People who are ill with a communicable disease often present at a medical facility before the cause of their symptoms is obvious (e.g. during the disease prodrome); their illness may be transmitted to all patients and staff who are susceptible. During the recent measles outbreak in King County, many clinics were confronted with measles exposures to staff whose measles immunity status was not known.

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that everyone who works in a health care facility have proof of immunity to measles, mumps, rubella, and varicella to prevent airborne spread of these diseases. This also applies to employees who do not have direct patient contact, such as administrative and maintenance staff.

Persons born in 1957 or later can be considered immune to measles, mumps, or rubella only if they have documentation of a) physician-diagnosed measles or mumps disease; or b) laboratory evidence of measles, mumps or rubella immunity (persons who have an "indeterminate" level of immunity upon testing should be considered nonimmune); or c) appropriate vaccination against measles, mumps, and rubella (i.e., administration on or after the first birthday of two doses of live measles vaccine separated by 28 days or more, at least one dose of live mumps vaccine, and at least one dose of live rubella vaccine).

Although birth before 1957 generally is considered acceptable evidence of measles, mumps and rubella immunity, health-care facilities should consider recommending a dose of MMR vaccine to unvaccinated workers born before 1957 who are in either of the following categories: a) those who do not have a history of measles or mumps disease or laboratory evidence of measles and mumps immunity, and b) those who lack laboratory evidence of rubella immunity. Rubella vaccination, or laboratory evidence of rubella immunity, is particularly important for female staff born before 1957 who can become pregnant. All employees should ensure that they are immune to varicella. Proof of immunity can be provided by: 1) giving a history of varicella disease, by self-report or that of a family member or 2) documentation of two doses of varicella vaccine, or 3) laboratory evidence of immunity to varicella.

Due to the fact that health care workers, if infected with influenza, have a high potential for transmitting influenza to high risk patients, health care workers are defined as a high priority group for influenza vaccination. Therefore health care workers should be offered influenza vaccinations as soon as this vaccine becomes available in October.

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