All adults should ensure that they are up-to-date with all of their recommended vaccines, but vaccinations for healthcare workers are especially important. People who work in healthcare settings are frequently exposed to germs while seeing or caring for patients, and direct contact isn’t always necessary to contract an infection.
Vaccination of healthcare personnel—from doctors and nurses to admissions clerks and ambulance drivers—protects from potentially dangerous diseases like flu and COVID-19, and protects patients and the community at large as well. The Advisory Committee on Immunization Practices (ACIP) recommends seven.
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1. COVID-19
Following the pandemic, the ACIP recommends that healthcare workers receive the COVID-19 vaccine. Although mortality rates tied to COVID-19 have declined since the beginning of the pandemic, in 2023, 76,446 reported deaths were associated with the virus.
People with the virus can remain contagious for up to 10 days after the first symptoms start, meaning that healthcare workers who are caring for these patients are at high risk for contracting the virus themselves.
Those most at risk for contracting COVID-19 include those over the age of 65, people with an underlying condition, such as cancer, lung disease, or diabetes, and anyone with an immunocompromised condition or weakened immune system. Healthcare workers with any of these conditions also have an increased chance of contracting COVID-19.
Recommendations
The CDC recommends everyone over the age of six months receive the COVID-19 vaccine, especially those who are considered high risk due to age or underlying medical conditions. Healthcare workers, as people who are likely to come into frequent contact with infected patients, are strongly encouraged to stay up to date on vaccinations for the virus.
There are currently two main types of COVID-19 vaccines available, including:
- mRNA vaccines (Pfizer-BioNTech or Moderna): mRNA vaccines are administered into the arm or thigh muscle. They teach the body how to make proteins, essentially training it to fight off the virus more effectively should it encounter it in the future.
- Protein subunit vaccines (Novavax): Protein subunit vaccines contain copies of the COVID-19 spike protein, which nearby cells pick up. The immune system, which knows these proteins do not belong in the body, creates antibodies to fight off the infection.
COVID-19 is an airborne disease, meaning that wearing face masks, washing your hands or wearing gloves, and disinfecting areas visited by infected patients also help to lower the risk of transmission.
2. Influenza Vaccine
An estimated 12,000 to 61,000 people die from influenza each year in the United States, making it one of the deadliest vaccine-preventable diseases in the country.
Healthcare workers are exposed to this infection from patients who have the flu. According to the Centers for Disease Control and Prevention (CDC), between 140,000 to 810,000 people are hospitalized each year for influenza, depending on the severity of the variant circulating that year.
The groups most vulnerable to hospitalization and death are young children, pregnant women, adults 65 and older, and people with underlying medical conditions—some of whom cannot get the flu vaccine.
Because flu is spread by droplets from coughing or sneezing and by fomite transmission (touching contaminated objects or surfaces), healthcare workers can be exposed even if they don’t come in direct contact with patients.
According to the CDC, around 80% of healthcare workers in the United States received the flu vaccine during the 2021-2022 flu season—meaning that a good number were unprotected from the virus.
Hospitals tend to have higher vaccination rates than long-term care facilities like nursing homes, and employees are much more likely to receive the flu vaccine if it is mandated by the state or their employer.
Recommendations
The ACIP recommends that everyone over the age of six months receive the annual flu vaccine, including—and most especially—healthcare workers.
There are nine flu vaccine options, including three specifically recommended for adults 65 and over (Fluzone High-Dose, Flublok, and Fluad).
3. Varicella (Chickenpox) Vaccine
Varicella, also known as chickenpox, is no longer commonplace in the United States thanks to widespread vaccination. But outbreaks still occur throughout the country, and cases can spread quickly in healthcare settings. The disease can be particularly dangerous for medically vulnerable patients, such as pregnant women.
People who have varicella infection can be contagious a day or two prior to getting the telltale rash. If you’re a healthcare worker in frequent contact with patients, the effects of an unrecognized infection can be costly.
