Hepatitis B Vaccination Laws for Healthcare Facilities: A State-by-State Survey

Some healthcare facilities must, by state law, assess, offer or require hepatitis B (HepB) vaccination for their patients and staff. This CDC survey — one of a series on vaccination requirements in healthcare facilities — maps those laws and their exemptions. The laws were collected from WestlawNext in January 5–20, 2016.

Why hepatitis B

• The disease: the hepatitis B virus (HBV) attacks the liver and can cause lifelong infection, cirrhosis, liver cancer, liver failure and death. It spreads when blood, semen or another body fluid from an infected person enters someone who isn't infected.
• Who should be vaccinated: the Advisory Committee on Immunization Practices (ACIP) recommends a first dose at birth and a completed series by 6–18 months, plus vaccination for older children and teens who missed it. CDC recommends HepB vaccination for children and adults — see Hepatitis B Vaccination.
• Healthcare workers: HBV has long been an occupational risk. It stays infectious on surfaces for long periods and can spread without visible blood, mostly through contaminated needles, syringes and other sharps. Many exposures go unnoticed, and even recognized ones often go without post-exposure treatment. In U.S. studies in the 1970s, healthcare workers had about 10 times the HBV infection rate of the general population.
• Progress: in 2011, ACIP reaffirmed that unvaccinated or partly vaccinated workers at reasonably anticipated risk of blood or body-fluid exposure should be vaccinated before exposure. From 1983 to 2010, HBV infections among healthcare workers fell about 98% — from an estimated 17,000 acute infections to 263 — thanks largely to routine pre-exposure vaccination and better infection control.

What the laws can require

Exemptions may be medical, religious, philosophical or other. Even where a law is silent, people with a medical contraindication are likely not required to be vaccinated. Here, "vaccination laws" include laws requiring proof of immunity.

Headline results

• 17 states have HepB vaccination or immunity requirements for healthcare workers; six have them for patients.
• By setting: 10 states for hospitals, 10 for long-term care facilities, 14 for ambulatory (outpatient) care facilities.
• A single law can cover several settings and populations — some states require hospitals to vaccinate newborns only, while requiring nursing homes to ensure at-risk employees are fully vaccinated.

By setting (number of states)

Examples from the laws

Hospitals — facilities providing inpatient, diagnostic and therapeutic care around the clock (24 hours a day):

• Oklahoma: birthing hospitals must ensure HepB vaccine is given to all live infants within twelve hours of birth; parents may refuse for medical reasons or personal beliefs.
• District of Columbia: newborns get the vaccine before discharge, unless a parent objects on religious grounds in writing or the mother tested negative for HBsAg (hepatitis B surface antigen, a protein on the virus's surface; a negative test means she isn't infectious).
• Texas: staff must make the vaccine available to any susceptible patient.
• Alaska: employee health programs must require evidence of HepB immunization, across hospital types.
• Arkansas: hospitals must plan to offer vaccination to all workers exposed to blood and other potentially infectious fluids.
• Rhode Island: evidence of immunity is required of all healthcare workers, except those with a medical exemption.
• Maine: designated facilities must make the vaccine available to at-risk workers; employees may claim a sincere religious or philosophical exemption in writing.

Long-term care — nursing homes and similar facilities serving people who can't manage independently:

• Illinois: nursing facilities must offer vaccination to susceptible residents within 10 days of admission and record whether each resident was immunized.
• New Jersey: facilities must routinely offer the vaccine to all employees.
• Texas: nursing facilities must offer at-risk employees the vaccine within 10 days of employment.
• South Carolina: direct-care staff handling blood, body fluids or sharps must be vaccinated unless they were offered the series and declined.
• Washington: vaccination isn't required for employees already fully vaccinated or with medical reasons not to.

Ambulatory care — outpatient facilities such as birth centers, dialysis centers and surgical centers:

• Ohio: dialysis centers must offer the vaccine to all susceptible patients and staff.
• New York: facilities with comprehensive HIV programs must screen and immunize patients against preventable infections, including hepatitis B.
• Texas: end-stage renal disease facilities must offer the vaccine to unvaccinated, susceptible new staff.
• District of Columbia: maternity-center staff exposed to blood must show full immunization.
• Kansas: birth-center workers handling blood must be immunized or document a written refusal.
• Washington: employee records must include HepB vaccination status and dates.

About this survey

Developed by CDC's Public Health Law Program with CDC's National Center for Immunization and Respiratory Diseases. It is not legal advice; its findings are the authors' and not necessarily CDC's official views. State-by-state tables are in the appendices and a combined PDF.

Sources

Based on "Menu of State Healthcare Facility Hepatitis B Vaccination Laws," Public Health Law Program, Centers for Disease Control and Prevention; a work of the United States government in the public domain.