Staff Declining MMR Immunisation and exposure considerations

Guidance for practices in regard of staff members who decline to be vaccinated

>>> Download a copy of this guidance (to access the flowchart links) here

Background

Since 1 October 2023, there has been an increase in measles cases across England though so far not many in the south of England. Practices may wish to prepare for a local increase in cases and part of that could be to ensure all staff are vaccinated appropriately. Practices should already have a policy regarding staff vaccinations/immunisations, and you may wish to review yours and update it if needed.

The UK Health Security Agency and NHS England issued a letter to the NHS in October 2023 about preparing for measles resurgence in England. Additionally, both this letter and the Green Book of Immunisation: Chapter 12 are clear that all staff should be up to date with their routine immunisations, especially MMR. All frontline healthcare workers should have satisfactory evidence of protection against measles (documented administration of vaccines or IgG levels) to protect both themselves and their patients. If there is any doubt about vaccination status, staff are encouraged to have the MMR.

If a practice has a member of staff who declines to be vaccinated the practice “must record a clear rationale for the decision […] this should include an appropriate risk assessment”, that risk assessment should always be tailored to that person's duties and the likelihoods of harm caused by the refusal. NHS England » Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings is a useful document to help you design a robust risk assessment to use in your own practice. Do not forget to utilise your Occupational Health provider and, if you feel training would be useful, organisations such as Practice Index often offer modules to meet that need.

Although your risk assessment can be locally designed, you may wish to consider the following:
Identification of risk factors (for example that measles is highly transmissible)
The level of risk (for example consider whether unvaccinated clinicians are a higher risk to patients than unvaccinated admin staff)
Mitigation measures (for example isolation for unvaccinated clinicians if exposed, reassign unvaccinated workers to non-direct patient roles)
Decision on continued work (for example, should unvaccinated clinicians be suspended until vaccinated)

This list is in no way exhaustive.