Immunization

Policy

Category: Human Resources
Subject: Immunization
Division: Human Resources and Corporate Services
Policy Number: CA.52.01.111
Effective Date: May 3, 2017

POLICY STATEMENT

In order to safeguard the well-being of both employees and clients, Wellington-Dufferin-Guelph Public Health (WDGPH) has established specific adult immunization and screening standards that all employees must adhere to as part of their employment contract. These standards are based on the recommendations in the Canadian Immunization Guide (2016).

SCOPE

This policy applies to all employees of WDGPH.

Immunization Requirements for Employees on Hire:

All employees require:

  • Current tetanus, diphtheria, pertussis - Publically Funded Immunization Schedules for Ontario (2015 or most recent), within 10 years;
  • Measles, mumps rubella (MMR) vaccine – one dose if born before 1970 and two doses if born 1970 or later, or a reactive MMR titre;
  • Annual influenza immunization;
  • Two-step tuberculosis (TB) skin test or proof of this test (if employee has documented two-step, then only a one-step is required; if an employee cannot get a skin test, refer to procedure CA.52.02.111 Immunization, Appendix 1 for options to rule out active disease);
  • Annual TB skin test based on risk activities (e.g. DOT visiting, TB clinic and Sputum Induction); and
  • Hepatitis B immunization (completed series; demonstrated immunity)

Employees’ personal health information collected by WDGPH is considered confidential information and will only be used for the purpose of determining and maintaining qualifications for employment at WDGPHWDGPH will comply with the Personal Health Information Protection Act (PHIPA), 2004.

DEFINITIONS

Adult Immunization – Mumps, measles, rubella (MMR); tetanus, diphtheria, pertussis (Td or Tdap), hepatitis B, and annual influenza.

Tuberculosis Screening – One-step and two-step TB skin test (TST); IGRA (Interferon-Gamma Release Assay – used as a confirmatory test for a positive TST), chest x-ray.

Statement of Medical Exemption Form (CA.30.01.166) – Certificate completed by a medical health care provider that provides documented evidence that the immunization is contraindicated to the person named in the certificate.

Employee Immunization Nurse (EIN) – Contracted by WDGPH to implement the policy CA.52.01.111 Immunization.

Occupational Exposure – Describes an exposure, or unprotected by an employee who is working with an individual with a communicable disease. For this policy the exposure is related to active TB

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.52.02.111  Immunization   
Ontario Immunization Guide http://www.health.gov.on.ca/english/providers/program/immun/pdf/schedule…
Personal Health Information Protection Act (PHIPA), 2004.
National Advisory Committee on Immunization (NACI) Guidelines
CA.30.01.111  Employee Immunization Data Form 
CA.30.01.166  Statement of Medical Exemption Form

 

CONTACT FOR INQUIRIES

CNO/Director, Community Health and Wellness

APPROVED BY

Director, Administrative Services


Procedure

Category: Human Resources
Subject: Immunization
Division: Human Resources and Corporate Services
Procedure Number: CA.52.02.111
Effective Date: May 3, 2017

PROCEDURE

Wellington-Dufferin-Guelph Public Health (WDGPH) has established immunization standards based on the Canadian Immunization Guide (2016). In order to meet the immunization requirements as detailed in policy CA.52.01.111 Immunization, the following process must be followed by all employees:  

RESPONSIBILITY OF MANAGEMENT:

  • To promote a safe working environment that meets WDGPH immunization standards.
  • To understand WDGPH policy CA.52.01.111 and procedure CA.52.02.111 Immunization and ensure adherence to by all employees.
  • To manage non-compliance with established WDGPH policies.

RESPONSIBILITY OF HUMAN RESOURCES (HR) FOR NEW EMPLOYEES:

  • To ensure the requirement for immunization and/or tests is included in all recruitment and selection procedures.
  • To provide all prospective employees with a copy of the policy CA.52.01.111 and procedure CA.52.02.111 Immunization, to insure informed consent.
  • To ensure that all offers of employment include a clause that prospective employees must agree to WDGPH’s immunization requirements, including tuberculosis (TB) screening, as part of their employment contract. A copy of CA.30.01.111 Employee Immunization Data form will be included with all offers of employment.
  • To notify the employee immunization nurse (EIN) of all new employees including name of the employee, date of hire and the program.

