Physician, Protect thyself

Dr. Suresh Chelliah*

Department of Paediatrics, Kauvery Hospital, Trichy-Cantonment, India

According to 2011 census, there are 2.2 million health workers including 677,000 allopathic doctors accounting for 31% of the health workforce and 200,000 AYUSH practitioners accounting for 9% of the health workforce. Nurses and midwives (30%) and pharmacists (11%) are the other two large groups. Others, including ophthalmic assistants, radiographers and technicians, account for 9% of the total.

Healthcare workers (HCWs) are at risk of exposure to serious, and sometimes deadly, diseases. If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you get infected or spread vaccine-preventable diseases. Protect yourself, your patients, and your family members. Make sure you are up-to-date with the recommended vaccines.

The following vaccines are mandatory for all healthcare workers.

Influenza vaccine: Flu vaccine should be taken annually by all health workers, including those who are pregnant and lactating. The best time to take flu vaccine would be before the monsoons every year.

TdaP vaccine: This contains toxoids against diphtheria and tetanus and vaccine against Pertussis which is less reactogenic than the old pertussis vaccine. If you have not taken TdaP in the past take one right now regardless of your previous tetanus toxoid dosages. Pregnant women should take 2 doses as advised by their doctor.

Cocoon vaccination is a new concept whereby we vaccinate adults who will be around a newborn baby when he or she is born. This way the newborn baby will not get exposed to pertussis for the first 6 months, after which his or her immunity will take over.

Hepatitis B vaccine: If not previously immunised take a full course of hepatitis B vaccine. Those previously immunised may either get a booster dose or get their antibody levels checked.

MMR vaccine (Mumps, Measles, Rubella): Most young adults, 30 years and below, would have received the vaccine and the older ones would have had the disease. Present recommendation is to take at least two Measles containing vaccine. Stand-alone Measles vaccine is not available in India. However, it is prudent for those planning to get pregnant to get a Rubella vaccine or an MMR shot, 3 months before pregnancy. Immunity against measles wanes, and to be absolutely sure, a dose of MMR may be taken by health workers, if their antibody levels are low.

Varicella vaccine: If you have not had a varicella vaccine, or the disease, take two doses at four-week interval. A live attenuated vaccine against zoster is available in select places and is approved for use after 55 years of age. The recombinant vaccine is not available in India now, and the jury is still out.

Pneumococcal vaccine: All those above 55 should take a dose of pneumococcal vaccine. Others at risk may take it according to their doctor’s advice.

Human papilloma virus vaccine: Vaccine is available against HPV, a can be taken by all women between 10 and 45 years of age. If the person is married, it may be prudent to discuss this with their obstetrician before taking it.

Anti-Rabies Vaccine (ARV): Though it is not recommended universally, for those of us who are exposed to bites by stray or pet dogs, which includes all of us who go walking or use two wheelers to commute, it is wise to take pre exposure prophylaxis. This will preclude the use of monoclonal antibody or Human Rabies immunoglobulin when there is a Class 3 bite in the future. Only 2 doses of ARV will be needed then in a previously immunised person.

Typhoid Vaccine: The Global Advisory Committee on Vaccine advisory, published in the WHO Weekly Epidemiological Record on 25 January 2019 recommends routine use of TCV as a single intramuscular dose for primary vaccination of infants and children from 6 months of age and adults <= 45 years of age and in catch-up campaigns in children <= 15 years of age in typhoid-endemic regions

Hepatitis A vaccine: Most adults who drank unprotected or chlorinated water that was the norm even in Medical colleges before the turn of the century are probably immune. If the IgG antibody against HAV is low, vaccine is advised. Safety during pregnancy is to be established.

Meningococcal vaccine: Vaccination is indicated in specific situations, such as during an outbreak. A single dose of vaccine (A + C) may be given to health care workers, laboratory workers, and close contacts of cases.

This list is not complete and in special circumstances, such as foreign travel, immune deficiency, post-exposure etc., special vaccinations may be necessary as advised by your physician. Furthermore, we need to vaccinate our children, according to the IAP schedule.

Vaccination against Japanese Encephalitis is not indicated in adults who reside in endemic areas. If you have moved in from a non-endemic area, the vaccine may be taken in consultation with your physician. Children below 18 should be given the vaccine if not done earlier.

Adapted from CDC guidelines Recommended Vaccines for Healthcare Workers | CDC and IAP Recommendations

Dr. Suresh Chelliah

Senior Consultant Paediatrician (Head – Academics)

Physician, Protect thyself

Physician, Protect thyself

Dr. Suresh Chelliah

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