Vaccine-preventable Diseases in The Dental Arena

In a recent review article published in the journal Dental Clinics of North America, Leslie R. Halpern, DDS, MD, PhD, MPH, from Meharry Medical College, Nashville, Tennessee, highlights vaccine-preventable diseases that pose a high risk in the dental healthcare setting.

Noting the global increase in transmissible vectors of infectious diseases, Dr. Halpern emphasizes that oral healthcare professionals are at high risk for transmission of significant bacterial and viral microorganisms, in particular because of their encounters with sharp instruments. “[D]entists experience puncture wounds by needles more than any other healthcare specialist,” she writes. However, studies continue to show that many dentists still do not use personal protective equipment to protect against exposure to infections.

Studies have also highlighted a low awareness of vaccine-preventable diseases among dental practitioners. Because several vaccine-preventable diseases are frequently transmitted in the dental care setting, a significant need exists to improve immunization by and among oral healthcare practitioners, to prevent spread of disease within communities.

Indeed, Dr. Halpern emphasizes that every dental practitioner should be immunized against important vaccine-preventable diseases throughout their oral healthcare career. In particular, the Centers for Disease Control and Prevention (CDC) recommend that dentists, as well as all other healthcare practitioners, receive the following vaccines:

• Hepatitis B: A 3-dose series if previously unvaccinated, followed by serology 1 to 3 months after the third dose to measure protective antibody titers.
• Influenza: One dose of vaccine annually.
• Measles, mumps, rubella (MMR): Clinicians born in 1957 or later without serologic evidence of immunity or previous vaccination should receive 2 doses of MMR vaccine, 4 weeks apart. Clinicians born before 1957 are considered to have been exposed to measles, mumps, and rubella. However, 2 doses of MMR vaccine should be considered for unvaccinated clinicians born before 1957 without evidence of disease or immunity to measles and/or mumps; similarly, 1 dose of vaccine should be considered for clinicians with no evidence of disease or immunity to rubella.
• Meningococcal: Clinicians who are routinely exposed to isolates of Neisseria meningitides should receive both MenACWY and MenB vaccines. They should also receive a booster with MenACWY every 5 years if risk of exposure continues.
• Tetanus, diphtheria, pertussis (Tdap): One dose of Tdap should be given to all clinicians who have not previously received it, and to pregnant clinicians with each pregnancy (see below). Td boosters should be given every 10 years thereafter.
• Varicella zoster (chickenpox): Clinicians without serologic evidence of immunity, previous vaccination, or verification of a history of varicella or herpes zoster (shingles) by a healthcare provider, should receive 2 doses of varicella vaccine, 4 weeks apart.

In addition, specific vaccines that are recommended for immunocompromised oral healthcare practitioners include the polysaccharide vaccines such as Haemophilus influenza type B and pneumococcal vaccines.

According to Dr. Halpern, “[C]ontinuing education that focuses on vaccine-preventable diseases will increase vaccine awareness and decrease the transmission of infectious diseases within the oral health practice setting.”

Further evaluation of vaccine effectiveness as a preventive strategy in the dental healthcare arena is also needed to develop an algorithm for immunization that centers on the oral healthcare practitioner, she concludes.