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2.0 Immunization Requirements

2.1 Hazard Exposure Assessment Forms

The Hazard Exposure Assessment (HEA) form is used to determine whether an employee is required to participate in immunization screening and tuberculosis (TB) surveillance programs. Employees must complete an HEA form upon hire and once a year thereafter.

Employees may receive vaccinations and/or TB testing during employee health clinics. The dates of these clinics are listed in the Center News newsletter and on Employee Health Clinics.

If necessary, an employee may contact the Occupational Health Program directly at 206.667.3474 to schedule an appointment.

2.2 Immunizations

The purpose of immunization screening and TB surveillance is to protect the health of patients, staff and volunteers. All required immunization screening and TB surveillance is provided free of charge to staff and volunteers. Staff and volunteers who are required to participate in the programs can send immunization documents to the OHNs at mail stop J3-200 or to the confidential fax number at 206.667.3467.

2.2.1 Hepatitis B

Hepatitis B Virus (HBV) is the major infectious hazard for healthcare and research personnel. The Hepatitis B vaccine series and titer is offered to all staff whose work involves the potential for exposure to blood and/or other potentially infectious material.

If an employee with potential exposure declines the vaccine series, he or she must sign a Hepatitis B Declination form. If the employee changes his or her mind in the future and requests the Hepatitis B vaccine series and titer, it is offered by Fred Hutch if the employee's work still involves the potential for exposure to blood and/or other potentially infectious material.

2.2.2 Tetanus

Tetanus, or lockjaw, is caused by a germ that enters the body through a cut or wound. Tetanus diphtheria (Td) vaccine is required of all Animal Health Department employees who have not had a tetanus booster in the past ten years.

Tetanus diphtheria (Td) vaccine is offered to, but not required of, employees who:

1. Have potential for exposure to live animals or animal tissues and who have not had a tetanus booster in the past ten years; and

2. Sustain a work-related laceration or puncture wound and who have not had a tetanus booster in the last five years.

2.2.3 Influenza

To reduce the spread of influenza to and from patients and employees, and to reduce staff illnesses and absenteeism during the influenza season, the influenza vaccine is offered to staff, volunteers, and Hutch Kids employees subject to CDC guidelines.

2.2.4. Vaccinia

Principal investigators who wish to use vaccinia (smallpox) must contact the Occupational Health Program at 206.667.3474 to determine whether a vaccinia vaccination is needed. If required, vaccinations are coordinated through the Occupational Health Nurse.

2.2.5 SCCA Vaccination Requirements

Staff and volunteers whose workspace is located in the SCCA building, or who have face-to-face interaction with SCCA patients as part of their jobs, must meet the following immunization requirements. (Interaction with SCCA patients does not include incidental contact with patients such as entering the SCCA building, riding on the elevator with patients, accessing the garage, attending meetings in the SCCA, etc.)

1. Rubeola (Measles)

     Acceptable evidence of immunity to rubeola includes one of the following:

  1. Providing a document showing proof of having received two rubeola or MMR vaccines; or
  2. Providing serological evidence of immunity to rubeola; or
  3. Providing documentation of a physician-diagnosed case of rubeola.

Note: Employees and volunteers who have negative rubeola titers without documentation of prior rubeola or MMR vaccines must receive two MMR (measles, mumps, rubella) vaccines. Those who can provide documentation of prior rubeola or MMR vaccines must receive one MMR vaccine.

2. Mumps

     Acceptable evidence of immunity to mumps includes one of the following:

  1. Providing evidence of having received two doses of mumps or MMR vaccine; or
  2. Providing serological proof of immunity to mumps; or
  3. Providing documentation of a physician-diagnosed case of mumps.

Note: Employees and volunteers who have negative mumps titers without documentation of prior mumps or MMR vaccines must receive two MMR (measles, mumps, rubella) vaccines. Those who can provide documentation of prior mumps or MMR vaccines must receive one MMR vaccine.

