Having recently undergone an occupational health review by my new employer, last week I received notification that I am not currently immune to Measles and need to receive an MMR vaccine. Interestingly, my immunity to German Measles (Rubella) and Mumps is intact, however, in receiving the MMR, I would nonetheless consequently receive a booster for those two diseases, as they are part and parcel of the combined vaccine.

The nurse who brought me into the exam room explained that the CDC is now strongly recommending drawing titers for Measles, Mumps and Rubella on all healthcare workers born in 1957 or later, although each state apparently makes its own decisions in this regard. For those born prior to 1957, the CDC recommends vaccination if the individual has no physician-documented history of disease or laboratory-based evidence of immunity. According to this nurse, many of us over 40 only received one MMR as children, and the evidence shows quite clearly that a series of two vaccines are much more likely to confer immunity over the course of a lifetime.

Of note, to the best of my knowledge, I actually already received two MMR vaccines at some point in my life. So, just out of curiosity, I will look through my records and try to discover whether my memory serves me correctly or not.

In terms of occupational testing for communicable diseases, those of us who work in the healthcare field are quite accustomed to tuberculin skin testing at regular intervals due to the continued prevalence of tuberculosis in the community. While I have indeed been exposed several times to patients with active TB, I have never had a positive ppd and expect that to continue. Be that as it may, TB is no laughing matter and I willingly submit to skin testing whenever I’m told to bear my hairy forearm.

Over the last decade or so, testing for immunity to Varicella has also become standard in most healthcare facilities in the United States. While Chicken Pox is a common childhood illness which most of us contract at some point in our tender years, there are those who did indeed never have the illness, and it is known to be considerably more dangerous for adults who are unfortunately stricken, especially when one considers that adults account for only 5% of cases but 35% of mortality. My wife, bless her heart, is an example of an adult who actually had a relatively severe case of Chicken Pox as a child but still developed a mild (but irksome) case once again as an adult, a rare and disconcerting experience. Luckily, her adult case was mild, however her risk of developing Shingles (Herpes Zoster) in later adulthood---which is caused by the same agent as Chicken Pox (Herpes Zoster Virus) and lives dormant in the basal ganglia of anyone who has had the childhood illness---is now somewhat higher. And if any of you have had patients or family members with Shingles, you know that it is an exquisitely painful experience which can often lead to Postherpetic Neuralgia, a chronic and neurological pain syndrome usually treated with antiviral drugs. 

In terms of other communicable diseases, Hepatitis B vaccination in 3 parts is, I asssume, universally practiced for healthcare workers, as is tetanus vaccination every 10 years. Influenza vaccine is, of course, widely recommended for all healthcare workers. In the event of an influenza pandemic, it is in the best interest of the society as a whole for healthcare personnel---and other public servants such as firefighters and police---to be protected from illness, so that they may serve their vital functions and maintain order and public health (this concept often referred to in public health circles as "force protection"). 

Over all, the United States, under the guidance of the CDC, appears to have a robust system of recommendations and guidelines for the screening and protection of healthcare personnel. Whether every state follows these recommendations to the letter is beyond the scope of this article, and this writer would urge readers to discuss these issues with managers and administrators at your particular facility, or perhaps your Congressperson if you are so inclined. If you, or someone you know, was born in 1957 or later, it would behoove the individual to pursue undergoing a titer to assure immunity or the need for a booster vaccination. Chances are, according to my new-found knowledge, a number of titers will reveal a lack of immunity to Measles, a physiological state easily remedied with the only slightly (and momentarily) painful MMR vaccine, the relative safety of which is quite high, statistically speaking. While the aforementioned CDC guidelines do indeed refer to healthcare workers in particular, I would assume that most medical providers would perform a titer on any earnestly curious or anxious patient desirous of such a test. 

So, friends, in six weeks or so I will return to the lab for my follow-up titer to ascertain if this additional MMR has done the job and delivered its promise of immunity from Measles. If not, it's another vaccination for me and a subsequent titer yet again. Watch for a follow-up article, and in the interest of public and personal health, please check your vaccination records. 

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NurseKeith is a nurse, consultant, writer and blogger. Please feel free to visit his blog, Digital Doorway .  

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