SummaryA structured questionnaire was administered to health-care workers (HCWs). The HCWs were also screened for measles, rubella, mumps, and varicella (MMRV) using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive (cost difference: €24,385) for varicella, although vaccination without screening was cheap (cost difference: €5693) for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs (2–7%) would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable

Alp, E

Cevahir, F

Demiraslan, H

Doganay, M

Gokahmetoglu, S

English

PubMed

Alp, Emine

Cevahir, Fatma

Gökahmetoglu, Selma

Demiraslan, Hayati

Doganay, Mehmet

Elsevier - Publisher Connector 

Prevaccination screening of health-care workers for immunity to measles, rubella, mumps, and varicella in a developing country: What do we save? 

E Alp

F Cevahir

S Gokahmetoglu

H Demiraslan

M Doganay

Crossref

BMC Proceedings

Prevaccination screening of health care workers for immunity to measles, rubella, mumps and varicella in a developing country. What do we save?

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Prevaccination screening of health care workers
for immunity to measles, rubella, mumps and
varicella in a developing country. What do
we save?
E Alp*, F Cevahir, S Gokahmetoglu, H Demiraslan, M Doganay
From International Conference on Prevention & Infection Control (ICPIC 2011)
Geneva, Switzerland. 29 June – 2 July 2011
Introduction / objectives
Immunity to measles, rubella, mumps, and varicella
(MMRV) is an important part of infection control
among healthcare-workers (HCWs).To evaluate the cost
effectiveness of prevaccination screening of HCWs
against MMRV.
Methods
A structured survey form,including data of age, gender,
job category, length of employment, history of MMRV
infections and status of MMRV vaccinations, was
applied to HCWs.Serologic screening for MMRV was
performed on HCWs using enzyme-linked immunosor-
bent assay (EIA).The cost of each test for MMR was
€2.5 and €5 for varicella.In a cost-effectiveness analysis,
MMR®(supplied by Ministry of Health from Serum
Institute of India for €2.5) and Varilrix®(GlaxoSmithK-
line-cheapest vaccination in the marketplace-€25) vac-
cines were used.
Results
One thousand and two hundred fifty-five HCWs were
tested.Of these, 798 (64%) were female and the age ran-
ged from 19 to 60 years (median 30).The median length
of employment was 5 (≤1-47 years).Of the employees
examined, 94% were immune to measles, 97% to rubella,
90% to mumps, 98% to varicella.The cost for screening
and then vaccination was €9942.5 for MMR and €6815
for varicella.The cost for vaccination without screening
was €2422.5 for MMR and €15900 for varicella.The cost
of vaccination without screening was significantly
expensive (cost difference: €9085) for varicella, however
cheap for MMR (cost difference: €7520).
Conclusion
For the immunization against MMRV in HCWs, immu-
nity rate, screening and vaccine cost and side effects
should be considered in developing countries. Cheaper
vaccines may be cost effective for vaccination without
screening, however prescreening may be rule out side
effects.
Disclosure of interest
None declared.
Published: 29 June 2011
doi:10.1186/1753-6561-5-S6-P277
Cite this article as: Alp et al.: Prevaccination screening of health care
workers for immunity to measles, rubella, mumps and varicella in a
developing country. What do we save? BMC Proceedings 2011 5(Suppl 6):
P277.
Erciyes University, Kayseri, Turkey
Alp et al. BMC Proceedings 2011, 5(Suppl 6):P277
http://www.biomedcentral.com/1753-6561/5/S6/P277
© 2011 Alp et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Summary: A structured questionnaire was administered to health-care workers (HCWs). The HCWs were also screened for measles, rubella, mumps, and varicella (MMRV) using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive (cost difference: €24,385) for varicella, although vaccination without screening was cheap (cost difference: €5693) for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs (2–7%) would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable. Keywords: Immunization, Healthcare worker, Vaccine, Vaccination, Cos

Emine Alp

Fatma Cevahir

Selma Gökahmetoglu

Hayati Demiraslan

Mehmet Doganay

Directory of Open Access Journals

Journal of Infection and Public Health

Prevaccination screening of health-care workers for immunity to measles, rubella, mumps, and varicella in a developing country: What do we save?

