Occupational Health Update

Weber, David J.; Rutala, William A.

doi:10.1016/j.idc.2016.04.008

Cited by 16 publications

(6 citation statements)

References 75 publications

(80 reference statements)

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“…The increased rates of laboratory-acquired meningococcal disease-as well as other infectious diseases-have been reported by multiple other authors as well (15)(16)(17)(18)(19). Within the US it is estimated that the incidence of meningococcal disease among microbiologists is 50fold higher than in the general population, i.e., 13 per 100 000 persons versus a general incidence rate of 0.2 per 100 000 (14,15,20). Due to their increased risk of meningococcal infection, augmented vaccination/ boosters are recommended for these special populations.…”

Section: At Risk Populationsmentioning

confidence: 89%

“…… have the potential for exposure to patients and/or infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air (20).…”

Section: At Risk Populationsmentioning

confidence: 99%

“…Ideally, the chemoprophylaxis would be administered within 24 hours of the exposure. If later than 14 days after exposure, antibiotics are unlikely to confer any added benefit (2,3,5,20,36).…”

Section: Review Articlementioning

confidence: 99%

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Autopsy Biosafety

Brooks¹,

Utley-Bobak²

2018

Academic Forensic Pathology

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Introduction: As invasive meningococcal disease progresses rapidly, often affects youth, and has a fairly high mortality rate, such cases are likely to fall under medical examiner/coroner (ME/C) jurisdiction. Morgue personnel may be at risk of contracting secondary meningococcal disease. We review the current scientific literature regarding Neisseria meningitidis infection and provide recommendations for the prevention of meningococcal disease at autopsy. Methods:A PubMed search utilizing applicable medical subject heading terms was performed retrieving articles for review from the preceding two decades. Pertinent current guidelines from multiple national organizations were also retrieved. Results:Invasive meningococcal disease is transmitted by direct contact with large respiratory droplets or oral secretions. While a surgical mask would normally provide adequate protection from large droplet spread, it does not prevent inhalation of smaller aerosolized particles such as those generated at autopsy. Prosectors are advised to routinely wear N-95 respirator masks or powered respirator hoods. All published cases of secondary meningococcal disease transmission to healthcare workers invariably arose in scenarios in which face masks/respirators were not employed; none of these cases involved meningococcal disease transmission to ME/C or other morgue staff. Discussion:In the event that no mask-or inadequate coverage such as a surgical mask-is employed during autopsy of a decedent suspected/confirmed to have invasive meningococcal disease, antibiotic prophylaxis is advisable. Assuming appropriate personal protective equipment is utilized, chemoprophylaxis is unnecessary. Routine meningococcal vaccination is not recommended, except for ME/C with specified immunocompromising conditions or traveling to hyperendemic/endemic meningococcal regions. Acad Forensic Pathol. 2018 8(2): 328-339 Downloaded from www.afpjournal.com by an AFP Journal subscriber This article is for personal use only and may not be shared or distributed in any fashion REVIEW ARTICLEImage 1: Recommended personal protective equipment (PPE) includes a surgical cap, impervious surgical gown with full sleeve coverage, shoe covers, respirator mask, full face shield, and double gloves.

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Section: At Risk Populationsmentioning

confidence: 89%

Section: At Risk Populationsmentioning

confidence: 99%

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Autopsy Biosafety

Brooks¹,

Utley-Bobak²

2018

Academic Forensic Pathology

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“…To prevent the transmission of varicella to healthcare workers, according to the Advisory Committee on Immunization Practices (ACIP)/Centers for Disease Control and Prevention (CDC), whom recommend that all healthcare workers (HCWs) be immune to VZV [1,22,23]. Therefore, the first step in the prevention of healthcare-associated transmission of VZV in a local screening program is to minimize the number of susceptible HCWs [12,24]. The history of vaccination or immunity for VZV should be determined at the time of initial employment in all HCWs.…”

Section: Discussionmentioning

confidence: 99%

Varicella Seroprevalence in Healthcare Workers at a Medical Center Following Changes in National and Local Hospital Vaccination Policies

Tsou

Shao

2019

IJERPH

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Background: Varicella seroprevalence in healthcare workers at a tertiary care hospital in Taiwan was assessed following the inclusion of varicella zoster vaccination in the national vaccination schedule in 2004 and was made a hospital policy in 2008. Methods: Seroprevalence data were extracted from records of pre-employment health check-ups performed between 2008 and 2018 at a single medical center. Staff with complete medical records and anti-varicella zoster virus immunoglobulin G (VZV IgG) titers were included. Sex and age group differences in terms of geometric mean titer (GMT) were compared using analysis of variance and chi-squared tests. The significance of the correlation between age and the anti-VZV IgG titer was tested by linear regression. The odds of significant associations among age, sex, vocation, and the years of national and hospital adoption of vaccination were determined using univariate and multivariate analyses. p < 0.05 was considered statistically significant. Results: Of the 7314 eligible participants, 5625 (76.90%) were women, and the mean patient age was 26.80 ± 8.00 years. The lowest VZV-positivity rates were in 18–20-year-old women (85.16%; GMT, 362.89 mIU/mL) and men (87.59%; GMT, 288.07 mIU/mL). VZV positivity increased with age (p < 0.001). Participants born before 2002 were more likely to be seropositive than those born after 2003 (odds ratio, 2.51 vs. 1.0; p < 0.001). The lowest seropositive rate was found in the nursing staff (88.91%; 95% confidence interval, 87.74%–90.05%). Varicella vaccine boosters have been required at pre-employment health check-ups since 2008 if anti-VZV antibodies were not detectable. A follow-up evaluation found marginal significant differences in the odds ratios of seropositivity after 2007 (p = 0.052), especially in 2008 and 2014 (p < 0.05) after the hospital policy launched. Conclusions: Despite public health efforts, a small number of healthcare workers were inadequately protected, and antibody titers were lower than required to maintain herd immunity. For effective prevention of nosocomial infection, VZV IgG status should be documented for all HCWs, and susceptible HCWs should be vaccinated to avoid outbreaks. Pre-employment screening and vaccination have increased immunity and need to be conducted to ensure protection of vulnerable patients.

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“…Therefore, the first step in the prevention of healthcare-associated transmission of VZV is to minimize the number of susceptible HCWs. 78 The history of prior varicella or vaccination should be determined at the time of initial employment in all HCWs. The seroprevalence of varicella among HCWs born in Korea before 1988 is reported as 96%.…”

Section: Prevention and Control Of Healthcare-associated Exposuresmentioning

confidence: 99%

Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus

2018

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Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.

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Occupational Health Update

Cited by 16 publications

References 75 publications

Autopsy Biosafety

Autopsy Biosafety

Varicella Seroprevalence in Healthcare Workers at a Medical Center Following Changes in National and Local Hospital Vaccination Policies

Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus

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