News Scan for Dec 12, 2013

Mandatory HCP vaccinations
NYC flu vaccine mandate
Lyme carditis and death

Societies endorse multiple mandatory immunizations for health workers

Three major infectious-disease societies said this week that healthcare personnel (HCP) should be required to receive all six vaccines that are recommended for them by the federal Advisory Committee on Immunization Practices (ACIP).

The statement was issued jointly by the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), and the Pediatric Infectious Diseases Society (PIDS). The recommended vaccines are for influenza; hepatitis B; measles, mumps, and rubella (MMR); varicella; tetanus, diphtheria, and acellular pertussis (Tdap); and meningococcal disease.

The IDSA and SHEA both endorsed mandatory flu vaccination for HCP in 2010, but the societies don't list any previous statements about requiring the other immunizations.

"When voluntary programs fail to achieve immunization of at least 90% of HCP, the Societies support HCE [healthcare employers] policies that require HCP documentation of immunity or receipt of ACIP-recommended vaccination as a condition of employment, unpaid service, or receipt of professional privileges," the statement says.

For workers who can't be vaccinated because of medical contraindications or vaccine shortages, employers should consider administrative or infection control measures to limit the risk of disease transmission, it adds. Such measures could include requiring the use of masks during flu season or reassigning workers away from direct care.

The statement defines HCP as all paid and unpaid people who work in healthcare settings and may be exposed to patients or infectious materials.
Dec 10 IDSA/SHEA/PIDS statement
CDC information on vaccines recommended for health workers


New York City mandates flu vaccine for preschoolers

In a unanimous Board of Health decision yesterday, children who attend preschool or daycare in New York City will be required to receive an influenza vaccine, according to the local CBS affiliate.

The rule will apply to children under 6 years old and takes effect in 30 days but won't be enforced until a year from now, said Jay Varma, MD, the city's deputy commissioner for disease control. "The requirement is that children who are attending a licensed preschool or day care center need to have received their influenza vaccination by Dec 31 of any given year," he said.

"We think we can prevent 20,000 to 25,000 kids a year from being sick," Varma said.

Parents can opt out for medical or religious reasons, the story said, or have their children attend a state preschool or daycare if they wish to avoid the mandate. The city's Board of Health comprises 10 members.
Dec 11 CBS New York story
NYC Health FAQ on the requirement


Report describes sudden death in 3 patients with Lyme carditis

Today's Morbidity and Mortality Weekly Report (MMWR) describes sudden death in three northeastern US patients in their twenties and thirties who had Lyme carditis, underscoring the need for early Lyme detection and assessment for cardiac symptoms, the authors say.

The first patient, from Massachusetts, died in November 2012. Postmortem interviews with next of kin revealed that the patient had general malaise and muscle and joint pain in the 2 weeks before death, and the patient lived alone with a dog that frequently had ticks.

Patient 2, from New York state, died in July of this year after having chest pain and collapsing at home. The patient had no known tick contact but was a hiker.

Patient 3, from Connecticut, collapsed while visiting New Hampshire and died in July. The patient lived on a heavily wooded lot and had frequent tick exposure. All three patients were diagnosed after death as having Borrelia burgdorferi infections.

In addition, donated corneas from two of the patients were transplanted to three recipients before the diagnosis of Lyme disease was made, but investigators found no evidence of disease transmission in the recipients.

The authors conclude, "Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions."
Dec 13 MMWR report

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