3. Rubella

     Acceptable evidence of immunity to rubella includes one of the following:

  1.   Providing evidence of having received one dose of rubella or MMR vaccine; or
  2.   Providing serological proof of immunity to rubella; or
  3.   Providing documentation of a physician-diagnosed case of rubella.

4. Varicella (Chickenpox)

     a. Acceptable evidence of immunity to varicella includes one of the following:

  1. Reporting a positive history of chickenpox disease; or
  2. Providing evidence of serological immunity to varicella; or
  3. Providing evidence of having received two varicella vaccines.

     b.  If the history of Varicella (Chickenpox) disease is negative or questionable, individuals must obtain a Varicella titer through the Occupational Health Program.  If the Varicella titer is negative, individuals must receive two Varicella vaccines, or sign the Varicella waiver if declining.

     c.  In 2008, the Advisory Committee on Immunization Practices (ACIP) recommended Zostavax for use in people 60 years of age and older to prevent herpes zoster (zoster) (i.e. shingles) and its sequelae.  Zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons. It is caused by reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established.

  1. Occupational Health does not provide the shingles vaccine. Persons interested in receiving the vaccine should talk to their primary care provider.
  2. SCCA does not require staff to receive the vaccine.
  3. If a staff member is unsure of his/her varicella history, a varicella titer can be requested through Occupational Health. If the titer is negative, the staff member will be advised to receive varicella vaccine (against chickenpox) not zoster vaccine.
  4. Staff members who receive the shingles vaccine can continue to work in the SCCA clinic unless a chickenpox-like rash develops following vaccination. If a rash develops, staff must contact Occupational Health immediately at 206.667.4866 and must refrain from work in the SCCA clinic until the rash has completely crusted over. 

5. Tetanus, Diphtheria and Pertussis (Tdap) Vaccine

A single dose booster of Tdap vaccine is required for people between the ages of 19 and 64 to protect against tetanus, diphtheria and pertussis.

6. Influenza

Influenza vaccine is offered to staff and volunteers as available, and as recommended by the respective Influenza Season guidelines issued by the Centers for Disease Control and Prevention. Although influenza vaccine is not required, completion of the Influenza Vaccination Status Form is mandatory for all employees. Completion of this form is required annually for all employees.

7. Titers and Declinations

Individuals who do not have immunization records must have the appropriate titers drawn.  Individuals who choose not to be vaccinated against Measles (Rubeola), Mumps, Rubella, Varicella, or Tdap must sign the corresponding waiver forms.  These individuals may be furloughed off of work during the period when there is a known or suspected case of these diseases in the SCCA Clinic.  If susceptible individuals become exposed to these diseases, they may be furloughed off of work during the communicable period to prevent the possibility of infecting other staff and patients.  The decision of furlough is at the discretion of the SCCA Infection Control Physician and/or designee.  Furlough will be leave without pay (LWOP) unless the employee chooses to use accrued vacation and/or unused personal holidays during this period.

2.2.6 Tuberculosis (TB) Surveillance

Staff and volunteers whose workspace is located in the SCCA building, or who have face-to-face interaction with SCCA patients as part of their jobs, must participate in the TB Surveillance program. (Interaction with SCCA patients does not include incidental contact with patients such as entering the SCCA building, riding on the elevator with patients, accessing the garage, attending meetings in the SCCA, etc.)

TB surveillance is also required of SCCA or Fred Hutch Staff whose work activity includes:

  1. Handling of tissue or organs potentially infected with TB; and
  2. Contact with populations at high risk for TB infection and/or work-related travel to areas with high prevalence rates for TB.

Employees and volunteers who must participate in TB surveillance must meet the following requirements:

  1. Complete a two-step TB process (two TB skin tests within a twelve month period) upon hire and annual TB skin testing thereafter; and
  2. Staff and volunteers with a history of a positive TB skin test must provide documentation of the positive TB test and report of a normal chest x-ray performed subsequent to the test.  If documentation cannot be obtained, a TB skin test must be placed to obtain the MM induration and a new chest x-ray must be performed to rule out active TB.  These individuals must also complete a TB symptom screening form upon hire and annually thereafter.