Diphtheria, tetanus, and varicella immunity in health care workers in neonatal units

Immunity to Varicella Zoster Virus in Healthcare Workers: A Systematic Review and Meta-Analysis (2024)

Healthcare workers (HCWs) are occupationally exposed to varicella zoster virus (VZV), and their inappropriate vaccination status could contribute to an outbreak involving both professionals and the patients they care for, with a potential impact on the general population. Therefore, since 2007, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCWs have evidence of immunity against varicella. The present meta-analysis was therefore designed to collect the available evidence on the seronegative status of VZV among HCWs. PubMed, Scopus, and Embase databases were searched without backward limit for articles reporting on the seroprevalence of VZV among HCWs, and all articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 1744 initial entries, a total of 58 articles were included in the quantitative analysis (publication range: 1988 to 2024), for a pooled sample of 71,720 HCWs. Moreover, the included studies reported on seroprevalence data on measles (N = 36,043 HCWs) and rubella (N = 22,086 HCWs). Eventually, the pooled seronegative status for VZV was estimated to be 5.72% (95% confidence interval [95% CI] 4.59 to 7.10) compared to 6.91% (95% CI 4.79 to 9.87) for measles and 7.21% (5.36 to 9.64) for rubella, with a greater risk among subjects younger than 30 years at the time of the survey (risk ratio [RR] 1.434, 95% CI 1.172 to 1.756). Interestingly, medical history of either VZV infection/vaccination had low diagnostic performances (sensitivity 76.00%; specificity 60.12%; PPV of 96.12% but PNV of 18.64%). In summary, the available data suggest that newly hired HCWs are increasingly affected by low immunization rates for VZV but also for measles and rubella, stressing the importance of systematically testing test newly hired workers for all components of the measles-pertussis-rubella-varicella vaccine.

Vaccination coverage and immunity levels against vaccine-preventable diseases in male Air Force recruits in Greece

AIM

Data about susceptibility rates in young adults are scarce. We estimated the complete vaccination rates, timeliness of vaccinations and susceptibility rates among male military recruits in Greece.

METHODS

A standardized form was used to collect data. Immunity against measles, rubella, varicella, hepatitis A and hepatitis B was serologically estimated.

RESULTS

We studied 385 recruits with a mean age of 23.5 years (range: 18.3-29.9 years). Complete vaccination rates were 94.3% for measles, 100% for rubella, 15% for varicella, 73.9% for hepatitis A and 96.5% for hepatitis B. Only 10.8% of participants were fully vaccinated against all five diseases. Timely vaccination was 47.2% for measles, 89.3% for rubella and 48.1% for hepatitis B. Recruits >23 years had a 1.5-fold increased probability for incomplete vaccinations compared to younger recruits. Laboratory-confirmed immunity rates were 80% against measles, 85.7% against rubella, 85.2% against varicella, 69.4% against hepatitis A and 77.1% against hepatitis B. It is estimated that approximately 388,696 persons aged 18-30 years are susceptible to measles, 277,640 persons to rubella, 287,736 persons to varicella, 595,664 persons to hepatitis A and 444,224 persons to hepatitis B in Greece.

CONCLUSION

Our study showed that young adults have significant immunity gaps against measles, rubella, varicella, hepatitis A and hepatitis B. Complete vaccination rates were suboptimal against hepatitis A and varicella. Strategies to access young adults and increase immunity rates through catch-up vaccination services should be investigated. A third dose of MMR vaccine should be considered for young adolescents in Greece.

Burden of varicella in Latin America and the Caribbean: findings from a systematic literature review

BACKGROUND

Varicella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs.

METHODS

A systematic literature review of published studies was complemented by "gray" literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC.

RESULTS

Seroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas.

CONCLUSIONS

Varicella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered.

