Pertussis vaccination for healthcare workers (WHC/2024/043)

Status:

Compliance / action.

Category:

Public health.

Title:

Pertussis Vaccine Offer for Healthcare Workers.

Date of expiry / review:

Non-applicable.

Required by:

Non-applicable.

Action by:

• Chief executives, health boards/trusts.
• Immunisation leads, health boards/trusts.
• Immunisation coordinators, health boards.
• Vaccination operational leads, health boards/trusts.
• Medical directors, health boards/trusts.
• Directors of primary care, health boards/trusts.
• Nurse executive directors, health boards/trusts.
• Directors of therapies and health Sciences, health boards/trusts.
• Chief pharmacists, health boards/trusts.
• Directors of public health, health boards/trusts.
• Directors of maternity services, health boards.
• Directors of workforce and organisational development, health boards/trusts.
• Executive Director of Public Health, Public Health Wales.
• Nurse Director, Public Health Wales.
• Head of Vaccine Preventable Disease Programme, Public Health Wales.
• Director of Vaccine Delivery, NHS Wales Executive.
• General practitioners.
• Community pharmacists.
• Digital Health and Care Wales.

For information to:

• Welsh NHS Partnership Forum.
• General Practitioner Council, Wales.
• Royal College of GPs.
• Royal College of Nursing.
• Royal College of Midwives.
• Royal College of Paediatrics and Child Health.
• British Dental Association.
• Royal Pharmaceutical Society.
• Community Pharmacy Wales.
• Care Inspectorate Wales.
• Chief Executive, Welsh Local Government Association for onward issue to:
  • directors of social services, local authorities
  • directors of public protection, local authorities
  • directors of education, local authorities
  • Social Care Wales
  • Health Education and Improvement Wales

Sender:

Dr Keith Reid, Deputy Chief Medical Officer (Public Health).

Welsh Government contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.
Email: wg.vaccinationsprogrammeteam@gov.wales

Enclosures:

None.

Dear colleagues,

I am writing to provide clarity on the occupational offer of pertussis vaccine to NHS Wales Healthcare workers (HCWs).

Since the end of 2023 there has been a large increase in notifications of suspected pertussis, commonly known as whooping cough, in Wales and across the UK.

Pertussis is a bacterial infection of the respiratory tract that spreads very easily and can sometimes cause serious illness. While most people recover without medical intervention, the risk of severe complications, including hospitalisation and death, is highest in very young babies. Five babies under 3 months old have already died this year in the UK: the first pertussis related deaths reported since 2019.

A high level of population immunisation is the most effective method of controlling whooping cough. The vaccine is offered to infants as part of the immunisation programme for babies at eight, 12 and 16 weeks and pre-school children aged three years and four months. It is also routinely offered to pregnant women between 16 and 32 weeks of pregnancy to help protect newborns until they are old enough to receive their first vaccination. However, vaccination rates have fallen over the past few years and consequently cases of pertussis have inevitably risen, as we have seen this year.

HCWs who come into contact with pregnant women and infants can also be a critical source of infection. In the light of this, and to help protect infants from pertussis, a Welsh Health Circular (WHC) was issued in 2019 setting out an occupational offer of pertussis vaccine for certain healthcare workers in NHS Wales organisations. Specifically, the previous WHC advised that healthcare workers who had not received a pertussis-containing vaccine in the last 5 years and had regular contact with pregnant women or young infants, would be eligible for a pertussis containing vaccine as part of their occupational health care.

Following the recent increase of incidents of pertussis and to help protect the most vulnerable, I would like to remind NHS Wales colleagues of the need to ensure that the occupational offer of pertussis vaccine to HCWs remains an active one.

