Vaccinations in the Workplace

June 2004

OCCUPATIONAL HEALTH & SAFETY

Table of Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . General Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Additional Vaccinations Recommended for Certain Occupational Groups. . . . . . . . . Hepatitis B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hepatitis A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rabies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Influenza Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selected Occupations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health Care Workers and Emergency Service Workers . . . . . . . . . . . . . . . . . . . . . . . Sewage and Waste Treatment Workers .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Child Care Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Travelling Workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 2 2 3 3 4 5 5 6 6 6 6 7

PLEASE NOTE
This publication is not designed to replace the legislation. Please use the original legislation to find out exactly what requirements apply to your business. To purchase copies of The Occupational Health and Safety Act, 1993 or The Occupational Health and Safety Regulations, 1996, contact: Saskatchewans Queens Printer B19 3085 Albert Street Toll Free: 1-800-226-7032 Phone: (306) 787-6894 Fax: (306) 798-0835 E-mail: qprinter@justice.gov.sk.ca Online: www.qp.gov.sk.ca Industries under federal jurisdiction such as transportation, broadcasting and telecommunications are governed by The Canada Labour Code. If you work in a federally regulated industry, please contact Human Resources and Development Canada at http://www.hrsdc.gc.ca.

Occupational Health and Safety

Introduction
A vaccination is a simple and effective way to prevent serious diseases or illnesses in workers who may be exposed to an infectious organism. Side effects are rare. A vaccination stimulates a persons immune system to protect against the infectious organism before it can cause disease or illness. Vaccinations are available for a number of infectious organisms that workers may be exposed to in the workplace. Employers need to be familiar with vaccinations recommended for workers in the Canadian Immunization Guide (CIG) and what duties they have related to worker vaccinations. This publication is based on the 6th edition of the CIG (2002) and will assist employers in becoming familiar with its current recommendations. Employers legal duties are also explained. Section 85 of the Saskatchewan Occupational Health and Safety Regulations, 1996 requires employers to: inform workers who may be exposed to an infectious material or organism of any vaccinations recommended in the CIG, or recommended by a Medical Health Officer or other physician with expertise in immunization or the control of communicable diseases; inform workers of risks associated with taking these vaccinations; and with a workers consent, arrange for the worker to receive these vaccinations during normal working hours and reimburse the worker for costs associated with receiving the vaccination The employer must take steps to ensure workers have been immunized before they begin tasks that may expose them to infectious organisms. Vaccinations should be started as soon as the worker is hired to do such work.

General Vaccinations
These are vaccinations recommended by the CIG for all adults to protect against infectious organisms that adults may be exposed to in their home, public and work environments. It is important for workers to see their physician or public health care provider to discuss general immunizations they need and to ensure these immunizations are up to date. The employer must inform workers of the following general vaccinations ONLY when the worker is likely to have significantly more exposure to the corresponding infectious organism at work. When this is the case, the employer must make arrangements for workers to have these vaccinations during their normal work time and reimburse them for the associated costs. There will not necessarily be a cost for these vaccinations. For example, the worker may already meet the eligibility criteria to receive the vaccination under the publicly funded vaccination program.

Vaccinations in the Workplace

The most recent edition of the CIG recommends that all adults, including workers, receive the following vaccinations: Diphtheria Tetanus Influenza for adults 65 or older, or those under 65 at risk of influenza-related complications, and others, see CIG Pneumococcal pneumonia for adults over 65 or those under 65 with conditions putting them at increased risk of pneumococcal disease Measles for all adults born in 1970 or later who are susceptible Rubella only for susceptible women of child-bearing age and health care workers Mumps only for adults born in 1970 or later with no history of mumps

Additional Vaccinations Recommended for Certain Occupational Groups

Workers in certain occupations may be exposed to infectious hazards that they normally would not come in contact with in everyday life. The CIG recommends additional vaccinations for certain occupational groups.