RESPONSIBILITY OF EMPLOYEE:

At Offer of Employment:

  • Prospective employees shall review all policies and procedures related to immunization prior to signing an employment offer. By signing the employment offer, employees are agreeing that they will comply with WDGPH adult immunization standards.
  • Prospective employees shall endeavor to ensure all immunizations are complete prior to their first date of employment. Where completion of immunization requires multiple appointments, evidence of the first dose and further scheduled appointments will be accepted as intent to complete the immunization requirements.
  • Prospective employees shall complete the CA.30.01.111 Employee Immunization Data form, sign and submit to the EIN five working days prior to their first day of employment.

Upon Commencement of Employment:

  • Employees who are unable to be immunized due to valid medical contraindications must provide to the EIN a CA.30.01.166 Statement of Medical Exemption Form completed by their primary care provider, five working days prior to their first day of employment. Employees who qualify for medical contraindications will be considered for potential accommodation provided such accommodation does not result in WDGPH failing to fulfill its obligations.

Annually and/or Ongoing, Employees will:

  • Ensure completion of all outstanding immunizations as identified in the completed CA.30.01.111 Employee Immunization Data form.
  • Comply with annual influenza immunization requirements and provide evidence of the same to the EIN by November 1st of each year. If provided by external provider (i.e. outside of WDGPH), documented evidence must be submitted.
  • Provide the EIN with documentation of all updated immunizations (performed outside of WDGPH).
  • Notify and report to the EIN for periodic TB skin test as outlined in this procedure. 

RESPONSIBILITY OF EIN:

For Prospective and New Employees:

If the new Employee:

  • Meets WDGPH’s established immunization standards, the EIN will check off ‘completed’ on the Employee Immunization Data form.
  • Does not meet WDGPH’s established immunization standards, the EIN will advise the new employee of the option to update these requirements through their primary care provider, or WDGPH clinic.
  • Is unable to meet WDGPH’s established immunization standards and provides medical documentation (CA.30.01.166 Statement of Medical Exemption Form) that indicates the employee is unable to comply due to valid medical reasons, the EIN will check off ‘unable to meet’ and indicate the reason on the Employee Immunization Data form and forward a copy of the form in a confidential manner to Human Resources (HR).
  • Refuses to complete or initiate immunization and it is not due to a medical condition, and there is no Statement of Medical Exemption Form, the EIN will advise HR who will work with the manager/director to clarify next steps.

EIN will record the employee’s immunization status information to maintain up-to-date and accurate centralized immunization employee records and follow-up with any open files to ensure all immunization is completed and the file is closed.

Ongoing Immunization Status:

  • The EIN will keep a list of all ongoing employee immunization requirements.
  • All positive tuberculin skin tests (TST) are reportable to public health. Following a positive TST the Medical Officer of Health (MOH) will make recommendations individualized to each employee regarding next steps. These may include chest x-ray, Interferon Gamma Release Assays (IGRA) screening, referral to a respirologist, CT scan and/or sputum collection. Prior Bacillus Calmette-Guérin vaccination (BCG) does not eliminate the usefulness of the TST in the majority of people. (See Appendix 1 attached).  IGRA test is a new advance in the diagnosis of Latent Tuberculosis Infection (LTBI). WDGPH will cover the time and cost to have this test done if the MOH determines it is necessary. (See Appendix 2 attached). It is recommended that employees follow-up with their health care provider anytime they have concerns of TB.
  • The EIN will remind employees of any upcoming immunization requirements a minimum of one month in advance. The EIN will advise the employee of the option to update these requirements through their primary care provider and/or, WDGPH clinical services.
  • The EIN will inform HR, who will follow-up with the appropriate manager for any employee who does not meet/maintain WDGPH’s immunization requirements.
  • The EIN will follow-up with any open files to ensure all immunization is completed or reported and the file is closed.
  • If after three months the employee has not fulfilled the immunization requirements, the EIN will again report this to HR, who will follow-up with the manager/director to clarify next steps.

