Immunisations and their vaccination schedule

Liverpool John Moores University requires that all students meet the immunisation and infection control standards as advised by the Department of Health 2007. This is done either prior to or during the commencement of your training. There are several immunizations that must be received or administered prior to clearance.

Attendance for immunisation is priority – It is your responsibility as a professional, in line with the advice from your Faculty and relevant professional bodies, to ensure your health and that of your patients or colleagues is not compromised by infection.

• Please ensure to eat and drink before the appointment; and to wear loose clothing.

Reactions

Reactions are rare but with all vaccines, they have the potential to cause side effects. Most tend to be mild and don't last longer than a few days. Some people don't get any side effects at all.

Common vaccine side effects

• injection site reactions (pain, swelling and redness)
• mild fever
• shivering
• fatigue
• headache
• muscle and joint pain

Rare vaccine side effects

A far less common, but serious, vaccine side effect is an immediate allergic reaction, also known as an anaphylactic reaction; less than 1 in a million cases – and are completely reversible.

If you experience breathing problems or a rash. Please go to A and E.

Not all illnesses that occur after vaccination will be a side effect. But if you are at all concerned please do not hesitate to contact us or your GP.

Here is a list of possible immunisations you may be offered:

Hepatitis B

Information

Hepatitis B (Hep B) is offered to all healthcare students who may have direct contact with patients’ blood, blood-stained body fluids or tissue.

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). The virus is transmitted by parenteral exposure to infected blood or body fluids. Transmission mostly occurs through intercourse; as a result of blood-to-blood contact (e.g. sharing of needles and other equipment by injecting drug users (IDUs), ‘needlestick’ injuries); through perinatal transmission from mother to child.

Schedule

The schedule requires three vaccines at 0, 1 and 6 months, with a blood test one to four months following the third injection. There are very few individuals who cannot receive hepatitis B vaccine and it is generally well tolerated. The most common adverse reactions are soreness and redness at the injection site for a few days only. Or documented evidence of previous vaccination dates.

Measles, Mumps and Rubella (MMR)

Measles

Measles is an acute viral illness caused by a morbillivirus of the paramyxovirus family. It is spread by airborne or droplet transmission. Measles can cause ear infections, pneumonia, fits and encephalitis (inflammation of the brain). It may be fatal.

Mumps

Mumps is an acute viral illness caused by a paramyxovirus. It is spread by airborne or droplet transmission. Mumps can cause meningitis, which can result in deafness. May cause inflammation of the pancreas, leading to pain, nausea and vomiting. In boys, it can cause infertility.

Rubella

Rubella also known as German measles is a mild disease caused by a togavirus. It is spread by droplet transmission. Rubella causes a rash and is harmful to developing babies in the first 10 weeks of pregnancy.

Schedule

The schedule requires two doses of the live vaccine to ensure immunity. The second dose should be given four weeks after the first dose. Or documented evidence of previous vaccination dates.

The vaccine is contraindicated in the following circumstances:

• those who are immunosuppressed
• those who have had a confirmed anaphylactic reaction to a previous dose of a measles-, mumps- or rubella-containing vaccine
• those who have had a confirmed anaphylactic reaction to neomycin or gelatin
• pregnant women.

Women are advised not to get pregnant for one month after receiving the MMR vaccination.

Tuberculosis (TB)

Information

Human tuberculosis (TB) is caused by infection with bacteria of the Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis, M. africanum or M.microti) and may affect almost any part of the body. The most common form is pulmonary TB, which accounts for almost 55% of all cases in the UK.

The symptoms of TB are varied and depend on the site of infection. General symptoms may include fever, loss of appetite, weight loss, night sweats and lassitude. Pulmonary TB typically causes a persistent productive cough, which may be accompanied by blood-streaked sputum or, more rarely, frank haemoptysis. Untreated, TB in most otherwise healthy adults is a slowly progressive disease that may eventually be fatal. Latent TB infection may reactivate in later life; particularly if an individual’s immune system has become weakened, for example by disease (e.g. HIV), certain medical treatments (e.g. cancer chemotherapy, corticosteroids, anti-TNF) or in old age.

Almost all cases of TB in the UK are acquired through the respiratory route, by breathing in infected respiratory droplets from a person with infectious respiratory TB.

