A must-have vaccine to protect patients?

UNC Health Care says it's ... pertussis

To keep young, vulnerable patients safe from a potentially life-threatening disease, the University of North Carolina Health Care in Chapel Hill requires employees to have a vaccine that protects against a respiratory illness.

But it's not the flu vaccine that's a condition of employment. It's the Tdap, a one-time vaccine that protects against pertussis, as well as tetanus and diphtheria.

"If they are not compliant as of November 1, they will not be working here, unless they have medical contraindications or written proof of having had the vaccine elsewhere," says David Weber, MD, MPH, medical director of occupational health and hospital epidemiology.

The Centers for Disease Control and Prevention recommends a single dose of Tdap for health care workers with direct patient contact, with a priority for those who care for babies younger than 12 months of age. For infants who are unvaccinated or only partially vaccinated, pertussis can be severe or even fatal.

Adults can receive the Tdap two years or later after their last tetanus booster.

Every year, about five to 10 cases of pertussis are diagnosed at the University of North Carolina Health Care, resulting in about one health care worker exposure each year. So far, there have been no hospital-based outbreaks of pertussis, says Weber. Pertussis can be difficult to diagnose because the initial symptoms mirror other respiratory diseases, says Weber.

But outbreaks elsewhere in the country have raised concerns about the disease. As of October, there were almost 6,000 suspected, probable or confirmed cases of pertussis in California — the highest since 1950 and seven times higher than in the same period last year. In the outbreak, 255 patients were hospitalized and 10 died — nine of them infants under the age of two.

California's Aerosol Transmissible Diseases Standard requires health care employers to offer the pertussis vaccine free of charge but does not mandate that health care workers receive it.

The University of North Carolina Health Care is unusual in requiring the pertussis vaccine. But Weber notes that, like other health care employers, the health system also requires immunity or vaccination with measles, mumps, rubella (MMR) and varicella.

"There are many things we require of our employees. This is just one of them," he says. "We believe to the extent possible we should provide the safest possible environment for our patients."

Some employees expressed concerns about the pertussis requirement, but Weber says many more were happy that the health system was requiring it. Because it's required, any adverse effects would be covered by workers' compensation, he notes. So far, there have not been any serious side effects. About 40% of employees had a sore arm after vaccination, he says.

Meanwhile, vaccinating against influenza has been somewhat more problematic because the vaccine must be given annually to about 5,000 employees. This year, UNC Health Care will track employees who receive the vaccine elsewhere (such as at local stores) as well as those who are vaccinated by occupational health.

The system's goal is to vaccinate 80% of employees against seasonal influenza. The goal is one of several linked to a bonus incentive.