Hepatitis B
Workers can get Hepatitis B infections from exposure to infectious body fluids, notably blood, through: Eyes Mucous membranes Damaged skin Skin punctures Urine, vomitus, tears, sweat, sputum, faeces or nasal secretions are not considered potentially infectious unless they are visibly contaminated with blood. Saliva is considered potentially infectious. The CIG recommends the Hepatitis B vaccination for health care workers such as nurses, doctors, laboratory staff and others; staff at long term correctional facilities; staff at institutions for the developmentally challenged and other workers at increased risk of occupational Hepatitis B infections. For example the following groups may be at increased risk of occupational Hepatitis B infections and should be considered for immunization: Emergency service workers, including paramedics and others with paramedical duties, such as firefighters or certain prison guards, and police officers or prison guards with duties likely to involve contact with aggressive or violent carriers of Hepatitis B. 2
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Funeral home workers and embalmers exposed to blood and body fluids on a daily basis. To determine the need for the vaccination, consider the evidence and the likelihood of exposure to potentially infectious materials. The Hepatitis B vaccination should be offered to any worker where evidence indicates they are reasonably likely to be exposed to blood and body fluids in the normal course of their daily work. Contact a Medical Health Officer when the need to provide the vaccination to a worker or a group of workers is uncertain. Full immunization involves three doses: an initial dose, a booster one month later and a final booster, one or more months after the first booster, depending on the brand of vaccination used. As up to 10% of the population may not respond properly to the vaccination, it is recommended that employers offer appropriate follow-up titre testing to workers receiving the Hepatitis B vaccination.

Hepatitis A
The Hepatitis A virus is spread by the faecal-oral route, through direct contact with infected people or indirectly by ingestion of contaminated materials such as water or foods, especially uncooked shellfish. The virus may persist for days or weeks in the environment. Workers may be infected after the accidental ingestion of body excretions (for example faeces, human sewage), secretions or materials contaminated with them. Certain occupational groups may be at increased risk of Hepatitis A. The CIG recommends the Hepatitis A vaccination for the following types of workers: Emergency relief workers and other workers likely to be sent abroad to areas with high rates of Hepatitis A infection. Staff of institutions for the developmentally challenged where ongoing Hepatitis A problems exist. Other workers, including zoo-keepers, veterinarians, researchers handling nonhuman primates, and certain laboratory workers handling or involved in research on Hepatitis A. Currently the CIG does not recommend the vaccination for health care workers, food handlers, sewage workers and staff at child care facilities. Full vaccination includes an initial dose, and a second dose six or more months later, depending on which brand of vaccination is used. Combination Hepatitis A/Hepatitis B vaccinations are available that are given in three doses similar to the Hepatitis B vaccination.

Rabies
Rabies virus can infect any mammal, though it is mainly reported in skunks, bats and domestic pets. In Saskatchewan, rabies is most commonly reported in skunks and brown bats. The CIG recommends a post-exposure rabies vaccination and other post-exposure management for any worker who has been bitten by an animal or had a cut, scratch or abrasion contaminated with potentially infected fluids from an animal unless the animal was known not to have the rabies virus.
Vaccinations in the Workplace

The CIG recommends the pre-exposure vaccination be offered to high-risk occupational groups including: Veterinarians, veterinary technicians, other veterinary employees that handle animals on a daily basis (while the CIG only mentions veterinarians and does not specifically mention veterinary technicians or other employees that handle animals regularly, these other employees should be included). Certain laboratory workers if indicated (for example, laboratory workers working with or researching the rabies virus). Wildlife workers, animal control workers. Full pre-exposure vaccination involves three doses at days 0, 7 and 21. The post-exposure vaccination and other treatment can depend on the species of animal and its condition if known at the time of exposure. Post-exposure treatment should be sought as soon as possible after exposure, and should be offered to exposed individuals regardless of the time since their exposure. Five doses are usually given to persons not previously immunized. The dose and dose schedule may be adjusted if the worker was previously immunized. Booster doses of the vaccination may be necessary for those who have been immunized. Workers who have been vaccinated should have their serum tested for rabies antibodies every two to three years. Laboratory workers working with live virus or involved in vaccination production should have their titres checked every six months (CIG).

Influenza Vaccination
It is recommended that health care providers and others who have significant contact with people identified as being at high risk of acquiring influenza, should be offered and receive annual vaccinations unless they have medical reasons not to (CIG).