Schedule

Students should have evidence of BCG vaccination either by a visible BCG scar or documented proof. Unless contraindicated, if there is no evidence of the BCG vaccination a Tuberculin Skin Test (Mantoux) will be performed. This will show whether your body has ever been exposed to TB germs.  You could have been exposed through having the BCG vaccination or through breathing in the TB germ. A small amount of liquid is injected just under the top layer of skin on your forearm using a very small needle and syringe. It may sting a little for a minute or two. The nurse will check the site after 2 or 3 days and tell you if anything more needs to be done.

If the test is positive, this may be because you have had a BCG vaccination or contact with the TB germ in the past.  In the case of a very strong reaction, you will be asked to have further tests and possibly treatment.

If the test is negative, this means that you have probably not been exposed to TB. A BCG vaccination may be offered if appropriate.

BCG Vaccination

The BCG vaccination gives protection against TB. The Department of Health recommends that all healthcare workers, or students, who will have contact with patients or clinical materials, should receive the BCG vaccine.

Schedule

BCG vaccine is given by a small injection just under the skin at the top of the left arm. BCG vaccine normally forms a blister and heals to leave a scar. Occasionally healing is delayed and complete healing may take several months. In extreme cases there can be scarring.  Rarely there may be headache or fever. Severe allergic reactions and complications are very rare. 

Varicella Zoster Virus (VZV)

Information

Varicella (chickenpox) is an acute, highly infectious disease caused by the varicella zoster (VZ) virus.

Varicella is transmitted directly by personal contact or droplet spread. The incubation period is between one and three weeks.

Herpes zoster (shingles) is caused by the reactivation of the patient’s varicella virus. Virus from lesions can be transmitted to susceptible individuals to cause chickenpox but there is no evidence that herpes zoster can be acquired from another individual with chickenpox.

In the absence of a definite history of chickenpox or shingles, a blood test will be taken for VZV to determine the student's immune status.

Schedule

The schedule requires two doses of the live vaccine to ensure immunity. The second dose should be given four weeks after the first dose.

The vaccine is contraindicated in the following circumstances:

• Immune-suppressed patients. For patients who require protection against chickenpox, seek advice from a specialist
• Women who are pregnant. Pregnancy should be avoided for one month following the last dose of varicella vaccine.
• A confirmed anaphylactic reaction to a previous dose of the vaccine
• A confirmed anaphylactic reaction to any component of the vaccine, including neomycin or gelatin.

Women are advised not to get pregnant for one month after receiving the VZV vaccination. 

Additional health checks

For paramedic and midwifery students who undertake exposure prone procedures (EPP). A blood test will be offered to check antibody levels for Hep B, C, and HIV; prior to commencing on placements.

EPP include procedures where the worker’s gloved hands may be in contact with sharp instruments, needle tips or sharp tissues inside a patient’s open body cavity, wound or confined anatomical space, where the hands or fingertips may not be completely visible at all times.

Hepatitis B

Please see earlier notes.

Hepatitis C

All Paramedics and Midwives will be offered a blood test for Hepatitis C (Hep C) antibodies on admission.

Hep C is a virus that is carried in the blood and body fluids which infects and damages the liver. If left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years.

Hep C often doesn't have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it. When symptoms do occur, they can be mistaken for another condition. Symptoms can include:

• flu-like symptoms, such as muscle aches and a high temperature (fever)
• feeling tired all the time
• loss of appetite
• tummy (abdominal) pain
• feeling and being sick

Human Immunodeficiency Virus (HIV)

All Paramedics and Midwives will be offered a blood test for HIV antibodies on admission.

HIV (human immunodeficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. AIDS (acquired immune deficiency syndrome) is the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus. While AIDS can't be transmitted from one person to another, the HIV virus can. There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life. 

If you are HIV positive please disclose this information to the Occupational health nurse in confidence, who will advise you of the appropriate procedures required to practice.

Any student with a positive blood borne virus test result may be referred to the Consultant Occupational Physician for a further assessment and advice.

For further information please visit GOV.UK.

Vaccination Requirements for all Health Care Students

For example, Nursing, Midwifery, Paramedics, Pharmacists, Social Care, Teaching.