediatric intensive care unit.
Where an infected healthcare worker (HCW) has provided direct clinical care to hospitalised infants (unimmunised or partially immunised), prophylaxis may be offered to these infants even when the duration of contact is less than 1 hour. This is consistent with some international guidelines and is recommended as a guide to aid the risk assessment. If a risk is deemed to exist, then chemoprophylaxis and/or vaccination should be offered for those in priority groups.
What to do if an unvaccinated healthcare worker is re-exposed to a further case of pertussis
A HCW who is re-exposed to a further case of pertussis and who has not received a pertussis containing vaccine in the previous 5 years should receive an additional course of antibiotics if within the time frame for public health action. There are currently no data on the duration of protection from a course of antibiotics for prophylaxis. Chemoprophylaxis should also be offered to HCW’s who have recently received a pertussis containing vaccine where exposure to an infectious case occurred less than 2 weeks after administration of the vaccine.