1. Purpose and Objectives

This guideline aims to minimise the risk of persons being exposed to a vaccine-preventable disease at  The University of Queensland.  This guideline outlines responsibilities for staff and students in relation to general vaccination requirements and provides information for workgroups who due to the nature of their activities at the University are at higher risk of exposure to a specific vaccine-preventable disease.

2. Definitions, Terms, Acronyms

Bacteria - micro-organisms that can cause infection. Micro-organisms are smaller than a blood cell but larger than a virus.

dT- diptheria, tetanus vaccine

dTpa- diptheria, tetanus and pertussis vaccine

HCW- healthcare worker

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

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

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.

3. Guidelines Scope/Coverage

This guideline applies to all staff, students and volunteers at The University of Queensland. 

4. Guidelines Statement

The University of Queensland seeks to minimise the risk, as far as is practicable, of persons at the University being exposed to a vaccine-preventable disease. Where a risk has been identified at the University, appropriate training, information and resources will be provided  to achieve effective infection control. This provision extends to appropriate vaccination recommendations for employees potentially at risk of exposure to vaccine-preventable disease. The information provided in this guideline however, does not replace the need for individual 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.  Staff and students who are pregnant or who have a serious illness or compromised immunity should also seek further medical advice. Men in sexual relationships with other men are also advised to seek further medical advice regarding specific immunisation recommendations (hepatitis A and B vaccinations are recommended and HPV vaccine may also be indicated).

5. Immunisation Guidelines

Some courses of study and occupations for students and workers at The University of Queensland are associated with health risks.  Workplace and academic supervisors have the responsibility to ensure all practicable measures are taken to ensure those at risk of being exposed to a vaccine-preventable disease are protected.  The risk of infectious disease transmission can be minimised by the following means:

• Preparing a risk assessment using the risk management process located at www.risk.admin.uq.edu.au

• Seeking advice from the Faculty, School or Centre in which you are working

• Seeking advice from the University Health Service, your own medical practitioner or, for work-related travel, a specialist travel clinic

• Appropriate immunisation prior to being exposed to situations associated with a risk of disease transmission.

Staff and students with an infectious disease have a duty of care to minimise the risk of transmission to other members of the University community.

It is recommended that all UQ staff and students have completed the National Immunisation Program Schedule as recommended by The Australian Government Department of Health.

Healthcare workers and students who are involved in direct patient contact or who might be exposed to blood or body fluids in the course of their work or study are required to be immunised against hepatitis B and/or provide proof of immunity or provide a Statement of Susceptibility.  Healthcare personnel should also refer to the section on screening in PPL Guideline 2.60.10 Working Safely with Blood and Body Fluids and sections 6 and 7 of this document.

Persons working with animals should refer to Section 7. Occupation-Related Vaccinations of this document.

Persons working with bats should refer to Section 7. Occupation-Related Vaccinations of this document and PPL 2.60.14 Working Safely with Bats and Flying Foxes: Lyssa Virus.

It is helpful to know what vaccinations you have had in the past.  You should consult your own health records, ask your parents about your previous vaccinations and/or contact your local doctor for further information.

6. Recommended Vaccinations for All Staff and Students

It is recommended that all staff and students, and particularly healthcare staff and students, are vaccinated against the following:

6.1 Diphtheria

• Individuals who have had 5 doses of diphtheria vaccine may be considered to have 'long lasting immunity' (NHMRC). However, all adults who reach the age of 50 years without having received a booster dose of dT in the previous 10 years should receive a further booster dose.
• Travellers to high-risk countries should receive a booster dose of dT (or dTpa) if they have not received one in the previous 10 years.
• If the basic course has not been given in childhood special considerations apply.
• For vaccination against tetanus and diphtheria a combined vaccine (ADT) is usually used.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.2 Hepatitis B

• Hepatitis B vaccination is recommended for all. It has been included as part of the national infant and childhood schedule since 2000. Staff and students at UQ who have not received hepatitis B vaccination as part of the national adolescent 'catch-up' program or as part of a travel immunisation schedule, may, as a requirement of their employment, need to seek further advice regarding vaccination. See further information under Section 7. Occupation-Related Vaccinations.

6.3 Influenza

• Influenza vaccination is strongly advised for those at occupational or personal health risk from influenza. The NHMRC recommends influenza vaccination for anyone who wishes to reduce the likelihood of contracting influenza.
• Influenza vaccine is administered annually. Immune-compromised persons who receive influenza vaccine for the first time are, however, recommended to receive 2 vaccine doses at least 4 weeks apart and 1 dose annually thereafter.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.
• Annual statements on influenza vaccine availability and recommendations for use can be checked on the Immunise Australia website.