Low vaccination coverage among italian healthcare workers in 2013

Vaccination of healthcare workers (HCWs) reduces the risk of occupational infections, prevents nosocomial transmission and maintains healthcare delivery during outbreaks. Despite the European directive and national legislation on workers' protection, immunization coverage among HCWs has often been very low. In light of Italian National Vaccination Plan 2012-2014 recommendations, the aim of this study was to assess levels of immunization and factors influencing adherence to vaccinations needed for HCWs in Puglia region, South Italy. The study was conducted using an interview-based standardized anonymous questionnaire administered to hospital employees in the period November 2009-March 2011. A total of 2198 health professionals responded in 51/69 Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and 12.2% other hospital personnel). Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7% for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving counselling from occupational health physicians (OHPs) was associated with influenza (OR = 1.8; 95%CI = 1.5-2.2; P < 0.001), hepatitis B (OR = 4.9; 95%CI = 3.9-6.3; P < 0.001), varicella (OR = 43.7; 95%CI = 18.9-101.7; P < 0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P < 0.001) and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P < 0.001) vaccine uptake.   OHPs should be trained with standard guidelines specific for healthcare settings and HCWs' risk groups to facilitate their crucial role in improving vaccine coverage among HCWs and increase awareness on the duty to protect both employees and patients.

Baseline immunity to diphtheria and immunologic response after booster vaccination with reduced diphtheria and tetanus toxoid vaccine in Thai health care workers

A prospective study to evaluate immune status against diphtheria and immunologic response after tetanus-diphtheria (Td) booster vaccination was conducted in 250 Thai health care workers (HCWs). A protective antibody was found in 89.2% of the HCWs (95% confidence interval [CI], 83.3%-91.5%) before receipt of the Td booster vaccination, compared with 97.2% (95% CI, 95.1%-99.3%) after receipt of the first dose of booster (P < .001). The mean antibody level against diphtheria increased from 0.39 IU/mL (95% CI, 0.35-0.44 IU/mL) before the Td booster vaccination to 1.20 IU/mL (95% CI, 1.12-1.29 IU/mL) after the vaccination (P < .001). Td booster vaccination should be considered for Thai HCWs to maintain immunity against diphtheria, which still circulates in Thailand.

Attitudes toward mandatory occupational vaccinations and vaccination coverage against vaccine-preventable diseases of health care workers in primary health care centers

BACKGROUND

The aim of this study was to assess the attitudes regarding mandatory occupational vaccinations and the vaccination coverage against vaccine-preventable diseases among health care workers (HCWs) working in primary health care centers in Greece.

METHODS

A standardized questionnaire was distributed to HCWs working in all primary health care centers in Greece (n = 185).

RESULTS

A total of 2,055 of 5,639 HCWs (36.4% response rate) from 152 primary health care centers participated. The self-reported completed vaccination rates were 23.3% against measles, 23.3% against mumps, 29.8% against rubella, 3% against varicella, 5.8% against hepatitis A, 55.7% against hepatitis B, and 47.3% against tetanus-diphtheria; corresponding susceptibility rates were 17%, 25%, 18.6%, 16.7%, 87.5%, 35%, and 52.6%. Mandatory vaccinations were supported by 65.1% of 1,807 respondents, with wide differences by disease. Multiple logistic regression analysis revealed higher rates of acceptance of mandatory vaccination in physicians compared with other HCW categories.

CONCLUSIONS

Despite the fact that two-thirds of HCWs working in primary health care centers in Greece support mandatory vaccination for HCWs, completed vaccination rates against vaccine-preventable diseases are suboptimal.

Attitudes regarding occupational vaccines and vaccination coverage against vaccine-preventable diseases among healthcare workers working in pediatric departments in Greece

We studied the attitudes with regard to occupational vaccines and vaccination coverage among healthcare workers in pediatric departments. Completed vaccination rates were 33%, 33%, 41.7%, 3%, 5.8%, 69.2% and 36.3% against measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Susceptibility rates were 14.2%, 15.7%, 14.6%, 7.6%, 87.4%, 22.6% and 61.8% for measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Mandatory vaccinations were supported by 70.6% of healthcare workers, with considerable differences by target disease.