1.0 Purpose and Scope

This guideline applies to all workers (staff and non-paid), contractors and students who are undertaking work, research or academic studies at the University of Queensland (UQ).

The information provided in this guideline is intended to assist UQ workers and students meet the requirements outlined in the associated UQ Procedures 2.60.08 Vaccinations and Immunisations. It provides information about general vaccination recommendations in accordance with the Australian Immunisation Handbook and guidance for individuals and workgroups who due to the nature of their activities at the University are at higher risk of exposure to a vaccine-preventable disease.

This guideline is intended to protect not only UQ workers, contractors and students but also the broader community. 

2.0 Key Requirements

UQ seeks to minimise the risk, as far as is practicable, of persons being exposed to a vaccine-preventable disease (VPD). Where an increased risk at the University is identified, appropriate training, information and resources must be provided to achieve effective infection control. This provision extends to appropriate vaccination and immunisation screening recommendations.

The information provided in this guideline does not replace the need for individual medical consultation. Those working in specialised settings such as certain microbiological laboratories or infectious disease wards or those who are required to travel overseas to work should seek additional medical advice.

UQ workers and students who are pregnant or who have a serious illness or compromised immunity should also seek further medical advice.

Additionally, all persons with a known infectious disease have a duty of care to minimise the risk of transmission, as much as possible, to other members of the University community and the general public.

3.0 Roles, Responsibilities and Accountabilities

UQ workers and students

All UQ workers and students are advised to have completed the current Australian National Immunisation Program Schedule as recommended by the Australian Government Department of Health.

Immunisation requirements for UQ workers, prospective workers and students will be identified where there is an increased risk of acquisition or transmission of a VPD (refer to Table 1 - Student Immunisation by Program/Course and Table 2 - Occupational Immunisation).

Workers and students who are moving to Australia from overseas are advised to seek medical advice prior to departure and bring relevant medical documentation with them.  On arrival it is advisable to also check with their Australian health care provider whether the vaccination schedule for their home country is equivalent to the Australian National Immunisation program schedule, as additional vaccinations may be required.

3.1  UQ workers

Specific vaccinations may also be required for those workers who are potentially at risk of exposure to VPD due to the inherent requirements of work tasks at the University.  Refer to section 4 of this guideline.

Prospective workers applying for healthcare related positions involving the risk criteria specified in section 4.1 of this guideline must comply with the pre-employment immunisation and screening requirements for their position. Please refer to the forms section of this guideline to locate – UQ Staff Healthcare Worker Form.

3.2                 UQ students

Prospective students must refer to the enrolment information for their particular academic program to confirm whether immunisation requirements apply as a condition of entry onto the program. Specific vaccinations are required for students who are potentially at risk of exposure to VPDs due to the inherent requirements of course studies at the University - for further detail refer to section 4.4 of the Procedures 2.60.08 Vaccinations and Immunisations and section 4 of this guideline.

Prospective Students enrolling in Faculty of Medicine and Faculty of Health and Behavioural Science programs must comply with the pre-placement immunisation and screening requirements for their clinical placements.

Some students may need to undertake additional vaccination or screening due to overseas placement requirements during their program e.g. medical students enrolled on the Ochsner Clinical School program.

Please refer to program entry requirements and the relevant Student Immunisation Records Form available from the faculty website and the forms section of this guideline.

3.3                 Residential college students

Residential college students are strongly advised to review and update their vaccination status as advised above and particularly due to the fact that they are living in close quarters with others.

Vaccination against meningococcal disease is particularly recommended for adolescents and young adults.  Refer to section 5.6 of this guideline for information regarding the meningococcal ACWY and the meningococcal B vaccinations. 

Annual Influenza vaccination is also highly recommended for students living in residential accommodation.

It is prudent to also ensure immunity to varicella and measles, mumps and rubella (MMR) in persons born in 1966 or later and entering University as outbreaks may occur. Refer to section 5.5 and 5.12 of this guideline.

4.0 UQ work, research or placements

Some persons at the University are potentially at risk of exposure to VPD as a consequence of their workplace tasks, course placements or research activities. The exact nature of tasks or work location should be taken into account when deciding immunisation requirements to minimise the risk of VPD acquisition or transmission occurring. Those workers or students in the categories listed below must be provided with appropriate information and training and referred for relevant vaccination and/or immunisation screening before exposure to identified risk occurs.  

Note that there are special issues for those who are immune-compromised or pregnant in terms of exposure to pathogens or vaccines. General advice on these may be found in the NHMRC guidelines.  Specific medical advice relevant to their own situation should be sought by the worker or student.

For all vaccines, prescribing details should be consulted particularly for contraindications or warnings.