6.4 Measles

• Measles vaccine is of benefit to individual adults, particularly health workers or those who lack a history of childhood illness or immunisation. All health care workers or those who work with children should be vaccinated with MMR and have documented evidence of 2 doses or serological evidence of protection for measles, mumps and rubella. It may be prudent to boost immunity to measles in young adults entering university as outbreaks may occur.
• For vaccination against measles, mumps and rubella a combined vaccine (MMR2) is usually used. Two doses of vaccine are needed and should be given at least a month apart.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.5 Mumps

• Mumps vaccine is of benefit to individual adults, particularly health workers or those who lack a history of childhood illness or immunisation. It is prudent to boost immunity to mumps in young adults entering university as outbreaks may occur.
• For vaccination against measles, mumps and rubella a combined vaccine (MMR2) is usually used. Two doses of vaccine are needed. In older individuals who have received only 1 dose of mumps-containing vaccine, a second dose can be given, as MMR, at any age.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.6 Pertussis

• 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 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 dose against diphtheria or tetanus, consider boosting their pertussis immunity on a once-only basis using the dTpa vaccination.  dTpa vaccination is strongly recommended for all adults who will be in close contact with babies and young children.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.7 Polio

• Polio vaccine boosters are not needed for adults who have been vaccinated as a child unless they are at special risk such as when traveling to areas or countries where polio is epidemic or endemic.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.8 Rubella

• Rubella vaccination is indicated for all (except females who are or may shortly become pregnant). In females it should be followed by a blood test in order to establish whether adequate immunity has been achieved.
• For vaccination against measles, mumps and rubella a combined vaccine (MMR2) is usually used. Two doses of vaccine are needed.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

6.9 Tetanus

• All adults in the community, including all staff and students, are advised to maintain their immunity to tetanus. Young adults who have received 4 doses in their first five years of life should have a further dose at the age of 15-19 years. Immunity following complete vaccination is long lasting. Maintenance of immunity with a routine booster at 10 yearly intervals is no longer recommended. A booster at age 50 is recommended. An additional dose is needed in the case of serious or contaminated injury if more than 5 years has elapsed since the last dose. If the basic course has not been given in childhood special considerations apply, and you should consult a doctor.
• VETERINARY and AGRICULTURE workers and similar: The situation is not clearly defined for those who receive minor tetanus-prone wounds frequently. A routine booster dose every 10 years is prudent for this group. Medical advice should be sought after suffering a tetanus-prone or dirty wound. After a tetanus-prone wound another tetanus immunisation may be needed if it is more than 5 years since the last vaccination.
• For vaccination against tetanus and diphtheria a combined vaccine (ADT) is usually used or for those who also require pertussis vaccination, a combined diptheria, tetanus, pertussis vaccine is available.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7. Occupation-Related Vaccinations

Additional vaccinations may be required for persons in the following occupations or student courses:

• Healthcare workers or students involved with direct patient care
• Workers or students working in remote indigenous communities
• Childcare students or workers caring for pre-school age children
• Laboratory workers or students exposed to human blood, body fluids or tissue
• Laboratory workers or students working with transmissible human or zoonotic pathogens
• Workers or students frequently exposed to waste water or sewerage
• Workers or students frequently in contact with animals, animal blood, tissues, products or animal waste
• Workers or students in contact with bats
• First Aid Officers.

Staff and students in the above categories should refer to the following list of occupational vaccination requirements.

7.1 Hepatitis A

• Vaccination should be considered for health care workers who work in rural and remote indigenous communities or who work in health units where the unit provides for substantial populations of indigenous children; pediatric wards, intensive care units or emergency departments.
• Vaccination should also be considered for childcare workers, carers of the intellectually disabled and for those who may be exposed to sewage at work, such as plumbers.

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.

Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.2 Hepatitis B

For all UQ healthcare workers employed in Queensland Health facilities, hepatitis B vaccination and/or proof of immunity or a Statement of Susceptability is required prior to commencing work.  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 Susceptability may be required prior to commencing a course at UQ and/or clinical placements.  Please refer to local faculty/school guidelines and also Queensland Health Vaccination of Health Care Workers.

The University of Queensland also requires hepatitis B vaccination and/or proof of immunity or a Statement of Susceptability whenever there is a risk of persons contracting hepatitis B in the workplace e.g. First Aid Officers and 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 six months followed by a blood test with Hep Bs Ab >10 IU/l) 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 (NHMRC Australian Immunisation Handbook 10th Edition 2013).
• Further tests are necessary if vaccination is unsuccessful or if Hep Bs Ag, Hep Be Ag or Hep B DNA are positive. Refer to PPL Guideline 2.60.10 Working Safely with Blood and Body Fluids.
• 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 A and B.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.3 Influenza

• Annual vaccination with influenza vaccine in autumn is recommended for all health care workers to protect both the HCW and the patients in contact with the HCW.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.4 Japanese encephalitis

Vaccination is needed for laboratory staff and 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.

• Travellers intending to visit high risk areas such as rural parts of Papua New Guinea and Asia should consult with a travel medicine specialist for further advice.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.5 Pertussis

• All healthcare workers and those working in early childhood care or education are recommended to be vaccinated against pertussis.
• A single dose booster of dTpa is recommended if 10 years have elapsed since a previous dose.
• Vaccinated healthcare workers and students who develop symptoms compatible with pertussis infection should still be investigated for pertussis and excluded from work until pertussis diagnosis is excluded.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.6 Polio

The risk of exposure to polio in the Australian community including the health care 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 endemic.