A structured questionnaire was administered to health-care workers (HCWs). The HCWs were also screened for measles, rubella, mumps, and varicella (MMRV) using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive (cost difference: €24,385) for varicella, although vaccination without screening was cheap (cost difference: €5693) for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs (2–7%) would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable

ALP MEŞE, Emine

DOĞANAY, Mehmet

GÖKAHMETOĞLU, Selma

DEMİRASLAN, Hayati

Erciyes University - AVESIS

Alp E

Cevahir F

Gokahmetoglu S

Demiraslan H

Doganay M

JP
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dournal of Infection and Public Health (2012) 5, 127—132
revaccination  screening  of  health-care  workers
or  immunity  to  measles,  rubella,  mumps,  and
aricella  in  a  developing  country:  What  do  we
ave?
mine  Alpa,b,∗,  Fatma  Cevahirb,  Selma  Gökahmetogluc,
ayati  Demiraslana,  Mehmet  Doganaya
Erciyes  University,  Faculty  of  Medicine,  Department  of  Infectious  Diseases  and  Clinical  Microbiology,
ayseri, Turkey
Erciyes  University,  Faculty  of  Medicine,  Infection  Control  Committee,  Kayseri,  Turkey
Erciyes  University,  Faculty  of  Medicine,  Department  of  Microbiology,  Kayseri,  Turkey
eceived  27  July  2011;  received  in  revised  form  3  November  2011;  accepted  4  November  2011
KEYWORDS
Immunization;
Healthcare worker;
Vaccine;
Vaccination;
Cost
Summary  A  structured  questionnaire  was  administered  to  health-care  workers
(HCWs).  The  HCWs  were  also  screened  for  measles,  rubella,  mumps,  and  varicella
(MMRV)  using  serological  methods.  One  thousand  two  hundred  and  ﬁfty-ﬁve  HCWs
were  tested.  Of  the  HCWs  examined,  94%  were  immune  to  measles,  97%  to  rubella,
90%  to  mumps  and  98%  to  varicella.  The  positive  predictive  values  of  histories  of
measles,  mumps,  rubella  and  varicella  were  96%,  93%,  100%  and  98%,  respectively.
The  negative  predictive  values  of  histories  of  measles,  mumps,  rubella  and  varicella
were  13%,  17%,  5%  and  2%,  respectively.  The  cost  of  vaccination  without  screening
was  signiﬁcantly  more  expensive  (cost  difference:  D24,385)  for  varicella,  although
vaccination  without  screening  was  cheap  (cost  difference:  D5693)  for  MMR.  Although
the  use  of  cheaper  vaccines  supports  the  implementation  of  vaccination  programs
without  screening,  the  cost  of  vaccination  should  not  be  calculated  based  only  on  the
direct  costs.  The  indirect  costs  associated  with  lost  work  time  due  to  vaccination  and
its  side  effects  and  the  direct  costs  of  potential  side  effects  should  be  considered.
 Presented at the 1st International Conference on Prevention and Infection Control, 29 June—2 July 2011, Geneva, Switzerland.
CPIC11-1340.
∗ Corresponding author at: Erciyes University, Faculty of Medicine, Department of Infectious Disease, 38039 Kayseri, Turkey.
el.: +90 5363146430; fax: +90 3524375273.
E-mail address: ealp@erciyes.edu.tr (E. Alp).
876-0341/$ — see front matter © 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
oi:10.1016/j.jiph.2011.11.003
128  E.  Alp  et  al.
However,  if  prescreening  is  not  conducted,  some  HCWs  (2—7%)  would  be  unprotected
against  these  contagious  illnesses  because  of  the  unreliability  of  their  MMRV  history.
In  conclusion,  the  screening  of  HCWs  before  vaccination  continues  to  be  advisable.
dulaziz  University  for  Health  Sciences.  Published  by  Elsevier