4.1                 Healthcare related roles and placements

Persons whose work or course program activities include tasks with risk of infectious disease transmission via direct or indirect contact with patients must provide evidence that they have been vaccinated against, or are not susceptible to the VPDs listed below:

• measles;

• mumps;

• rubella;

• varicella; and

• pertussis (whooping cough).

​ Risk criteria includes:

• those who have regular face to face contact with hospital patients;

• those who have regular face to face contact with; clients who are immune compromised, have been diagnosed with a chronic disease, are pregnant, pre-school age or elderly.

• those whose normal work location or course placement is in a clinical area such as a hospital ward, emergency department, outpatient clinic, dental clinic or other clinical healthcare facility and includes non-clinical staff.

• those whose work or course placement frequently or regularly requires attending a clinical area such as a hospital ward, emergency department, outpatient clinic, dental clinic or other clinical healthcare facility and includes non-clinical staff.

Refer to the forms section of this guideline and the Queensland Health Vaccination of Healthcare Workers Guideline. 

Tuberculosis screening for healthcare related roles and placements

It is a UQ requirement that those whose work or course program activities include the risk criteria above must also show evidence of screening for past tuberculosis exposure or latent infection.  The screening must be in the two years previous to employment or commencing student placements.  Refer to section 5.11 of this guideline.

Hepatitis B immunisation for healthcare related roles and placements

Persons who interact in clinical health facilities and have direct contact with patients or who may be exposed to human blood or body fluids as a result of their work or placement activities, must be vaccinated against hepatitis B.

Tasks that involve direct patient contact may include (not an exhaustive list):

• providing clinical care or treatment of any kind;

• assisting a patient to undertake activities of daily living such as eating, using the toilet or mobilising;

• any manual handling of patients.

Other tasks with risk of hepatitis B exposure in healthcare settings include:

• collecting, transporting, handling or processing of pathology samples;

• cleaning of spills that may contain blood or body substances of any kind;

• manual handling or transporting of deceased people;

• post mortem examination or autopsies;

• bed making and cleaning;

• handling of soiled or contaminated linen;

• handling of clinical or laboratory waste or waste receptacles;

• cleaning in a patient room, using cleaning, repairing or maintaining equipment, surfaces or other items used in clinical areas or laboratory setting.

Refer to section 5.2 for further detail regarding hepatitis B vaccination. 

Exposure prone procedures (EPP)

An exposure-prone procedure (EPP) is a procedure where there is a risk of injury to the Health Care Worker (HCW) resulting in exposure of the patient’s open tissues to the blood of the worker. These procedures include those where the workers hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

Reference – Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses - 2019

Persons who undertake EPP as a requirement of their job or coursework must also submit an Exposure Prone Procedure Declaration signed by a Medical Practitioner prior to exposure. The Medical Practitioner must confirm that the person can safely perform EPP and has undertaken screening for Hepatitis B, C and HIV within the twelve months of their commencing employment or course program.

Dentistry students must repeat the screening and EPP declaration in the third and fifth year of their course. 

Prospective employees applying for Healthcare related positions at the University must comply with the pre-requisite immunisation requirements specified in the position description and letter of offer – Refer to section 3 of Procedures 2.60.08 Vaccinations and Immunisations.  

All healthcare providers are strongly recommended to also be vaccinated against influenza on an annual basis.  Refer to section 5.3 of this guideline.

4.1.1 Healthcare providers – remote indigenous communities

Healthcare providers who work or are on placement in remote indigenous communities and/or regularly provide care for Aboriginal or Torres Strait Islander children in the Northern Territory, Queensland, South Australia or Western Australia, must be immunised against hepatitis A in addition to the vaccines listed for all healthcare providers.  Refer to section 5.1 of this guideline. 

4.2 Childcare workers and students

UQ workers and students who currently work or intend to work with pre-school age children are strongly recommended to be vaccinated against measles, mumps, rubella (if not immune), varicella (if not immune) and also pertussis (dTpa). Annual influenza vaccination is also strongly recommended.

4.2.1 Early childhood education and care

UQ workers and students who currently work or intend to work in early childhood education and care are recommended to be immunised against hepatitis A as well as those diseases listed in section 4.2 for Childcare workers and students.

4.3 Laboratory workers and students 

4.3.1 Human blood, body fluids or tissue

UQ workers and students who are directly involved with handling human tissue, blood or body fluids must be immunised against hepatitis B - see section 5.2 of this guideline.

4.3.2  Human or zoonotic infectious pathogens

Laboratory workers and students interacting with human or zoonotic infectious pathogens must refer to PPL procedure 2.40.02 Biosafety Requirements, as permission from The University of Queensland Institutional Biosafety Sub-Committee may be required prior to work commencing. A risk assessment for the pathogen involved must be undertaken to identify if a vaccination is available to protect against disease transmission in the workplace.