Periodic TB Skin Test:

  • TB skin tests are completed annually for an employee that in the course of their normal duties and using airborne precautions intentionally interact with clients who have active TB.
  • Twice annually (January and June), the Manager of Control of Infectious Diseases, will advise the EIN the names of the employee who in the course of their normal duties, intentionally interact with clients who have active TB.
  • Appointments for TB skin test and reading will be set up through the EIN.
  • TB skins tests will be planted by clinical employee in the office of the employee’s choice and read by the EIN, 48–72 hours later; or the employee may opt to seek their own practitioner and provide the EIN with written results of the test.
  • Employees who, outside the course of their normal duties or while not at work, become exposed to an individual with active TB will be followed up according to the standard practice of the Control of Infectious Diseases Team.
  • Employees who, outside the course of their normal duties or while not at work, become exposed to an individual with active TB, may elect to have the EIN read their skin test if warranted.
  • Employees who, while in the course of their normal duties while at work who are exposed to an individual with active TB, may elect to have the EIN read their post exposure TB skin test. If positive, the procedure details as outlined in “Ongoing Immunization Status” will apply.

RESPONSIBILITY OF HR/EIN for Annual Influenza Immunization:

For Ontario Nurses Association (ONA) members, refer to the Collective Agreement regarding influenza immunization.

Employees hired prior to 2005 are recommended, but not required, to obtain their annual influenza immunization. If the employee chooses not to be immunized, work accommodations or an unpaid leave of absence may result.

Employees are to obtain their annual influenza immunization no later than November 1st of each year unless the agency sets a later date based on vaccine supply etc.

  • HR will give a list of all employees, indicating those hired prior to 2005, to the EIN designate prior to October 24th each year.
  • The EIN will submit to HR by November 8th, a list of all employees, hired after 2005, who:
    • have received their annual influenza vaccine by November 1st of each year;
    • are unable to obtain their annual influenza vaccine due to medical reasons including a date as to when they may be able to receive their vaccination; or
    • do not fit into any of the above categories.
  • Upon receipt of the list noted above, HR will inform the manager who will follow-up with each outstanding employee to confirm course of action for compliance.  If the manager has employees unwilling/unable to comply, they will determine with the employee’s director, the need for:
    • work accommodations; or
    • unpaid leave of absences. 

Exception for employees who joined WDGPH prior to September 2005:   only employees who are assigned to work in programs where there is close contact (within 2 metres) with high-risk individuals and/or settings in which high-risk individuals live, are required to be immunized prior to November 1st each year. This guideline is in accordance with the annual National Advisory Committee on Immunization (NACI). The two metre distance is established as it is the distance whereby someone could transmit a droplet spread disease (PIDAC: Routine and Additional Precautions). All other employees who joined WDGPH prior to September 2005 are strongly recommended to receive the annual immunization for influenza.

Hepatitis A Recommendation:

Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. Vaccines are available for long-term prevention of HAV infection in persons one year of age and older. Employees who regularly prepare food for the public or who may come into contact with human feces laboratory samples or water/environment contaminated with human feces as part of their employment duties are recommended to be aware of their immune status to HAV and discuss this with their healthcare provider. There are three ways to determine immune status:

  • Documentation of receipt of two doses of hepatitis A vaccine at least six months apart;
  • Laboratory evidence of immunity; and
  • Physician diagnosed confirmation of disease.

Varicella-Zoster Virus (chicken pox) Recommendation:

Varicella (chickenpox) is a common childhood infection caused by varicella-zoster virus, a herpes virus. This virus can cause significant concerns for the adult population. All employees are recommended to be aware of their immune status to varicella-zoster virus. There are three ways to determine this:

  • Documentation of receipt of two doses of varicella vaccine at least four weeks apart;
  • Laboratory evidence of immunity; and
  • Physician diagnosed confirmation of disease.

Employees who are unsure if they have received the vaccine or if they experienced chicken pox diseases are recommended to have a serum titre drawn to determine their status. Those without immunity to the varicella-zoster virus should discuss their options with their healthcare provider.  

