Occupational Health requirements for students and applicants to the Faculty of Medicine and Health

Immunisation  

Why do I need immunity?  

What happens with the vaccination?   

Hepatitis B*

Hep B is a disease caused by the Hep B virus. The disease mainly affects the liver.  Hep B is transmitted by exchange of blood or other body fluids.  It is a serious infection, which can be fatal.

You only need a tiny amount of infected blood to come into contract with a cut or wound on your body, or via a needlestick injury, to allow the virus to enter your bloodstream, multiply and cause infection.   

A course of Hep B consists of three vaccines given over a six-month period with the following intervals: 0 (first attendance), 1 month and 6 months.  Sometimes an accelerated course is given which consists of 1st, 2nd and 3rd vaccinations each one month apart, followed by a booster at 12 months.

Both courses are followed by a blood test conducted after 8 weeks of completion of the course.  This blood test is to check whether you have antibodies to the virus.  You will not be fully protected against Hep B until you have fully completed the course of vaccination.  It is therefore important that you attend all vaccination appointments.   

Measles, Rubella and Mumps (MMR)  

Measles is spread by airborne or droplet transmission.  Individuals are infectious from the beginning of the prodromal period (when the first symptom appears) to four days after the appearance of the rash.  It is one of the most highly communicable infectious diseases.

The most common complications of measles infection are otitis media, pneumonia, diarrhoea and convulsions. Other, rarer complications include encephalitis and subacute sclerosing panencephalitis (SSPE). The case fatality ratio for measles is age related is high in children under one year of age, lower in children aged one to nine years, and rises again in teenagers and adults. Complications are more common and more severe in poorly nourished and/or chronically ill children, including those who are immunosuppressed.   
 
Rubella is a mild febrile rash illness caused by Rubella virus and is transmitted from person to person via droplets (the virus is present in throat secretions).  It can affect anyone who is not protected.  Rubella infection of the foetus may have severe consequences on the development of baby’s organs, which may result in birth defects or problems at a later stage in life.  The type of complications may vary in nature and severity, depending on the stage of pregnancy when the infection occurred.  Complications affect 85 out of 100 babies whose mothers had rubella just before or at the beginning of the pregnancy.  Complications include deafness, cataracts, heart defects, brain disorders, intellectual disability, bone alterations, liver and spleen damage.  

We need to see documentary evidence of a blood test demonstrating you have immunity to measles and rubella or evidence of receiving two MMR vaccinations (this can generally be obtained through your GP practice).

If you are immune to rubella and measles you are considered likely to be immune to mumps and therefore we do not need to screen you for mumps.

Everyone is entitled to receive two doses of MMR vaccine, as it is part of the national Public Health schedule for immunisations. Therefore, you may choose to attend your GP practice to obtain these vaccinations in advance of enrolment.  The GP should not charge you for this service.

Students that do not have immunity to measles or Rubella will require two vaccines given at one-month intervals. You cannot start placement until you have had at least one dose.  Further blood tests are not required following vaccination.   

Varicella (Chickenpox) 

You must be immune to chickenpox as it is important to protect you and patients from this.  Patients who are most at risk of the complications of chickenpox are elderly people, new-borns and infants whose mothers never had chickenpox or the vaccine, pregnant women who haven’t had chickenpox or the vaccine, those who are immunosuppressed, for example those taking medication that suppresses their immune system, having cancer treatment, or those who have diseases such as HIV.   
 
 
 

Students that do not have immunity to chickenpox will require two vaccines given at one month intervals.  You cannot start placement until you have had at least ONE dose.  Further blood tests are not required following vaccination.

We need to have a clear history that you have had chickenpox OR a copy of a blood test result demonstrating you have immunity or evidence of vaccination.  Students from a tropical or subtropical climate will need to be screened for chickenpox if no documentary evidence is provided.  If you have no evidence of immunity we will take a blood test to ascertain this.  We will notify you if you need vaccinations because you are not immune.

Pertussis:  

Midwifery and Paediatric nurses only  

From July 2019, Midwifery students and Children’s Nursing students who have not received a Pertussis containing vaccine in the last 5 years must receive a pertussis containing vaccination booster.  These students are likely to work with women in the last month of pregnancy and likely to have close and/or prolonged clinical contact with severely ill young infants. 

Students who do not have evidence of a pertussis vaccine available therefore eligible students will receive a single diphtheria/tetanus/3 or 5 component acellular pertussis (depending on vaccine brand)/inactivated polio vaccine. 

Human tuberculosis (TB)** 

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.  

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

BCG is recommended for unvaccinated, tuberculin-negative healthcare worker (HCW), who has either direct contact with TB patients or with potentially infectious clinical materials or derived isolates. We need to ensure you are provided with some protection against TB whilst on your clinical placement. Vaccination does not necessarily make you immune but provides you with some protection; we cannot say how much and for how long, but it is thought to be around fifteen years to a lifetime in some cases. 

We will be looking for evidence of a BCG scar (likely to be on your left upper arm) or evidence from your GP that you have had the BCG vaccination.

All students will be required to complete a TB screening questionnaire. This form will help us to identify which students may require a Quantiferon blood test.

If you do not have a BCG scar we will arrange for you to have either a Mantoux skin test or a  

Quantiferon blood test. If you have recently moved to the UK from a country with high rates of TB or have signs and symptoms of TB we will arrange a Quantiferon test to check for infection. The results of the tests will help us decide if you need to have a BCG vaccination.  

IMPORTANT: If you need a Mantoux test we will inform you of the date of your two appointments.  

There will be an appointment for the test and a second for the nurse to check the result of the test 48 hours later and, where appropriate give you a BCG vaccination. You MUST attend both  appointments. Failure to attend Mantoux appointments is one of the main reasons why students miss the deadline for being cleared for placement. We cannot arrange a one-off Mantoux appointment as the vaccine is only available in a multi-dose vial: we arrange Mantoux clinics when many students requiring the test can attend on the same date. It is therefore extremely important that you attend the dates that you are given and do not miss them. 

Pertussis: Midwifery and Paediatric nurses only 

From July 2019, Midwifery students and Children’s Nursing students who have not received a Pertussis containing vaccine in the last 5 years must receive a pertussis containing vaccination booster.  These students are likely to work with women in the last month of pregnancy and likely to have close and/or prolonged clinical contact with severely ill young infants.

Students who do not have evidence of a pertussis vaccine available therefore eligible students will receive a single diphtheria/tetanus/3 or 5 component acellular pertussis (depending on vaccine brand)/inactivated polio vaccine.