It is important to be vaccinated prior to work with the pathogen commencing and medical advice will be needed about the length of time needed before exposure to the pathogen in question. 

• Persons handling veterinary specimens or working with Q fever organism (Coxiella burnetii) must undertake screening and if indicated, Q fever vaccination.  Refer to section 5.13 of this guideline.

• Persons handling unscreened human tissue, blood or body fluids must be immunised against hepatitis B.  Refer to section 5.2 of this guideline.

• Persons working with bat tissues, lyssaviruses or rabies virus must be immunised against rabies.  Refer to section 5.9 of this guideline.

• Persons working with Mycobacterium Tuberculosis must undertake baseline screening of their TB status prior to work commencing.  Refer to section 5.11 of this guideline. 

• Persons working with Japanese encephalitis virus must be immunised against this disease.

• As a general principle, persons working with any pathogen that is potentially preventable by immunisation should be vaccinated.

Further information about working safely with biohazardous material can be obtained from UQ Biosafety webpage. Pathogen Safety Sheets for some infectious micro-organisms can be obtained from:

• Public Health Agency of Canada - provides Pathogen Safety Data Sheets and Risk Assessments for a comprehensive list of pathogens.

• American Biological Safety Association webpage allows you to search micro-organisms to tell you what risk group they are.

4.4 Interacting with waste water, sewerage or soil

Persons frequently interacting with waste water or sewerage such as plumbers or those conducting waste water/sewerage research are recommended to be immunised against hepatitis A and tetanus - see sections 5.1 and 5.10.

4.4.1 Grounds workers and gardeners

Persons frequently handling manured soil should have received a complete childhood tetanus vaccination schedule (a 3 dose primary schedule as an infant and 2 booster doses at age 18 months and 4 years) and an additional booster dose as an adolescent. A tetanus-containing vaccine booster is recommended for all adults at 50 years of age and at 65 years of age if it is more than 10 years since the last dose.

Adolescents and adults who have never had a tetanus-containing vaccine are recommended to receive 3 doses of tetanus-containing vaccine with at least 4 weeks between doses, and booster doses at 10 years and 20 years after the primary course.

The need for tetanus-containing vaccine in people with a tetanus-prone wound, with or without tetanus immunoglobulin, depends on the nature of the wound and the person's vaccination history.  Refer to section 5.10 of this guideline.

In addition, immunity against Q-fever is recommended for people who regularly mow and slash grass contaminated with animal excreta if the site has recently been used for livestock grazing or is densely populated with kangaroos or other wildlife. In addition, those exposed to animal manures in fertilisers and soil conditioners should also consider Q-fever prevention. Refer to section 5.13 of this guideline. 

4.5 Interacting with animals including animal blood, tissues, products or animal waste

UQ workers or students who work with agricultural animals or wildlife as outlined in 2.60.13 Q-Fever Screening and Immunisation must be screened and/or vaccinated against Q fever - also see section 5.13 of this guideline.

Veterinary workers and students are also recommended to receive annual influenza vaccination - see section 5.3 of this guideline.

Agricultural workers and those who work with animals should also be immunised against tetanus - see section 5.10 of this guideline.

Persons who work with bats or with animals in a rabies-endemic area must seek advice about rabies vaccinations.

4.5.1        Bats or Australian Bat Lyssavirus (ABL virus) 

Australian bat lyssavirus is a virus that can be transmitted from infected bats. Persons interacting with bats or ABL virus must be immunised against rabies and comply with recommended post vaccination and post exposure screening recommendations - Refer to section 5.9 of this document.

4.5.2 Pigs or poultry

Persons frequently in contact with pigs or poultry are strongly recommended to have annual influenza vaccination.  Refer to section 5.3 of this guideline.

4.6 First Aid Officers

First aid officers appointed for the University are recommended to be immunised against hepatitis B. Refer to section 5.2 of this guideline and PPL Guideline 2.60.10 Working Safely with Blood and Body Fluids.

4.7 Mortuary technicians and embalmers

Baseline screening for tuberculosis and immunisation against tetanus and hepatitis B is recommended for mortuary technicians and embalmers. For those likely to be exposed to faecal material as part of the embalming process, immunisation against hepatitis A is also recommended.

4.8 Work related travel or fieldwork activities

For all travel, particularly international travel seek specialised travel health advice and vaccinations and refer to information provided in the PPL 2.30.09 Work Off-Campus procedure and guideline. Travellers are also responsible for reading the travel advice issued by the Department of Foreign Affairs and Trade - Smart Traveller website.

