Background
The US Centers for Disease Control and Prevention (CDC) has listed vaccination as one the top 10 public health achievements,1 and vaccines have led to a tremendous reduction in deaths due to vaccine-preventable disease in the United States alone.Reference Roush and Murphy2 There are over 22 million persons employed in healthcare in the United States, making healthcare personnel (HCP) an important population to target for vaccination efforts. Promoting vaccination for HCP as defined by the CDC is likely to become even more essential given the rising incidence in the United States of vaccine-preventable diseases such as measles and pertussis.3
Vaccination of HCP has benefits beyond just individual protection. Because HCP who are infected can transmit their infections to patients, visitors, and other HCP, protecting HCP through vaccination can reduce the risk of spread of these infections within healthcare facilities.Reference Hasan, Lynch and King4,Reference Maltezou, Dounias, Rapisarda and Ledda5 Presenteeism (ie, the act of working while ill, which is common among HCP) can increase this risk.Reference Kuster, Böni and Kouyos6,Reference Brown Marusiak, Sickbert-Bennett, Babcock, Westreich, Lessler and Weber7 Optimizing HCP vaccination can reduce illness-related days out of work, thereby enhancing the resiliency of our healthcare systems to be able to provide care to all who need it, especially during periods of high community infection activity. The benefits of influenza immunization of HCP have been demonstrated in geriatric long-term-care facilities; total patient mortality was significantly lower in those sites where HCP were routinely vaccinated as compared with sites where routine vaccination was not offered to HCP (10% vs 17% and 14% vs 22%).Reference Carman, Elder and Wallace8,Reference Potter, Stott and Roberts9 More recent studies have reported that increased rates of HCP vaccination were associated with a significant decrease in the incidence of healthcare-associated influenza in vaccinated HCP.Reference Salgado, Giannetta, Hayden and Farr10,Reference Tian, Ma and Ran11
To protect patients, visitors, and HCP, selected vaccines have been recommended for HCP by the World Health Organization (WHO),12 CDC,13,14 professional associations, and other groups15–17 as core patient and HCP safety measures. The SHEA Board believes that ensuring patient safety begins with vaccinating susceptible healthcare personnel for vaccine preventable diseases. Vaccination of HCP is essential to protect HCP and reduce risks to patients and visitors,
Vaccines recommended for healthcare personnel
In 2021, SHEA published a policy statement that recommended that immunity to selected vaccine-preventable diseases be a condition for employment (ie, mumps, measles rubella [MMR]; varicella; pertussis [tetanus toxoid, diphtheria, acellular pertussis; Tdap], and influenza), and we reaffirm this position statement.Reference Weber, Talbot and Weinmann18 Additionally, maintaining up-to-date immunization status for vaccines against illnesses like COVID-19 should be strongly recommended where evidence suggests likely benefits to HCP and where increased HCP vaccination can reduce the risk of healthcare-associated transmission. Immunity can be established by written proof of an adequate course of immunization for vaccines.13 Other options, depending on the vaccine, may include physician diagnosed disease, physician diagnosed disease with laboratory confirmation, and/or positive serology.13
All HCP should be counseled to receive vaccines recommended for all adults including vaccines for COVID-19, Hepatitis B, Human Papillomavirus (HPV), Polio, Respiratory Syncytial Virus and (RSV), and Zoster. Recommendations may be specific to adults within certain age groups and specified risk factors.14,17 Pregnant HCP should be counseled by their medical providers about receiving the following vaccines: Influenza, Tdap, RSV, and COVID-19.14,17 The American College of Obstetrics and Gynecology provides additional information on vaccines for during pregnancy.19
The COVID-19 pandemic had an enormous impact on healthcare facilities and public health in the United States.Reference Henderson, Haessler and Weber20 Studies of the COVID-19 vaccines have demonstrated good effectiveness against infection and higher effectiveness against hospitalizations.Reference Scott, Abers and Marwah21 Given the potential for waning immunity following vaccination, varying degrees of natural immunity due to prior COVID-19 infection, and the presence of risk factors for severe infection among some HCP and patients who might be exposed to infected HCP, healthcare facilities should recommend that their HCP are up to date with COVID-19 vaccinations. Healthcare facilities should provide HCP with evidence-based data on safety and effectiveness of COVID-19 vaccines and make the COVID-19 vaccine available to HCP who choose to be immunized. All healthcare facilities should have an up-to-date policy for assessing immunity to vaccine preventable diseases prior to new HCP entering the facility, providing vaccines to susceptible HCP, and providing recommended booster doses/yearly doses of vaccine.