Booster doses for adults are not necessary unless they are at special risk, such as:

• travellers to areas or countries where poliomyelitis is epidemic or endemic (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
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.7 Rabies

• Staff and students who handle Australian bats, Australian Bat Lyssavirus (ABL) in a laboratory, or who work with animals in areas where rabies is endemic should have pre-exposure rabies vaccination and rapid post exposure treatment after a bite, scratch, or needlestick injury from a bat or possibly infected animal.
• People who work with ABL in a laboratory should have their antibody levels tested every 6 months.
• People 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.
• People with impaired immunity should have their antibody levels tested 2-3 weeks after the third dose of the vaccine.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.8 Tuberculosis (TB) (BCG)

• At the start of employment or study program all healthcare workers, healthcare students, embalmers and workers involved in conducting autopsies should be screened for previous infection or immunisation and most will need a screening skin mantoux (Tuberculin) test.
• The BCG is no longer routinely recommended to mantoux-negative healthcare workers. It is however still recommended for certain high risk employment groups eg embalmers, port mortum staff, people working in infectious disease units dealing with TB etc.
• Persons working in high risk occupations as described above will be offered vaccination (BCG) unless the vaccination is contraindicated for medical reasons. Persons who have positive tests will be followed up by the Specialised Health Clinic Queensland Health
• Healthcare workers who may be at high risk of exposure to drug-resistant cases should 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 (reference 1 below).
• TB testing and the immunisation (BCG), if recommended, are available from the Division of Specialised Health Services, Specialised Health Services Building, Cornwall St, Princess Alexandra Hospital Campus, Woolloongabba, Qld. 4102 Enquiries - 38963979 Appointments – 38963963.

7.9 Varicella (chicken pox)

• Varicella vaccination is strongly recommended for all non-immune health care personnel (including students) particularly if working in maternity, neonatal or paediatric wards, or with immune-compromised patients.
• If a blood test shows varicella antibodies (varicella IgG antibodies) then the person is considered immune and does not require vaccination.
• Healthcare workers who are not immune must not care for patients with chicken pox or shingles.
• 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.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.10 Infectious pathogens - laboratory staff and students

• Staff and students who work with particular organisms in a laboratory may need vaccination against these organisms. It is important to be vaccinated against these diseases prior to exposure. Medical advice will be needed about the length of time needed pre-exposure.
• Japanese encephalitis, yellow fever and meningococcal disease vaccines are available if required at the University Health Service.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

7.11 Veterinary Science, Agricultural Science

Staff students and volunteers who work with animals should be immunised against tetanus and should also seek advice about rabies vaccinations if working with bats or with animals in a rabies-endemic area.

Veterinary Science, Agricultural Science and other staff or students who work with animals should be immunised against Q fever (see 7.12).

7.12 Q fever

• Protection against Q fever transmission is recommended for persons working with cattle, sheep, goats, some feral animals or 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. Protection from Q fever transmission is also recommended for persons working in a laboratory setting with the organism Coxiella burnetii.  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 University Health Service and UQ Q-Fever Guideline for details of the UQ University Health Service Q fever screening and vaccination programme.
• Consult the prescribing details for the vaccine, particularly for contraindications and warnings.

Note that there are special issues for pregnant students in terms of exposure to pathogens or vaccines. General advice on these may be found in the NHMRC guidelines. Students who become pregnant are advised to seek specific advice relevant to their own situation.

8. 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.

Legal issues concerning the transmission of infection may arise after many years. It is advisable to keep such records indefinitely.

9. Cost of Vaccination

Vaccination costs for students and volunteers are not covered by the Pharmaceutical Benefit Scheme, Medicare, Queensland Health or by the University.  Some students with full private medical coverage (which has hospital and ancillary cover) may receive partial reimbursement for vaccine costs.

The Faculty, School or Centre in question will pay for the vaccination of staff if they are required by the University to be vaccinated due to workplace exposure or work-related travel.

10. Failure to Comply

These recommendations are intended to protect visitors, staff, students and their patients. Failure to comply can lead to an increased risk of serious illness for staff, students, and their patients. Failure to comply with recommended vaccination or proof of immunity may result in staff or students being unable to undertake work that places them at risk of infection. Queensland Health makes hepatitis B vaccination, or proof of immunity, mandatory for all health care workers in Queensland Health establishments. Failure to comply could result in a situation where some students cannot complete the practical requirements of their course or degree. Consult your program coordinator for further details.

11. Further Assistance and Advice

Clinical assistance and expert advice are available from the University Health Service,

Additional advice can be obtained from the Occupational Health Nurse Adviser in Occupational Health and Safety Division by emailing ohs@uq.edu.au or phoning 3365 2365.

12. References

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

• http://www.nhmrc.gov.au/guidelines/publications/cd33
• http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_infection_control_healthcare.pdf

NHMRC. The Australian Immunisation Handbook, 10th Edition. Canberra: National Health and Medical Research Council, 2013.

• http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

Qld Government Centre for Healthcare Related Infection Surveillance and Prevention

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

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