Consider vaccination for Japanese Encephalitis Virus (JEV) for UQ workers or students who are living or working in the outer Torres Strait islands during the wet season.  Refer to The Australian Immunisation Handbook for guidelines.

5.0 Occupational Vaccinations and Immunisation Screening

5.1 Hepatitis A

Hepatitis A is an acute infection of the liver caused by the hepatitis A virus. The severity and duration of the infection varies however for most affected people the symptoms are self-limiting and usually resolve within 3 weeks. The symptoms are often more severe in adults compared to childhood cases and occasionally the symptoms of hepatitis A infection in adults can be seriously debilitating and last several months. Transmission of the virus usually occurs via faecal/oral transfer for example by drinking contaminated water, eating food that has been handled by an infected person or touching infected faeces from contaminated nappies or towels.

Vaccination must be considered for healthcare workers who live or work in rural and remote indigenous communities or who work in health units where the unit provides for substantial populations of indigenous children.

It is also recommended that childcare workers, carers of the intellectually disabled and for those who may be exposed to sewage at work, such as plumbers and persons conducting waste water/sewerage research are protected against hepatitis A transmission.

To avoid unnecessary vaccination, it is recommended that the following groups be screened for pre-existing natural immunity to hepatitis A:

• those born before 1950;

• those who spent their early childhood in endemic areas; and

• those with an unexplained previous episode of hepatitis or jaundice. (N.B. Such a previous episode cannot be assumed to be hepatitis A).

If, upon screening, a person has total Hepatitis A antibodies or anti-HAV IgG, they are considered to be immune. It can be assumed that he/she has either had previous, perhaps unrecognised, HAV infection, or less likely, has been previously immunised. Hepatitis A vaccination in this instance would therefore not be required.

Hepatitis A vaccine is administered as two injections 6 to 12 months apart. A combined vaccine against hepatitis A and hepatitis B is available.

For further information about Hepatitis A, refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.2 Hepatitis B

Hepatitis B is a serious infection which causes inflammation of the liver. Hepatitis B is transmitted via parenteral exposure (see definition section 8.1) to the blood or body fluid of an infected person. Immunisation against hepatitis B is the most effective way of preventing infection transmission.

UQ requires hepatitis B vaccination and/or proof of immunity or a Statement of Susceptibility whenever there is a risk of persons acquiring or transmitting hepatitis B in the workplace e.g. healthcare staff, laboratory staff working with unscreened human blood or body fluids.

There is good evidence that a successfully completed primary course (three injections, the second at one month, the third at four to six months followed by a blood test with Hep Bs Ab >10 IU/l at least 4 weeks following last dose) provides long lasting protection in normal (immune-competent) individuals. If the primary course has produced a protective level of antibodies as detailed above, routine boosters are not recommended (Australian Immunisation Handbook). Further medical advice is necessary if vaccination is unsuccessful or if Hep Bs Ag, Hep B c Ab or Hep B DNA are positive. Refer to PPL Guideline 2.60.10 Working Safely with Blood and Body Fluids.

Hepatitis B vaccination and/or proof of immunity or a Statement of Susceptibility is required prior to commencing work or placement in a Queensland Health clinical facility. Please refer to Queensland Health Vaccination of Healthcare Workers Guideline.

For all UQ healthcare students, hepatitis B vaccination and/or proof of immunity or a Statement of Susceptibility is required prior to commencing a healthcare programs at UQ and/or clinical placements. Please refer to program entry requirements and also Queensland Health Vaccination of Health Care Workers Guideline.

A combined vaccine against Hepatitis A and Hepatitis B is available.

An approved rapid immunisation schedule is available for persons requiring urgent immunisation against Hepatitis B or Hepatitis A and B.

For further information about Hepatitis B, refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.3  Influenza

Influenza is a highly contagious disease caused by infection from Influenza type A or B (or rarely C) virus. These viruses infect the respiratory passages and lungs and can develop into a serious illness in some people, particularly those who are elderly, pregnant or have an underlying medical condition.

Annual vaccination with influenza vaccine in autumn is strongly recommended for those at personal or occupational risk from influenza, including the following:

• All healthcare workers (HCW) and HCW students, to protect both the HCW and the patients they interact with.

• Persons who work with children or care for persons with developmental disabilities. 

• Persons who frequently interact with pigs and/or poultry.

• Persons living in close quarters in residential accommodation such as student residential colleges.

Immune-compromised persons who receive influenza vaccine for the first time are recommended to receive two vaccine doses at least 4 weeks apart and one dose annually thereafter.

Influenza vaccination is available free of charge to staff during the annual UQ flu campaign in autumn each year. Students can access vaccination from their own GP or from UQ Health Care at St Lucia and Gatton campuses.

