207021 Measles, mumps, rubella (MMR) and varicella policy in career fire departments: Rationale, implementation and screening results

Sunday, November 8, 2009

Dana C. Drew-Nord, PhD, MS, APRN , School of Nursing, Community Health Systems, Occupational and Environmental Health, University of California, San Francisco, San Francisco, CA
OiSaeng Hong, PhD, RN , School of Nursing, University of California, San Francisco, San Francisco, CA
Stephen Nord, MD , Premier COMP Medical Group, Inc., Pleasanton, CA
The Centers for Disease Control (CDC) recommends that health care workers, including first responders, be immunized against influenza, hepatitis B, MMR and varicella. Many fire departments spend more time and resource providing emergency medical services than fire suppression. However, many departments have not implemented the CDC recommendation. One must understand the risks associated with non-immunity, as well as the costs that can be mitigated by such a policy. Avoidance of workers' compensation claims, third party actions, cross-contamination between care recipients and co-workers, and extended absences from the workplace requiring overtime coverage are benefits from such a policy.

An MMR/Varicella policy must be developed with input and acceptance from the administration and the union. Such policies are readily integrated into existing post-offer and annual physical examinations.

The CDC estimates that only 5-9% of the population would be non-immune to measles and rubella due to historic public health immunization efforts. Findings from two career fire departments in the San Francisco Bay Area revealed high non-immune rates. Of the 262 firefighters (ages 23 to 58) tested, 46.9% were not immune to one or more of the titered diseases. “Measles only” was highest with 19.8%; “mumps only” with 7.3%; “rubella only” and “measles and mumps together” each with 6.5%. “Varicella only” and other disease titer combinations were 1.5% or less of the total.

These findings of high non-immune rates provide significant implications for occupational health practice and policy related to developing and implementing MMR/Varicella polices for career firefighters to protect themselves and their communities.

Learning Objectives:
1.List four benefits to fire departments and communities with the implementation of an MMR/Varicella policy. 2.Describe the steps to designing and implementing an MMR/Varicella policy. 3.Identify the expected level of non-immune status for MMR and varicella.

Keywords: Communicable Disease, Occupational Exposure

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been directly involved for eight years in providing wellness-fitness exams to career fire departments as a primary care/occupational health nurse practitioner. I am in the process of completing my PhD disseration on wellness-fitness and cardiovascular findings in career firefighters.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Premier COMP Medical Group, Inc. Occupational health services Stock Ownership

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.