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This  study  included  1255  HCWs,  of  whom  611  (49%)
were nurses,  336  (27%)  were  cleaning  staff,  241
(19%) were  patient  care  staff  and  67  (5%)  were  other©  2011  King  Saud  Bin  Ab
Ltd.  All  rights  reserved.
Introduction
Measles,  rubella,  mumps,  and  varicella  (MMRV)
are highly  contagious  diseases,  and  pose  a great
risk to  health-care  workers  (HCWs).  Immunity  to
MMRV is  an  important  part  of  infection  control
among HCWs,  both  for  their  own  health  and  for
the health  of  patients.  The  Centers  for  Disease
Control and  Prevention  (CDC)  strongly  recom-
mends the  immunization  of  HCWs  against  MMRV
infections.  Pre-vaccination  screening  or  mass  vac-
cination  can  be  implemented  according  to  the
cost-effectiveness  analysis  for  each  healthcare
facility [1].  Most  studies  have  demonstrated  that
serological  screening  before  vaccination  is  cost
effective  [2—4].
However,  cheap  vaccines  are  now  produced  in
India, and  these  vaccines  are  now  being  supplied  by
the Turkish  Government’s  Ministry  of  Health.  The
recommendation  to  vaccinate  HCWs  without  pre-
screening  depends  on  their  MMRV  history.  In  this
study, we  aimed  to  evaluate  the  cost  effective-
ness and  beneﬁt  of  the  prevaccination  screening  of
HCWs for  immunity  to  MMRV  provided  privately  or
by the  government’s  Ministry  of  Health.
Materials and methods
Institution
This  study  was  conducted  at  the  Erciyes  Univer-
sity Hospital,  a  referral,  tertiary  hospital  with  1300
beds in  the  Central  Anatolian  region  of  Turkey.  In
2010, this  hospital  had  758  nurses,  406  patient  care
staff members  and  368  cleaning  staff  members.
An Infection  Control  Committee  was  established  in
1997, and  a  training  program  concerning  health-
care workers’  health  and  immunization  has  been
in place  since  2000.  However,  a  national  vaccina-
tion program  providing  MMRV  vaccinations  for  HCWs
was not  established  by  the  Ministry  of  Health  until
January  2011.  Prior  to  2011,  HCWs  were  vaccinated
privately.
s
r
ltudy design
 structured  questionnaire,  including  data  on
ge, gender,  number  of  siblings,  childhood  resi-
ence location,  profession,  department,  length  of
mployment,  history  of  MMRV  infections  and  sta-
us of  MMRV  vaccinations,  was  administered  to
CWs between  December  2010  and  April  2011.
he hematology,  oncology,  infectious  diseases,  and
ediatric departments;  the  bone  marrow  trans-
lantation  unit;  and  the  laboratories  were  deﬁned
s areas  of  risk  [4].  Serological  screening  for
MRV was  performed  on  HCWs  using  an  enzyme-
inked immunosorbent  assay  (EIA-EUROIMMUN®-
ermany).  The  cost  of  each  MMR  test  was  D2.5,  and
he cost  of  each  varicella  test  was  D5.  The  MMR®
supplied  by  the  Ministry  of  Health  from  the  Serum
nstitute  of  India  for  D2.5)  and  Varilrix® (Glaxo-
mithKline, the  cheapest  commercially  available,
t D25)  vaccines  were  used  for  the  cost  analysis.  In
 cost-effectiveness  analysis,  only  the  cost  of  the
IA and  vaccines  were  included.  Other  direct  and
ndirect medical  or  non-medical  costs  could  not  be
valuated. Because  the  CDC  recommends  two  doses
f vaccine  for  HCWs,  the  total  vaccination  price  was
alculated  for  two  doses.
tatistical analysis
ata  were  analyzed  using  SPSS  version  15.0
Chicago, IL,  USA).  Univariate  and  multiple  binary
ackward  logistic  regression  analyses  were  used  to