For further information about Influenza, refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.4 Japanese encephalitis

Japanese encephalitis (JE) is a serious infection of the brain caused by a mosquito transmitted virus. JE occurs mainly in Southeast Asia and China and occasional cases in eastern Indonesia and Torres Strait. There have been occasional outbreaks in Torres Strait and one case in North Queensland prior to the publication of this document. 

Vaccination is required for laboratory staff working with JE and is recommended for those who will be living or working on the outer islands of the Torres Strait for a cumulative total of 30 days or more during the wet season (December to May). Those visiting the outer islands in the dry season (June to November) do not require vaccination. Those visiting only the inner islands, including Thursday Island, do not require vaccination.

Workers and students intending to visit high risk areas such as rural parts of Papua New Guinea and Asia must consult with UQ Health Care (St Lucia Campus) or a travel medicine service or specialist for further advice. 

For further information about Japanese encephalitis refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.5  Measles, Mumps and Rubella (MMR)

For information about Measles, Mumps and Rubella infection refer to the Qld Health Conditions Directory.

All those in healthcare related roles and placements with direct or indirect patient contact must ensure they have received 2 doses of MMR vaccine or provide evidence that they are immune to these diseases.  This also applies to UQ staff or students who regularly interact as part of their UQ work or study  with persons who are immune compromised, have a chronic health condition,  are pregnant, pre-school age or elderly.

Residential college students should have their vaccination records reviewed to ensure they have received 2 doses of MMR vaccine as MMR are highly contagious and can spread rapidly amongst persons living in close quarters. Although the incidence of these diseases has declined in Australia since the introduction of universal vaccination in the 1980's, there has been an increase in measles and mumps infections among adolescents and young adults who were not fully vaccinated against MMR.  Large outbreaks of measles infection have occurred in many countries including developed countries and it is recommended that all persons travelling internationally ensure that they are protected against measles infection.

Women should be screened for rubella antibodies shortly before every pregnancy, early in the pregnancy or if pregnancy is contemplated, irrespective of a previous positive rubella antibody result. Women should not receive the vaccine if they are pregnant or might become pregnant within 28 days. 

Persons born prior to 1966 are not required to be screened or vaccinated against MMR as persons in this age group are considered to have immunity (unless serological evidence indicates otherwise). MMR vaccination is contraindicated in those who are immune-compromised. Rubella containing vaccines are also contraindicated in pregnancy.

For further information about MMR refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.6 Meningococcal disease

Meningococcal disease is a severe illness that can cause death or profound life-long disability including brain damage, hearing loss and/or limb loss. It is an uncommon condition which occurs when meningococcal bacteria invade the body resulting in meningococcal meningitis or meningococcal septicaemia. Meningococcal bacteria are present in the throat or nasal passages of approximately 10% of the community. Most of these people are not affected by the presence of the bacteria and remain well but can transmit the bacteria to others. A small percentage of those infected may subsequently develop illness and will require urgent medical attention and treatment with antibiotics.

5.6.1 Meningococcal disease caused by A, C, W, and Y serotypes

At the time of publication of this document free vaccination is available for 15-19 year olds as part of the National Immunisation Program.  The program targets 15 - 19 year olds, who have the highest rates of meningococcal carriage and it is recommended that unvaccinated students 19 years of age or younger consider being vaccinated. 

Immunisation against meningococcal ACWY is also now part of the infant immunisation schedule.

5.6.2 Meningococcal disease caused by B serotype

Meningococcal B vaccination is recommended in a 2-dose schedule for all adolescents aged 15 - 19 years due to their higher risk of serotype B meningococcal disease compared with other ages. Meningococcal B vaccination is particularly recommended for adolescents and young adults living in close quarters, such as military recruits and students living in residential accommodation. Vaccination is recommended prior to entry to such high risk settings or as soon as possible after entry. This vaccination is currently not covered by the National Immunisation Program and is therefore not without cost to the patient.

For further information about meningococcal disease refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.7 Pertussis (Whooping Cough)

Pertussis (Whooping Cough) is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It can cause a persistent cough in adolescents and adults and in babies the infection can be life-threatening.

Vaccination against pertussis is recommended for any adult who wishes to reduce the risk of infection for themselves and for any close contacts who may be vulnerable to an increased risk of poor health outcome if infected. It is recommended that adults who have previously been vaccinated as a child against pertussis, and who require a booster against diphtheria or tetanus, consider boosting their pertussis immunity using the dTpa vaccination. dTpa vaccination is strongly recommended for pregnant women and all adults who will be in close contact with babies and young children including those working in early childhood care or education with children <4 years of age.