Studies have shown that a single provider with varicella can expose more than 30 patients to chickenpox, as well as dozens of coworkers. Adults also tend to be more seriously affected by chickenpox, with some experiencing pneumonia, bacterial skin infections, encephalitis (brain inflammation), and sepsis (blood infection).
Recommendations
According to the ACIP, unvaccinated healthcare workers with no laboratory evidence of immunity or documented proof of diagnosis with chickenpox should get two doses of the vaccine, spaced four to eight weeks apart.
There is only one varicella vaccine, called Varivax, approved for use in adults in the United States. It is delivered by subcutaneous injection.
There may be an added benefit of getting Varivax. Studies in children have shown that varicella vaccination reduces the risk of shingles in later life because the virus that causes chickenpox is the same one that causes shingles. The same may apply, at least in part, if you receive Varivax as an adult.
Varivax is not a substitute for the shingles vaccine Shingrix. Even if you receive Varivax as a healthcare worker, you will need to be vaccinated against shingles if you are 50 or older.
4. Hepatitis B Vaccine
Hepatitis B is a chronic viral infection that spreads through blood and other bodily fluids. Over 850,000 people are believed to be infected in the United States, with around 21,000 new infections occurring every year.
Because many people with hepatitis B don’t feel sick, they can spread the virus without even knowing it. If left untreated, hepatitis B can lead to potentially serious conditions, including cirrhosis and liver cancer.
Healthcare workers who are regularly exposed to blood and other bodily fluids are at constant risk of hepatitis B. Vaccination is central to preventing infection, as well as maintaining infection control in healthcare settings.
Prior to routine hepatitis B vaccinations of healthcare workers, a staggering 18% of those working in the medical and dental fields were believed to have been infected. Within 10 years thereafter, the rate dropped to 6%.
Recommendations
The ACIP recommends a two- or three-dose hepatitis B vaccination series for healthcare workers, depending on the vaccine. There are three hepatitis B vaccines approved for use by the U.S. Food and Drug Administration (FDA).
| Vaccine Name | Doses/Schedule | Route |
|---|---|---|
| Engerix-B | 3 delivered at 0, 1, and 6 months | Intramuscular injection |
| Heplisav-B | 2 delivered at 0 and 4 weeks | Intramuscular injection |
| Recombivax HB | 3 delivered at 0, 1, and 6 months | Intramuscular injection |
Healthcare workers should be tested one to two months after their final dose to verify that they have achieved the desired immune response (as measured by hepatitis B-specific antibodies).
5. MMR Vaccine
Measles was declared eliminated from the United States in 2000, but the disease has made a huge comeback due, in large part, to the rise of anti-vaccination campaigns. As a result, sporadic outbreaks still occur in the United States, including the 2019 outbreak that affected over 1,200 people in 31 states.
Measles is easily transmitted among children in pediatric offices and care units. Although measles vaccinations in schools have largely reduced such incidents, anti-vaccination sentiments are feared to reverse many of those gains.
In 2008, an unvaccinated 7-year-old boy with measles visited a pediatrician’s office in San Diego and inadvertently passed on the virus to four other children—three of whom were too young to receive the measles, mumps, and rubella (MMR) vaccine. One was hospitalized with severe measles complications.
Even in developed countries like the United States, roughly one in five people who contract measles needs to be hospitalized.
While rubella and mumps tend to be less serious than measles, unvaccinated healthcare workers can pass the viruses to medically vulnerable patients, like pregnant women, who are at greater risk of harm.
Vaccination is by far the most effective way to prevent these potentially serious diseases.
Recommendations
According to the ACIP, unvaccinated healthcare workers born in 1957 or after should get two doses of the MMR vaccine at least 28 days apart. Vaccination should be considered for unvaccinated healthcare workers born before 1957.
MMR vaccine recommendation:
- One dose if lacking proof of immunity against rubella only
- Two doses if lacking proof of mumps and/or measles
There are two MMR vaccines approved for use in the United States (MMR 2, Priorix). Both are delivered by subcutaneous injection, under the skin.