nvestigate the  factors  related  to  the  immunity  of
CWs. A  p-value  <0.05  was  considered  signiﬁcant.
esultstaff. Of  these,  798  (64%)  were  female.  The  ages
anged  from  19  to  60  years  (median  30).  The  median
ength of  employment  was  5  years  (≤1—47  years).
Prevaccination  screening  of  health-care  workers  for  immunity  to  measles,  129
Table  1  The  validity  of  history  for  MMRV  disease  or  vaccination.
Measles  Mumps  Rubella  Varicella
Sensitivity  (%) 80  78  67  83
Speciﬁcity  (%)  47  45  100  20
PPV  (%)  96  93  100  98
NPV  (%) 13 17 5 2
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uPPV, positive predictive value; NPV, negative predictive value.
f  the  employees  examined,  94%  were  immune  to
easles,  97%  to  rubella,  90%  to  mumps  and  98%
o varicella.  The  validity  of  the  history  of  MMRV  is
hown in  Table  1.
In  the  multivariate  analysis,  no  association  was
ound between  immunity  to  varicella  and  age,
ender, number  of  siblings,  childhood  living  area,
rofession,  working  in  a  risky  department  or  length
f employment  (Table  2).  In  the  multivariate
nalysis for  measles,  age  (OR:  1.004,  95%  CI:
.002—1.006)  and  male  sex  (OR:  1.983,  95%  CI:
.172—3.355)  were  associated  with  immunity;  for
ubella, working  in  a  risky  department  (OR:  2.714,
5% CI:  1.405—5.241)  was  associated  with  immu-
ity; and  for  mumps,  female  sex  (OR:  1.591,  95%
I: 1.105—2.290)  was  associated  with  immunity
Tables 3—5).
The  total  cost  of  screening  and  vaccination  was
10,538  for  MMR  and  D7415  for  varicella.  In  con-
rast, the  cost  of  vaccination  without  screening  was
4845 for  MMR  and  D31,800  for  varicella.  The  cost
f vaccination  without  screening  was  signiﬁcantly
e
p
t
Table  2  Characteristics  associated  with  susceptibility  to  v
Factor Univariate
Odds  ratio
Age  0.982  
Length  of  employment  1.015  
Number  of  siblings  1.141  
Gender
Female  1
Male  1.401  
Professions
Others  1
Nurses  1.297  
Patient  care  staff  3.662  
Cleaning  staff  1.672  
Risky  department
Yes 1
No 0.920  
Living  area  in  childhood
Village 1
City 0.235
Town  0.251  ore  expensive  (cost  difference:  D24,385)  for  vari-
ella; however,  vaccination  without  screening  was
heap for  MMR  (cost  difference:  D5693)  (Table  6).
iscussion
CWs  are  at greater  risk  of  MMRV  than  the
eneral population.  MMRV  are  usually  mild  in  pre-
iously healthy  children;  however,  these  diseases
an be  more  severe  and  complicated  in  adults
nd immunosuppressed  patients.  Maintenance  of
mmunity is  an  essential  part  of  prevention  and
nfection-control  schemes,  and  MMRV  vaccination
s strongly  recommended  by  the  CDC  for  HCWs  [1].
owever,  there  is  no  general  agreement  on  the
mmunization  program.  Serological  screening  need
ot be  performed  prior  to  vaccinating  against  MMRV
nless  the  health-care  facility  considers  it  cost
ffective.  However,  in  previous  studies,  screening
rior to  vaccination  was  found  to  be  cost  effec-
ive due  to  high  immunity  rates  in  developing
aricella.
 logistic  regression  analysis
 95%  CI
0.930—1.038
0.951—1.083
0.928—1.403
0.577—3.405
0.288—5.832
0.506—26.495
0.330—8.467
0.378—2.236
0.031—1.771
0.029—2.167
130  E.  Alp  et  al.
Table  3  Characteristics  associated  with  susceptibility  to  measles.a
Factor  Univariate  logistic  regression
analysis
Multiple  logistic  regression
analysis  (backward)
Odds  ratio  95%  CI  Odds  ratio  95%  CI