Special use vaccines
Certain vaccines may be indicated for HCP (eg, Anthrax, Diphtheria, Ebola, Hepatitis A, Mpox, Polio, and Rabies) traveling outside of the United States in either personal or occupational capacity. These HCP should, as with any US traveler, receive counseling based on the countries to which they will be traveling22 and preexposure prophylaxis for vaccine-preventable diseases.23
Increasing uptake and decreasing barriers
SHEA recommends that immunity to select vaccine-preventable diseases be a condition of employment for HCP. The rationale has been previously described and includes studies that demonstrated that this is the only approach that can ensure HCP coverage of >95%.Reference Weber, Talbot and Weinmann18,Reference Black, Yue and Ball24,Reference Pitts, Maruthur, Millar, Perl and Segal25 To increase access and decrease barriers for HCP, healthcare facilities should provide recommended vaccines at no cost to HCP and at convenient times and locations. Other interventions that have been demonstrated to improve HCP vaccine coverage include the use of mobile vaccination carts, incentives, strong support by senior leadership, and education regarding benefits of immunization and risks of transmission of vaccine-preventable infections within healthcare settings.Reference Talbot, Bradley, Cosgrove, Ruef, Siegel and Weber26 Options for administration include having the vaccines administered on site by occupational health services or by pharmacists (if allowed by state law/regulations) at an onsite pharmacy.
As required by federal regulations, all persons receiving a vaccine should be provided with the appropriate Vaccine Information Statement (VIS).27 Healthcare facilities should provide for exemptions based on medical contraindications and religious objections and should also adhere to their state’s laws and regulations.28
Conclusions
HCP are at risk for acquiring and transmitting vaccine-preventable diseases. SHEA strongly recommends optimizing HCP immunity through occupational health vaccination requirements and recommendations and by facilitating HCP access to these vaccines. Creating the infrastructure to promote HCP vaccination protects HCP and the community of patients that they serve in the many locations and settings where healthcare is delivered.
Financial support
All authors are members of the 2025 SHEA Board of Trustees and received travel reimbursement for attendance at in-person SHEA Board meetings during their terms (3 annually), apart from GML. JTJ reports receiving a grant from CDC and royalties from UpToDate. RA reports receiving travel support as a speaker for ECCMID and IDWeek and serving as the CIDS India AMS and IIPC Subcommittee Chair. JES reports a grant from AHRQ and a contract with PCORI (both paid to the institution), travel reimbursement for attending the PCORI D&I meeting, and serving as a voting member of PACCARB. ESS reports grant funding from CDC and ASPR, royalties from UpToDate, consulting fees from HHS/BARDA/CARB-X for research on IPC practices for MDROs, and serving as Past President of the Massachusetts Infectious Diseases Society. DJW reports CDC Epicenter funding (paid to the institution), consulting fees and honoraria for presentations from Pfizer and GSK (vaccines) and BD, Germitec, and PDI (disinfectants), and serving on the adjudication board for Moderna. All other authors report no conflicts of interest related to this article.
Competing interests
The following disclosures reflect what has been reported to SHEA. To provide thorough transparency, SHEA requires full disclosure of all relationships, regardless of relevancy to the guideline topic. Evaluation of such relationships as potential conflicts of interest is determined by a review process which includes assessment by the SHEA Conflict of Interest Committee and may include the Editor of Infection Control and Hospital Epidemiology (ICHE). The assessment of disclosed relationships for COI will be based on the relative weight of the financial relationship (ie, monetary amount) and the relevance of the relationship (ie, the degree to which an association might be interpreted by an independent observer as related to the topic or recommendation of consideration). The reader of this guidance should be mindful of this when the list of disclosures is reviewed.