Considerations
Many people who were vaccinated with MMR don’t recall getting the vaccine or have a record of their childhood vaccinations. If you have evidence, you won’t need to get vaccinated.
Healthcare workers can get tested for immunity using a DNA-based PCR test instead of automatically getting revaccinated if they don’t have vaccine records.
6. Tdap Vaccine
There are several kinds of tetanus vaccines: Tdap (tetanus, diphtheria, and acellular pertussis) and Td (tetanus and diphtheria), and DTaP. It is recommended to have at least one dose.
Although they can all be used as tetanus booster shots for adults, only Tdap protects against pertussis (whooping cough). In a healthcare setting, this is a very important distinction.
Pertussis, a respiratory disease mainly spread through coughing and sneezing, can be particularly dangerous for young infants. Because the early symptoms of pertussis can seem like the common cold, many adults with pertussis don’t even realize they have been infected and can pass it to others.
This makes pertussis particularly dangerous in neonatal intensive care units (NICUs) where transmission of the bacteria to newborns can be fatal. Despite these hazards, less than half of all healthcare workers receive the vaccine, according to a 2017 study in the American Journal of Preventive Medicine.
Recommendations
According to the ACIP, healthcare workers who haven’t been or are unsure if they’ve been vaccinated against pertussis should get a dose of Tdap. This is true even if they recently received the Td vaccine as part of the recommended vaccine schedule for all adults (in which a Td booster is given every 10 years).
There are two Tdap vaccines approved for use by the FDA.
| Vaccine Name | Doses | Ages | Route |
|---|---|---|---|
| Adacel | 1 | 10 years and over | Intramuscular injection |
| Boosterix | 1 | 10 years to 64 years only | Intramuscular injection |
Healthcare workers who are pregnant should also receive a Tdap during the third trimester of each pregnancy to prevent transmission to their newborn.
7. Meningococcal Vaccine
Meningococcal disease is a bacterial infection that can cause meningitis, a condition in which the protective lining of the brain and spinal cord (called the meninges) becomes inflamed.
Meningococcal meningitis is relatively rare but can be serious, resulting in seizures, deafness, shock, multi-organ failure, and death within a matter of hours. Adolescents and young adults are particularly vulnerable.
It is not common for healthcare workers to become infected with meningococcal disease from patients, but it can occur if there is direct exposure to saliva or respiratory secretions (whether from contact with patients or saliva or sputum samples obtained for the lab).
This is especially true during outbreaks at universities or colleges where the disease can spread rapidly through dorms.
Recommendations
Microbiologists who are routinely exposed to Neisseria meningitidis should get a meningococcal conjugate vaccine and serogroup B meningococcal vaccine. One vaccine option, Penbraya, includes all these types, but is approved only for people under age 25.
There are fix meningococcal vaccines approved for use by the FDA.
| Vaccine Name | Doses/Schedule | Serogroups | Route |
|---|---|---|---|
| MedQuadfi | 1 | A, C, W, Y | Intramuscular injection |
| Menveo | 1 | A, C, W, Y | Intramuscular injection |
| Bexsero | 2 delivered at 0 and 6 months | B | Intramuscular injection |
| Trumenba | 2 delivered at 0 and 6 months | B | Intramuscular injection |
| Penbraya | 2 delivered at 0 and 6 months | A, B, C, W, Y | Intramuscular injection |
Summary
Vaccination is important for all adults, especially healthcare workers, who face higher risks of exposure to infectious diseases. Key vaccines for healthcare personnel include COVID-19, influenza, varicella, hepatitis B, MMR, Tdap, and meningococcal vaccines. Vaccines protect workers from serious illnesses while safeguarding patients and the community.
The CDC and ACIP stress the importance of staying up-to-date, as healthcare workers are not only likely to be exposed to infectious diseases, but also often treat patients who are not vaccinated themselves. Hygiene practices like mask-wearing and handwashing further reduce transmission risks, creating safer healthcare environments.
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