Disease Outbreak:

In the event of an outbreak of a vaccine preventable disease within the boundaries of WDGPH, the MOH and/or a director, is responsible for determining if current assignments negatively impact the health of individual employees or the public and/or impact the organization’s ability to manage an outbreak. The EIN will provide the MOH and/or directors with information regarding employee immunization status when requested during a disease outbreak.

Where the risk exists and a vaccination is available, it may be required that employees receive additional immunization/test to respond to the current medical crises. In such situations, the cost of the additional immunization/test is covered by WDGPH.

Records Management:

All employee immunization records will be stored in the WDGPH electronic health record (EHR) filing cabinet. When an employee leaves the organization, their EHR will be closed and the information contained in the record will be retained according to the WDGPH Retention Schedule. 

 

DEFINITIONS

Adult Immunization – Mumps, measles, rubella (MMR); tetanus, diphtheria, pertussis (Tdap), hepatitis B and annual influenza.

Tuberculosis Screening – One-step and two-step TB skin test (TST); IGRA– used as a confirmatory test for a positive TST), chest x-ray.

Statement of Medical Exemption Form – Certificate completed by a medical health care provider that provides documented evidence that the immunization is contraindicated to the person named in the certificate.

Employee Immunization Nurse (EIN) – Contracted by WDGPH to implement the policy CA.52.01.111 Immunization.

Occupational Exposure – Describes an exposure, protected or unprotected by an employee member who is working with an individual with a communicable disease. For this policy the exposure is related to active TB

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy:  CA.52.01.111  Immunization 

CA.30.01.111 Employee Immunization Data Form

CA.30.01.166 Statement of Medical Exemption Form

Ontario Immunization Guide http://www.health.gov.on.ca/english/providers/program/immun/pdf/schedule…

Personal Health Information Protection Act (PHIPA), 2004.

National Advisory Committee on Immunization (NACI) Guidelines

Appendix 1 – BCG Vaccination and TST Test Results

Appendix 2 – IGRA

CONTACT FOR INQUIRIES

CNO/Director, Community Health and Wellness

APPROVED BY

Director, Administrative Services

Appendix 1:[1]

BCG Vaccination and TST results:

BCG vaccination is not considered a cause of a positive TST under the following circumstances:

BCG vaccination was given only in infancy, and the person tested is now aged 10 years or older;
There is a high probability of TB infection: close contacts of an infectious TB case, Aboriginal Canadians from a high-risk community or immigrants/visitors from a country of with high TB incidence; or
There is high risk of progression from TB infection to disease (e.g. pregnancy).

BCG should be considered the possible cause of a positive TST under the following circumstances:

BCG vaccination was given after 12 months of age; AND
There has been no known exposure to active TB disease or other risk factors; AND
The person is either Canadian-born non-Aboriginal; OR
An immigrant/visitor from a country with low TB incidence.

Appendix 2:[2]

IGRA Recommendations for use in Canada (please refer to Canadian Tuberculosis Standards, 7th edition for complete information)

  1. Neither TST nor IGRAs should be used for testing:
  • People who have a low risk of infection and a low risk of progression to active TB disease if they are infected;
  • Diagnosis of active TB in adults;
  • Routine or mass screening for LTBI of all immigrants (adults and children); and
  • Monitoring of anti-TB treatment response.
  1. IGRA’s are preferred for testing but a TST is acceptable for:
  • Individuals who have received BCG as a vaccine after infancy (one year of age) and/or have received BCG vaccination more than once; and
  • Individuals from groups that historically have poor rates of return for TST reading.
  1. TST is recommended but an IGRA is NOT acceptable:
  • Whenever it is planned to repeat the test later to assess risk of new infection such as repeat testing in a contact investigation or serial testing of health care workers with potential for ongoing exposure.
  1. Both TST or IGRA can be used to enhance sensitivity:
  • When risk of infection, progression and poor outcome is high;
  • In children under age 18 with suspected TB disease; and
  • Initial IGRA is indeterminate.

[1] Canadian Tuberculosis Standards, 7th Edition pg. 76
[2] Canadian Tuberculosis Standards, 7th Edition pg. 88-90