In particular, HCWs who work with the following cohorts should be offered an occupational pertussis vaccination, if they have not had one in the past five years:

• HCWs with regular and close clinical contact with women in the last month of pregnancy and severely ill young infants. This includes:
  • clinical staff who work in areas where pregnant women are likely to attend in their last month of pregnancy (for example midwifery, obstetrics and maternity settings)
  • neonatal and paediatric intensive care staff who are likely to have close and or prolonged clinical contact with severely ill young infants
• HCWs with regular clinical contact with young unimmunised infants in hospital or community settings; examples include:
  • general paediatric staff
  • paediatric cardiology staff
  • paediatric surgical staff
  • paediatric emergency medicine
  • health visitor staff
• HCWs with intermittent clinical contact with young unimmunised infants in the community; this includes HCWs in general practice

It is important to be aware that HCWs in these groups have been eligible for a pertussis vaccination since 2019 and therefore may now be eligible for another dose.

Vaccinating these HCWs not only helps prevent transmission of pertussis infection to vulnerable infants and pregnant women in healthcare settings but also mitigates against the often disruptive and resource-intensive consequences of such incidents, including mitigating the risk of staff absence.

As this is an occupational offer, eligible HCWs should contact their occupational health representative to find out how to receive their vaccine. Occupational health teams should work with line managers to identify staff who are eligible. Staff members should also notify occupational health if they have had a pertussis containing vaccine elsewhere for example as part of the pregnancy programme.

Further operational guidance can also be found at annex A

Yours sincerely
Dr Keith Reid
Deputy Chief Medical Officer (Public Health)

Vaccine products

The recommended vaccines are acellular pertussis-containing vaccines Repevax, ADACEL and Boostrix-IPV. These are combination vaccines that, in addition to pertussis antigens, contain diphtheria toxoid, tetanus toxoid, and inactivated poliovirus. There are no current issues with the supplies of these vaccines.

Repevax

Repevax diphtheria / tetanus / 5-component acellular pertussis / inactivated polio vaccine (dTaP/IPV) – manufactured by Sanofi Pasteur.

Contact 0800 854 430 (option 1) or gb-vaccinecustomerservices@sanofi.com to order vaccines.

ADACEL (diphtheria / tetanus / 5-component acellular pertussis)

ADACEL does not contain IPV. Not suitable for individuals with latex allergy. Manufactured by Sanofi Pasteur. Order details as above.

Boostrix-IPV

Boostrix-IPV, diphtheria / tetanus / 3-component acellular pertussis / inactivated polio vaccine (dTaP/IPV) – manufactured by GlaxoSmithKline.

Contact AAH Pharmaceuticals on 0344 561 8899 (option 1) to order vaccines.

All pertussis-containing vaccines are supplied as single doses of 0.5 ml. They are inactivated so do not contain live organisms and cannot cause the diseases they protect against.

Vaccines should be stored in the original packaging at +2˚C to +8˚C and protected from light.

Contraindications

There are very few individuals who cannot receive pertussis-containing vaccines. When there is doubt, rather than withhold vaccine, appropriate advice should be sought from:

• local immunisation team / immunisation coordinator
• Welsh Medicines Advisory Service

The vaccines should not be given to those who have had:

• a confirmed anaphylactic reaction to a previous dose of a diphtheria, tetanus, polio or pertussis-containing vaccine
• a confirmed anaphylactic reaction to neomycin, streptomycin or polymyxin B (which may be present in the vaccine in trace amounts)
• a confirmed anaphylactic reaction to any component or excipient of the vaccine
• ADACEL should not be given to individuals with a latex allergy

Precautions

Minor illnesses without fever or systemic upset are not valid reasons to postpone immunisation. If an individual is acutely unwell, immunisation should be postponed until they have fully recovered.

Additional information

Pertussis-containing vaccines are recommended for all pregnant women from 16 weeks gestation and can be given to those who are breastfeeding. HCWs who are pregnant should be vaccinated as recommended under the maternal pertussis programme (ideally between 16 and 32 weeks.

Pertussis vaccines can also be given to those with immunosuppression and HIV infection, but they may not make a full antibody response and may require re-immunisation on specialist advice.

Incidents and outbreaks in healthcare settings

Guidelines for the Public Health Management of Pertussis in Healthcare Settings still apply and are available to view and download.