Document text
National Center for Emerging and Zoonotic Infectious Diseases
EVIDENCE TO RECOMMENDATIONS FOR
CHIKUNGUNYA VACCINE USE AMONG
LABORATORY WORKERS
Susan Hills, MBBS, MTH
CDC Lead , Chikungunya Vaccines Work Group
Arboviral Diseases Branch
Division of Vector -Borne Diseases
Fort Collins, Colorado
ACIP meeting, October 26, 2023
Infections among laboratory workers
At least 44 chikungunya virus infections identified among laboratory
workers worldwide over ~ 50 years1–3
–43 cases overt disease, 1 asymptomatic infection, no deaths
4 disease cases in US laboratorians since chikungunya became notifiable disease in 2015
–One case hospitalized for observation, no deaths
Identified cases underestimate all infections as no formal laboratory surveillance system
1.The Subcommittee on Arbovirus Laboratory Safety of the American Committee on Arthropod -Borne Viruses. Am J Trop Med Hyg 1980;
2.Rusnak JM, et al. J Occup Environ Med 2004; 3. US national arboviral disease surveillance system, 2015 –2022
Routes of transmission
Aerosol
Percutaneous
–Needlestick while working with and
injecting mice
–Forceps prick while dissecting mosquitoes infected with chikungunya virus
Mucosal (possible)
Policy question
Should chikungunya vaccine be recommended for
laboratory staff at risk for chikungunya virus infection?
Laboratory worker Evidence to Recommendations notes
Same GRADE assessment as vaccination for travelers
Considered data on cross -protection from vaccine against
3 genotypes of chikungunya virus
–Only limited data from laboratory studies to confirm cross-
protection
–Chikungunya virus considered single serotype and limited
genotype -specific differences in antigenicity
–No evidence of re -infection in humans with different genotypes
Evidence to Recommendations: Public health problem
Topic Decision Comment
Public health
problemNo, not of public health importance overall•Only occasional US laboratory -acquired
infections reported
•Potential for acute infection with severe polyarthralgia and possible chronic
arthralgia
Values Laboratorians likely think
desirable effects large relative to undesirable effects
No important variability•Scientists will understand risks of disease
and risks and benefits of vaccination
Evidence to Recommendations: Public health problem
Topic Decision Comment
Public health
problemNo, not of public health importance overall•Only occasional US laboratory -acquired
infections reported
•Potential for acute infection with severe polyarthralgia and possible chronic
arthralgia
Values Laboratorians likely think
desirable effects large relative to undesirable effects
No important variability•Scientists will understand risks of disease
and risks and benefits of vaccination
Evidence to Recommendations: Acceptability
Topic Decision Comment
Acceptability Yes, acceptable to key
stakeholders•Acceptable for occupational health directors, laboratory managers, and laboratorians because will improve safety
Resource use Yes, reasonable and efficient allocation of resources•Limited number of staff undertaking research or specific diagnostic work with chikungunya virus
•Small cost to avoid impact and costs of worker becoming infected
Equity Probably increased •If employer offers vaccination, will improve safety for staff and addresses an occupational health issue
Evidence to Recommendations: Resource use
Topic Decision Comment
Acceptability Yes, acceptable to key
stakeholders•Acceptable for occupational health directors, laboratory managers, and laboratorians because will improve safety
Resource use Yes, reasonable and efficient allocation of resources•Limited number of staff undertaking research or specific diagnostic work with chikungunya virus
•Small cost to avoid impact and costs of worker becoming infected
Equity Probably increased •If employer offers vaccination, will improve safety for staff and addresses an occupational health issue
Evidence to Recommendations: Equity
Topic Decision Comment
Acceptability Yes, acceptable to key
stakeholders•Acceptable for occupational health directors, laboratory managers, and laboratorians because will improve safety
Resource use Yes, reasonable and efficient allocation of resources•Limited number of staff undertaking research or specific diagnostic work with chikungunya virus
•Small cost to avoid impact and costs of worker becoming infected
Equity Probably increased •If employer offers vaccination, will improve safety for staff and addresses an occupational health issue
Evidence to Recommendations: Feasibility
Topic Decision Comment
Feasibility Yes, feasible •Likely build on existing occupational
health program
Balance of consequences
o Undesirable
consequences clearly outweighdesirable consequences in most settingso Undesirable consequences probably outweigh desirable consequences in most settingso The balance between desirable and undesirable consequences is
closely balanced or uncertaino Desirable
consequences
probably
outweigh
undesirable
consequences
in most settingso Desirable
consequences clearly outweigh undesirable consequences in most settingso There is insufficient evidence to determine the balance of consequences
Draft recommendation
Chikungunya vaccination is recommended for laboratory
workers with potential for exposure to chikungunya virus
Information accompanying recommendations
Local biosafety committee should undertake risk assessment
of potential for chikungunya virus exposure considering
–Type of work to be performed
–Biosafety level at which work is being conducted
Vaccination not necessary for workers handling routine clinical samples
Draft recommendation
Chikungunya vaccination is recommended for laboratory
workers with potential for exposure to chikungunya virus