All those in healthcare related roles and placements with direct or indirect patient contact must be immunised against pertussis and must receive a pertussis booster if more than 10 years have elapsed since their last dose. Persons interacting with persons who are immune compromised, have a chronic health condition or who are pregnant, pre-school age or elderly must also comply with the same standard of pertussis immunisation as described for healthcare workers.

Vaccinated healthcare workers and students who develop symptoms compatible with pertussis infection should still be investigated for pertussis and must be excluded from the workplace until a pertussis diagnosis is ruled out.

For further information about pertussis refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.8 Poliomyelitis (Polio)

Poliomyelitis is an infection caused by polioviruses. Most infections cause mild disease, however, the virus can affect the central nervous system and cause paralysis and permanent disability.

It is important to retain high vaccination rates against polio in Australia while the disease remains endemic in other parts of the world.

All adults are recommended to have completed a full course of poliomyelitis vaccination as part of the National Immunisation program (at 2, 4 and 6 months of age with a booster at 4 years of age). 

Further boosters are not required except for the following persons at special risk, such as:

• travellers to areas or countries where poliomyelitis is epidemic or endemic or with recent cases including vaccine derived polio - see http://www.polioeradication.org for more information on affected countries, or

• Healthcare workers, including laboratory workers, in possible contact with poliomyelitis cases.

For those exposed to a continuing risk of infection, booster doses are desirable every 10 years.

The risk of exposure to polio in the Australian community including the healthcare setting is considered too low to routinely recommend polio boosters to healthcare students. Polio vaccine (the inactivated polio vaccine by injection) is recommended for students who will be undertaking a period of training in countries where polio is present.

For further information about polio refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.9 Rabies/Australian bat lyssavirus (ABL)

Rabies is a disease of the nervous system caused by the rabies virus. Rabies infects domestic and wild mammals and is spread to humans through close contact with infected saliva, usually via an infected animal bite or scratch. Rabies in humans is almost always fatal once symptoms develop. Rabies is not found in Australia but a close relative of the virus called the Australian bat lyssavirus, can be found in Australian bats.

UQ veterinary and wildlife workers and students who handle Australian bats, or researchers who work with Australian Bat Lyssavirus (ABL) in a laboratory, or those who work with animals in areas of the world where rabies is endemic, must have completed a pre-exposure rabies vaccination course. Workers and students must seek rapid post exposure treatment in the event they are bitten or scratched or sustain a contaminated needle stick injury when handling a bat or other potentially infected animal. Please refer to PPL 2.60.14 Working Safely with Bats and Flying Foxes: Lyssa Virus for information about pre exposure vaccination, post exposure treatment and the requirement for on-going rabies boosters and rabies antibody monitoring. Also refer to the Work Health and Safety Queensland, Australian bat lyssavirus and handling bats for further information about safely handling bats.

5.9.1 Rabies/ABL screening

UQ workers and students likely to be exposed to bats in Australia or overseas or potentially rabid animals overseas, should have antibody levels checked or be re-vaccinated every 2 years. Those with impaired immunity should have their antibody levels tested 2-3 weeks after the third dose of the vaccine.

UQ Workers and students who work with ABL in a laboratory must have their antibody levels tested every 6 months and receive booster doses, if required, depending on the antibody level.

For further information about rabies refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.10 Tetanus

Tetanus is an acute disease caused by the bacteria Clostridium tetani. This bacteria is commonly found in soil, dust and manure. The bacteria can contaminate wounds and produce a toxin which causes painful muscular contractions and spasms. Unvaccinated persons are at risk of developing tetanus if they sustain a wound contaminated by tetanus bacteria.

All adults in the community, including all UQ workers and students, are advised to maintain their immunity to tetanus. All adults should have received a complete childhood tetanus vaccination schedule (a 3 dose primary schedule as an infant and 2 booster doses at age 18 months and 4 years) and an additional booster dose as an adolescent.  A tetanus-containing vaccine booster is recommended for all adults at 50 years of age and at 65 years of age if it is more than 10 years since the last dose.  Vaccination is recommended every 10 years for travellers to countries where health services are difficult to access. Travellers with a higher risk of a tetanus-prone wound are recommended to be vaccinated every 5 years.

The need for tetanus-containing vaccine in people with a tetanus-prone wound, with or without tetanus immunoglobulin, depends on the nature of the wound and the person’s vaccination history.

Adolescents and adults who have never had a tetanus-containing vaccine are recommended to receive 3 doses of tetanus-containing vaccine with at least 4 weeks between doses, and booster doses at 10 years and 20 years after the primary course.