Length  of  employment  1.157  1.088—1.231
Age  1.004  1.002—1.006  1.004  1.002—1.006
Number  of  siblings  1.172  1.041—1.319
Gender
Female 1 1
Male 1.755 1.042—2.954  1.983  1.172—3.355
Professions
Others 1
Nurses  0.755  0.263—2.166
Patient  care  staff 1.206  0.376—3.869
Cleaning  staff 1.266  0.410—3.913
Risky  department
Yes 1
No 1.116 0.687—1.813
Living  area  in  childhood
Village 1
City 1.121 0.609—2.064
Town 1.678 0.744—3.785
ere,
a
e
pa Variables included in multiple logistic regression analysis w
countries  [2,3,5].  In  this  study,  the  immunity  rate  to
MMRV was  high  among  HCWs  (90—97%).  Despite  this
high seropositivity,  vaccination  with  cheap  vaccines
without  screening  seemed  cost  effective.  In  a  pre-
vious study  from  Turkey,  Celikbas  et  al.  [2]  found
the immunity  rate  for  MMRV  to  be  92—98%.  They
used the  cheapest  vaccine  prices  on  the  market
a
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Table  4  Characteristics  associated  with  susceptibility  to  ru
Factor Univariate  logistic  regression
analysis
Odds  ratio  95%  CI  
Age  0.996  0.951—1.0
Length  of  employment  0.985  0.941—1.0
Number  of  siblings  0.981  0.848—1.1
Gender
Female  1
Male  1.566  0.751—3.2
Professions
Others  1
Nurses  1.068  0.241—4.7
Patient  care  staff  0.705  0.151—3.2
Cleaning  staff  1.242  0.258—5.9
Risky  department
Yes 1  
No  2.714  1.405—5.2
Living  area  in  childhood
Village 1
City 1.393  0.618—3.1
Town 2.630  0.780—8.8 length of employment, age, number of siblings, gender.
nd  found  screening  prior  to  vaccination  to  be  cost
ffective.  Additionally,  in  their  analyses,  they  pro-
osed that  the  vaccination  of  HCWs  for  MMR  without
ntibody  screening  tests  would  be  cheaper  if  the
roportion  of  immune  HCWs  was  <78%.  The  differ-
nce in  the  ﬁndings  is  probably  due  to  the  extremely
heap vaccines  from  India,  at  D2.5  per  dose,  that
bella.
Multiple  logistic  regression
analysis  (backward)
Odds  ratio  95%  CI
43
31
34
65
26
97
85
1
41  2.714  1.405—5.241
39
69
Prevaccination  screening  of  health-care  workers  for  immunity  to  measles,  131
Table  5  Characteristics  associated  with  susceptibility  to  mumps.
Factor  Univariate  logistic  regression
analysis
Multiple  logistic  regression
analysis  (backward)
Odds  ratio  95%  CI  Odds  ratio  95%  CI
Length  of  employment  1.012  0.985—1.039
Age  1.011  0.983—1.041
Number  of  siblings  1.032  0.949—1.122
Gender
Male 1  1
Female 1.591 1.105—2.290  1.591  1.105—2.290
Professions
Others 1
Nurses 1.281 0.583—2.813
Patient  care  staff 0.818  0.359—1.861
Cleaning  staff  1.330  0.582—3.036
Risky  department
Yes 1
No 0.770 0.511—1.161
Living  area  in  childhood
Village 1
City 0.920 0.543—1.553
Town 1 0.530—1.886
Table  6  The  cost  of  vaccination  with  or  without  screening.
Cost  of  screening  +  vaccination
of  susceptible  HCWs
Euro  ($)
Cost  of  vaccination
without  screening
Euro  ($)
Cost  differencea
Euro  ($)
MMRb 1248  ×  2.5  (measles)  +  1244  ×  2.5
(mumps)  +  1247  ×  2.5
(rubella)  +  238  × 5
(vaccination)  =  10,538  (14,437)
969  ×  5  =  4845  (6638)  +5693  (7799)
Varicellac 1243  × 5 +  24  × 50 =  7415
(10,159)
636  × 50  =  31,800  (43,566)  −24,385  (33,407)
a 1 euro = 1.37 American dollars ($).
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nCost of each test was D2.5, cost of MMR vaccine was D5 fo
c Cost of test was D5, cost of varicella vaccine was D50 for 
ere  used  in  our  study.  In  addition,  the  EIA  tests
ere supplied  from  Europe,  and  the  cost  of  each