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Selected Occupations
Health Care Workers and Emergency Service Workers
The CIG recommends the following vaccinations: Hepatitis B (See Additional Vaccinations above) Influenza (See General and Additional Vaccinations, above) Rabies (See Additional Vaccinations above) Hepatitis A (See Additional Vaccinations above) Typhoid. Typhoid vaccination should be offered because it is recommended for laboratory personnel who frequently work with Salmonella typhi6. Varicella. The varicella zoster live-virus vaccination is recommended for workers with frequent contact with children and who do not have a reliable, documented history of immunity to the virus. The vaccination is recommended for female workers of child-bearing age without this documented immunity. The vaccination should not be given during pregnancy. BCG. The BCG vaccination may be considered for health care workers at high risk of exposure to Tuberculosis (TB) and/or multi-drug resistant TB and where normal protective measures and control precautions against infection transmission are inadequate. Consult the TB Unit of Saskatchewan Health and the OHS Division guide Protecting Emergency Response Workers from Infectious Diseases. Diphtheria, Tetanus. The CIG recommends primary immunization (three doses) and an immunization booster in the last ten years. When a worker receives a tetanusprone wound at work a booster may be needed after a consultation with a physician. Measles (MMR vaccination). For workers born after 1970, without reliable, documented immunity. Polio. The employer should encourage workers to determine if they were immunized as children. Workers who were not immunized as children should be advised that vaccinations are available for adults. Health care workers in close contact with individuals who may be excreting wild or vaccination strains of poliovirus should be offered the vaccination. Rubella. The CIG recommends vaccinations for female staff of child-bearing age without reliable, documented immunity. This vaccination should not be given to pregnant workers. The CIG should be consulted for more specific indications for the above vaccinations.

Vaccinations in the Workplace

Sewage and Waste Treatment Workers

Hepatitis A. Overall, strong evidence is lacking to support a requirement that employers offer routine vaccination to sewage and waste treatment workers for Hepatitis A virus. However, the employer should inform workers that the vaccination is available and what protection it provides. Employers may wish to consider offering this vaccination to their sewage workers. Tetanus and Diphtheria. The CIG recommends a primary vaccination (three doses) and a booster every ten years. When a worker receives a tetanus-prone wound at work, a booster may be needed after a consultation with a physician.

Child Care Workers

Hepatitis A and B. At present, the CIG does not recommend routine vaccinations against Hepatitis A for child-care workers, although some jurisdictions do make this recommendation. Child-care workers are not known to be at increased risk for Hepatitis B. Rubella and Varicella. See descriptions under health care-workers. Polio. The CIG recommends polio vaccination for non-immunized child-care workers who will be caring for children in countries where live oral poliovirus (OPV) is used.

Travelling Workers
Workers who are required to travel to certain countries may need unique vaccinations and / or preventative medication, depending on their destination. Recommendations will vary based on age, destination, medical history, and legal requirements for entry into a country. General recommendations cannot be made. Employers of workers who travel internationally must seek advice from a health care provider knowledgeable about vaccinations needed for foreign travel (usually this can be accomplished by consulting/contacting an international travel clinic at least six to eight weeks before the intended departure).

Summary
Certain occupations are more likely to be exposed to infectious organisms or materials at work. Employers need to be aware of vaccinations recommended by the CIG (or a Medical Health Officer or other physicians with expertise in immunization or control of communicable diseases) against infectious disease hazards in their workplace. There is an employer duty to inform workers about recommended vaccinations, arrange for workers to receive these vaccinations during normal working hours and reimburse workers for the associated costs.

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References
The Occupational Health and Safety Regulations, 1996 The Canadian Immunization Guide, 2002, Health Canada http://www.phac-aspc.gc.ca/ Protecting Emergency Response Workers from Infectious Diseases, Occupational Health and Safety Division. http://www.lrws.gov.sk.ca/protecting-emergency-response-workers-infectious-disease

Vaccinations in the Workplace

OCCUPATIONAL HEALTH & SAFETY

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