Agricultural workers, veterinary workers and others at risk of sustaining penetrating injuries (i.e. an animal bite) or soil contaminated injuries, should be fully vaccinated against tetanus. The situation is not clearly defined for persons in these groups who are working in Australia and likely to receive minor tetanus-prone wounds frequently. They should seek medical advice about the need for and frequency of booster doses if they regularly sustain minor injuries in the course of their work. A combined vaccine is normally used which contains tetanus and diphtheria (ADT) and for those who require pertussis protection there is a combined diphtheria, tetanus, pertussis vaccine available.

For further information about tetanus refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.11 Tuberculosis screening

Tuberculosis (TB) is a bacterial infection that can affect almost any part of the body but most commonly infects the lungs (pulmonary tuberculosis). Please refer to QH Health Conditions Directory for more information about this condition.

At the start of employment or a study program with the University, persons who perform tasks that would allow acquisition and/or transmission of TB during their work or placement activities must undergo baseline screening for previous infection prior to work or placement activities commencing.

A Queensland Health Tuberculosis Risk Assessment Questionnaire is to be completed as a minimal requirement by: 

• Healthcare workers who perform tasks that would allow acquisition and/or transmission of TB during their work or placement activities - refer to UQ Healthcare Worker - infectious Disease Screening and Vaccination Record. [25]
• Healthcare students - refer to entry requirements for course program.

A Quantiferon Gold TB blood screening test, organised via a General Practitioner or a tuberculin skin test (TST) via the Queensland Health clinical TB screening service or a suitably accredited private pathology provider, must be undertaken for persons in the following categories:

• Healthcare workers or students who have a TB exposure risk history as identified on the TB Risk Assessment Questionnaire
• Embalmers and workers involved in conducting autopsies.
• Laboratory workers conducting research with Mycobacterium tuberculosis.

Laboratory workers conducting on-going research tasks with Mycobacterium Tuberculosis must also undertake TB screening on an annual basis and a final screening test on exiting the project.  

Persons who have a positive TB screening test will be referred to the Specialised Health Services - Queensland Health for further follow up.

The BCG vaccine is no longer routinely recommended for TST negative healthcare workers. However BCG vaccination should be considered for TST negative healthcare workers at high risk of being exposed to drug-resistant TB.

Healthcare workers who may be at high risk of exposure to drug-resistant cases should consult Queensland Health Centre for Healthcare Related Infection Surveillance and Prevention for advice.

For further information, refer to Table C.21 of the Australian Guidelines for the Prevention and control of Infection in Healthcare 2010  or contact the Division of Specialised Health Services - Queensland Health.

5.12 Varicella (Chickenpox)

Varicella is a highly contagious disease caused by the varicella-zoster virus. In healthy children, the disease is usually a mild illness however life-threatening complications are known to occur. For most, the disease presents with mild cold-like symptoms with a rash appearing after 2 days. The rash has characteristic itchy blisters that last approximately 4-5 days. Varicella infection can however be much more severe in adults and can cause serious and have even fatal consequences for persons who are immune-compromised. Varicella can also have harmful consequences for an unborn baby therefore pregnant women and those with new-born infants should seek urgent medical advice if they have close contact with a person who has been diagnosed with varicella infection.

Varicella vaccination is mandatory for all non-immune healthcare related personnel (including students) and is particularly important if working in maternity, neonatal or paediatric wards, or with immune-compromised patients.

• UQ Healthcare workers and Healthcare students must be vaccinated with 2 doses of varicella or provide evidence of varicella immunity.

• A person is considered immune and does not require vaccination if a blood test shows varicella (IgG) antibodies.

• Persons who are not immune to varicella must avoid contact with those with chicken pox or shingles infections.

• Recently vaccinated healthcare workers (within the last 6 weeks) who develop a rash from the vaccine should not be in contact with susceptible patients for the duration of the rash.

• Varicella is a live vaccine and is contraindicated in those who are immune compromised or pregnant. Pregnancy should also be avoided for at least 28 days post varicella vaccination.

• For further information about varicella refer to Qld Health Conditions Directory and the Australian Immunisation Handbook.

5.13 Q-fever

Q-fever is a zoonotic infection transmitted by the bacterial microorganism Coxiella burnetii, usually via dust and aerosols from infected animals. Protection against Q-fever transmission is recommended for persons working with cattle, sheep, goats and some feral animals (and for those who frequently work in areas where these animals are kept). This also includes persons who are frequently exposed to products, materials or waste from these animals.  Workers and students considered to be at significant risk of infection transmission include those working in agricultural and farms, veterinarians and veterinary students, wildlife research and persons working in a laboratory setting with the organism Coxiella burnetii. In addition to those who work with high-risk animals, Q-fever protection may be applicable where there is airborne dust from mowing, slashing, earthworks, excavation and digging if the site is contaminated with animal excreta. E.g. if the site has recently been used for livestock grazing or is densely populated with kangaroos or other wildlife. In addition, those exposed to animal manures in fertilisers and soil conditioners should also consider Q-fever prevention.

