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Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Vaccinations

Course Author(s): Géza T. Terézhalmy, DDS, MA

Vaccinations

OHCP shall be vaccinated against vaccine preventable infections in accordance with current state and federal regulations, as well as recommendations made by relevant professional organizations.

  1. Background

    Immunization programs have markedly reduced the incidence of vaccine-preventable diseases. Today, a substantial percentage of morbidity and mortality from several vaccine preventable diseases occurs in adults who escaped natural infection or immunization and who now are at increased risk of these diseases because of lifestyle, advancing age, the presence of certain chronic diseases, or occupation (e.g., healthcare workers).

  2. Execution/Compliance
    1. Mandated hepatitis B vaccination series
      1. Hepatitis B vaccine is made available at no cost to OHCP, without a history of prior immunization, at the time of initial assignment to tasks in which exposure may occur.
      2. If the hepatitis B vaccination series is declined, the person must sign a copy of the Mandatory Hepatitis B Vaccination Declination Form (Box 1).

Box 1. Mandatory Hepatitis B Vaccination Declination Form.5

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring Hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine, at no charge to myself. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

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Employee Signature                                                     Date
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      1. If subsequently the person decides to submit to vaccination, while still covered under the standard, the hepatitis B vaccination series is made available at that time.
      2. Post-vaccination seroconversion - 1st vaccination series
        1. Testing for HBsAb is strongly recommended 1-2 months after the 3rd dose of the 1st vaccination series
        2. A HBsAb titer of >10 mIU/mL is considered adequate
        3. A person who do not develop an adequate antibody response to the 1st vaccination series will be offered a second 3-dose series
      3. Post-vaccination seroconversion - 2nd vaccination series
        1. Testing for HBsAb is strongly recommended 1-2 months after the 3rd dose of the 2nd vaccination series
        2. If no antibody response occurs, testing for HBsAg is strongly recommended
          1. HBsAg-negative OHCP will be counseled about precautions to prevent HBV infection and the need to obtain HBIG prophylaxis for any known or probable parenteral exposure to HBsAg-positive blood.
          2. HBsAg-positive OHCP will be referred for post-exposure evaluation and follow-up and counseled about the need for work restrictions to prevent the transmission of HBV to others.
    2. Booster doses of the HB vaccine
      1. At this time, routine booster doses of the hepatitis B vaccine are not indicated; if at a future date booster doses are recommended, they will be made available at no cost to OHCP.
    3. Other vaccines highly recommended for all OHCP include influenza, measles, mumps, rubella, varicella, and pertussis.
    4. In certain circumstances, OHCP should also be vaccinated against meningococcal disease, typhoid fever, and poliomyelitis.
    5. Vaccines recommended for adults in general include the pneumococcal polysaccharide vaccine, tetanus and diphtheria toxoids, human papillomavirus vaccine, zoster vaccine, and hepatitis A vaccine.
    6. OHCP unable or unwilling to be vaccinated as recommended will be educated regarding their exposure risk and the management of work-related illness and work restrictions (if applicable).
    7. Documentation of vaccination status
      1. The vaccination status of OHCP is documented in their individual Medical Record and includes the following information:
        1. The dates of vaccination (where applicable or available)
        2. Evidence of immunity (where applicable or available)
        3. A signed copy of the mandatory hepatitis B vaccination declination form (where applicable)
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