Immunizations for Older Adults: Recommendations for Hospital Volunteers

August 21, 2017 Hunter Zahedi

Many older adults consider volunteering in hospitals, clinics, nursing homes, and other health care facilities. While their risk of being exposed to infectious disease is low, they are considered 'health care workers' by the CDC and state agencies that set policies for immunization practices. Before volunteering, these older adults must receive the proper immunizations for their safety and the safety of others. 

Even volunteers who do not have any direct patient contact must still receive immunizations. Many time, the potential to spread infection comes from contact with surfaces such as doorknobs, books, water pitchers, snacks and snack trays. For people with significantly reduced ability to fight off infection, such as those undergoing chemotherapy or with HIV infection, or people who have lost their spleen, a seemingly mild infection can quickly turn deadly.

Religious objections to vaccines can be valid, but will not be accepted for health care workers. If a person has a religious objection to vaccines, other volunteer opportunities should be sought. An oral history or family recollection of previous immunization is also not considered valid. Without adequate written documentation of immunizations, vaccination should be repeated.

The CDC, the Centers for Disease Control, makes recommendations for the health of the nation to state health departments. States then make the requirements based on those recommendations. In some cases, individual centers are given the option to make standards for their own staff, when the CDC does not have the evidence to require a vaccination or screening.

MMR vaccine is one of those vaccines where older adult volunteers may find that requirements are different from state to state, and even from facilities. This vaccine is a live virus vaccine, and protects against measles, mumps, and rubella. These diseases can leave catastrophic consequences behind, including severe birth defects, brain damage, and infertility. Vaccination started in this country in 1967. It is assumed that people born before that date have naturally acquired immunity.

But because of the dangerous nature of these illnesses, and because we know that immunity wanes with age, many facilities and states require all volunteers to either get an MMR vaccine or take the blood test that provides serological evidence of immunity to rubella.

If the particular state or facility requires MMR vaccine, it is recommended that it be given along with other routine vaccines for the age of the person. If other live virus vaccines are to be given, they either need to be given all together or separated by at least a month. This can be discussed with the health care provider.

Influenza vaccination is required annually, and is not at this time a live vaccine. This requirements for all health care workers is usually not allowed an opt-out.

The Hepatitis B vaccination is a three-shot series that provides immunity to Hepatitis B. With a history of previous shots, the Anti-HBs serological testing can be done to document immunity. For those coming to the US from other countries, the series still needs to be taken or immunity documented. Standards in other countries included a prevention shot of immunoglobulin during outbreaks; that will not confer lasting immunity.

The series of immunizations are given over a six month period with the first two one month apart and the third five months after the second. Some facilities require serological testing after the series to ensure immunity, and if it has not been obtained, a fourth immunization is given. Check with the individual facility to determine if this testing and fourth dose are required.

Of these required immunizations, the MMR is a live vaccine and the others are inactivated vaccines, so they can be all given at the same time.

State requirements for TB skin testing before hospital volunteer opportunities are different in different geographic regions of the country. Some states leave the decision to particular facilities. It is important to determine the appropriate test if any preventive treatments were given out of the country, or if there is a history of a previous positive test.

Hospital and health care volunteering is a wonderful opportunity. Volunteers can prepare themselves with a trip to the primary health care provider before beginning the volunteer opportunity to make sure their immunizations are up to date. For more information, please contact us.

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