MR test  was  D2.5.  For  the  varicella  vaccine,  which
as purchased  commercially  at  standard  prices,
re-screening before  vaccination  was  found  to  have
onsiderable  cost  savings.
In this  study,  we  only  calculated  the  cost  of
he vaccines  and  EIA.  Another  limitation  of  this
tudy was  that  we  did  not  create  data  simula-
ions for  the  cost  of  screening  versus  the  cost
f immunizing.  Although  cheaper  vaccines  suggest
hat vaccination  without  screening  is  cost  effec-
ive, the  costs  should  not  be  calculated  based  on
nly the  direct  costs  of  vaccination  itself  (vac-
ine and  its  administration).  The  indirect  costs  of
accination  associated  with  lost  work  time  and
h
w
vo doses.
oses.
ide  effects  of  the  vaccine  and  the  direct  costs  of
otential side  effects  (medical  care  costs  includ-
ng provider  visits,  tests  and  medications)  should
e considered  [3,6].  Mild  adverse  reactions  (fever,
enderness,  redness,  rashes,  etc.)  are  reported  in
pproximately  5—15%  of  those  vaccinated,  whereas
erious  adverse  reactions  (serious  allergic  reaction,
ncephalopathy,  etc.)  are  observed  in  only  one  per
illion doses  administered  [7].  However,  if  pre-
creening  were  not  conducted,  some  HCWs  (2—7%)
ould  be  unprotected  against  these  contagious  ill-
esses because  of  the  unreliability  of  their  MMRV
istories.
The positive  predictive  value  of  MMRV  history
as high,  in  the  range  of  93—100%.  In  other  studies,
aricella  history  had  the  highest  reliability  because
R132  
of  its  easy  diagnosis  by  physicians  or  parents.  The
reliability  of  varicella  history  was  high  in  our  study
(98%), and  the  reliability  of  rubella  history  was  the
highest (100%).
In the  literature,  age  and  working  in  a  risky
department were  found  to  be  important  factors
associated with  seropositivity  [4,8,9].  For  measles,
an association  was  found  between  immunity  and
age, and  for  rubella,  an  association  was  found
in this  study  between  immunity  and  working  in
a risky  department.  No  association  was  found
between immunity  to  MMRV  and  the  number  of  sib-
lings, childhood  living  area,  profession  or  length
of employment.  The  median  length  of  employment
was 5  years,  ranging  from  ≤1  to  47  years.  This
may explain  the  high  immunity  rates  of  HCWs.  In
another study  from  Turkey,  177  medical  students
in their  ﬁfth  year  of  medical  school  were  screened
for various  infectious  diseases.  The  immunity  rates
for measles  (56.5%)  and  varicella  (56.5%)  were
lower than  those  observed  in  this  study,  whereas
the immunity  rates  for  rubella  (96.0%)  and  mumps
(92.1%)  were  high,  as  in  this  study  [10].  There  is  no
information  about  herd  immunity  in  Turkey.  How-
ever, a  national  vaccine  program  for  MMR  began
in 1970,  and  MMR  cases  have  declined  over  the
years.
In conclusion,  immunity  rates  and  the  costs  of
screening,  vaccines  and  side  effects  should  be  con-
sidered in  the  immunization  of  HCWs.  Despite  the
availability  of  cheap  vaccines,  the  prescreening  of
HCWs seems  advisable.
Funding:  No  funding  sources.
Competing  interests: None  declared.
Ethical approval: Not  required.
[
Available  online  at  wwwE.  Alp  et  al.
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Prevaccination screening of health care workers for immunity to measles, rubella, mumps and varicella in a developing country. What do we save?

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