Q-fever screening must be undertaken prior to Q-fever vaccination. Screening includes a serum antibody test and skin testing. Screening identifies those who should not be vaccinated to avoid side effects. Vaccination must be preceded by a negative blood and skin test performed by a specifically trained doctor. See the UQ Health Care website and UQ Q-Fever Guideline for details of the screening and vaccination program.

For further information about Q-fever please refer to the QH Health Conditions Directory and the Australian Immunisation Handbook.

6.0 Documentation

Written documentation, such as an International Certificates of Vaccination booklet, should be kept of all immunisations. Apart from acting as an official record of immunisations for overseas travel, it is also designed to serve as a permanent record of routine and work/course related immunisations. Records of associated blood and other test results also should be retained.

Personal records should be kept indefinitely by the individual. 

Occupational immunisation records for workers and students should be retained by the University for a period of 25 years after the person has ceased work or study with the University.  Refer to section 6 of the associated UQ Procedures 2.60.08 Vaccinations and Immunisations.

7.0 Further advice and assistance including vaccination

Clinical assistance, expert advice and vaccinations are available from UQ Health Care (St Lucia Campus, Gatton Campus and Wooloongabba). Additional advice can be obtained from the Vaccination Compliance Nurse or the Occupational Health Nurse Adviser in the Health, Safety and Wellness Division, email: immunisation@uq.edu.au or OHNA@uq.edu.au or phone 3365 2365.

8.0 Appendix

8.1                 Definitions, terms, acronyms

Anti-HAV - serum antibody to hepatitis A virus.

ABL - Australian bat lyssavirus.

Bacteria - micro-organisms that can cause infection. 

BCG- Bacillus Calmette-Guerin vaccine.

dT- Diphtheria, tetanus vaccine.

dTpa- Diphtheria, tetanus and pertussis vaccine.

HCW- Healthcare worker - person who provides care to patients in a hospital, health service or community care setting.

HDR - Higher Degree by Research.

Hep Bs Ab - Hepatitis B surface antibodies.

IgG - immunoglobulin G, a group of antibodies that protect against a wide range of infecting organisms.

Immunisation - the process of inducing immunity to an infectious agent by administering a vaccine.

Immunity - the ability of the body to fight off certain infections; immunity can result from naturally acquired infection or from vaccination.

MMR Vaccine - Measles, Mumps, Rubella vaccine.

Parenteral - brought into the body via a route other than the digestive tract. 

Statement of Susceptibility - letter from a medical officer, infection control practitioner or vaccine service provider stating that an individual is not susceptible to a specific disease.

SOP - Safe Operating Procedure.

Student - a student enrolled at the university and includes undergraduate, post graduate and HDR.

Tetanus prone injury - Please refer to section 4.19.9 'Tetanus-prone wounds in the latest edition of the  Australian Immunisation Handbook.

TB - Tuberculosis - is an infectious disease caused by the bacterium Mycobacterium tuberculosis.

TST - Tuberculin Skin Test (also known as Mantoux test).

UQ Worker - For the purposes of this guideline, this includes:

UQ Worker (staff) - includes all continuing, research (contingent funded), fixed term and casual employees as well as apprentices and trainees, and

UQ Worker (non-paid) - includes HDR candidates, sabbatical/visiting academics/researchers, vacation scholars, volunteers and students on work experience.

Vaccination - the administration of a vaccine; if vaccination is successful, it results in immunity.

Virus - a minute living organism smaller than bacteria that can cause infections.

VPD - Vaccine preventable disease.

8.2              References and resources

Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010) National Health and Medical Research Council (NHMRC)

http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare.pdf

NHMRC.

The Australian Immunisation Handbook. Canberra: ATAGI and National Health and Medical Research Council, 2018.

https://immunisationhandbook.health.gov.au/ 

Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses - 2019

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdna-bloodborne.htm 

Qld Government Centre for Healthcare Related Infection Surveillance and Prevention

http://www.health.qld.gov.au/chrisp/default.asp

Qld Government health conditions directory. 

http://conditions.health.qld.gov.au/HealthCondition/Home

Qld Health Guideline: Vaccination of Health Care Workers

http://www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-321-9.pdf

Qld Health Fact Sheet: Hepatitis B Vaccination for Students

http://www.health.qld.gov.au/chrisp/resources/fs-student-HBV.pdf

Q-fever

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-15

Tetanus

https://ppl.app.uq.edu.au/content/2.60.10-working-safely-blood-and-body-fluids