Health Care Personnel Are Focus of ACIP's Revised Pertussis Recommendations

March 04, 2011 05:05 pm David Mitchell

Health care personnel and their immunization needs were a chief focus of the CDC's Advisory Committee on Immunization Practices, or ACIP, during its Feb. 23-24 meeting in Atlanta. And, in recognition of multiple ongoing outbreaks of pertussis, committee members voted to bring guidance for health care personnel in line with pertussis recommendations the ACIP made for the general population last year.

The new ACIP recommendation specifically calls for all health care personnel who have not previously received tetanus, diphtheria and acellular pertussis, or Tdap, vaccine to receive a single dose as soon as feasible -- regardless of the interval since their last dose of tetanus and diphtheria toxoids, or Td, vaccine. Furthermore, health care facilities should take steps to encourage such immunizations, including providing Tdap to their personnel at no cost.

Health care personnel already were recommended to receive Tdap, but the precise wording of the new recommendation -- to disregard the interval since receiving Td -- adds a sense of urgency, according to one FP expert.

ACIP Terminology Change

During its Feb. 23-24 meeting in Atlanta, the CDC's Advisory Committee on Immunization Practices recommended replacing the term "health care workers" with "health care personnel." The change was based on committee members' belief that use of the new terminology would ensure an understanding that both paid health care workers and health care volunteers are included in its recommendations.

"Because of the pertussis outbreak and the resurgence of pertussis, the recommendation is to do it as soon as possible," said Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the ACIP and associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix.

California, for example, had more than 8,600 reported cases of pertussis(www.cdph.ca.gov) throughout 2010, and many other states have reported high rates of the disease.

The ACIP also voted to recommend postexposure prophylaxis(www.cdc.gov) against pertussis for all health care personnel -- regardless of vaccination status -- who have unprotected exposure to pertussis and are likely to expose high-risk patients, including infants and pregnant women.

Personnel who do not have contact with high-risk patients can either receive postexposure prophylaxis or be monitored for 21 days after pertussis exposure and treated at the onset of symptoms of pertussis.

All of the committee's existing policies regarding immunizations for health care personnel will be included in a compendium committee members approved for dissemination during last month's meeting.

According to Jonathan Temte, M.D., Ph.D., a member of the ACIP and a professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, the compendium likely will be published as a Morbidity and Mortality Weekly Report supplement by the end of the year.

"There are recommendations for health care personnel in other documents," Temte said. "This is an effort to put everything in one unified document. It provides stakeholders with a go-to source of information."

Although the 120-page document could be used as a reference manual for infection control personnel and others in hospitals and other health care facilities, Temte said, a tool that would be more helpful for practicing physicians -- a health care personnel immunization schedule -- likely will be developed based on the larger document.


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