Perspective Open Access
Like 0


Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.


Article metrics loading...

Loading full text...

Full text loading...



  1. Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev. 2000;13(3):385-407.  https://doi.org/10.1128/CMR.13.3.385  PMID: 10885983 
  2. Kuster SP, Shah PS, Coleman BL, Lam P-P, Tong A, Wormsbecker A, et al. Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis. PLoS One. 2011;6(10):e26239.
  3. World Health Organization (WHO). WHO recommendations for routine immunization - summary tables. Geneva: WHO. [Accessed 27 Mar 2018]. Available from: http://www.who.int/immunization/policy/immunization_tables/en/
  4. Centers for Disease Control and Prevention (CDC). Recommended Vaccines for Healthcare Workers. Atlanta: CDC; 2018. Available from: https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html
  5. European Parliament. Parliament resolution (2017/2951(RSP)) of 19 April 2018 on vaccine hesitancy and the drop in vaccination rates in Europe. Official Journal of the European Union. Luxembourg: Publications Office of the European Union, 18.11. 2019:C 390. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:C:2019:390:FULL&from=EN
  6. Council of the European Union. Council Recommendation (ST/14152/2018/REV/1) of 7 December 2018 on strengthened cooperation against vaccine-preventable diseases. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 28.12.2018:C 466. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:C:2018:466:FULL&from=EN
  7. European Parliament. Parliament Directive (2000/54/EC) of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work. Official Journal of the European Union. Luxembourg: Publications Office of the European Union 17.10.2000:L262/21. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32000L0054&from=EN
  8. European Council. Council Directive (2010/32/EU) of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and EPSU (Text with EEA relevance). Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 01.06.2010:L 134/66. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32010L0032&rid=1
  9. Sundell N, Dotevall L, Sansone M, Andersson M, Lindh M, Wahlberg T, et al. Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections. Euro Surveill. 2019;24(17):1900114.  https://doi.org/10.2807/1560-7917.ES.2019.24.17.1900114  PMID: 31039835 
  10. European Centre for Disease Prevention and Control (ECDC). Risk of measles transmission in the EU/EEA, 21 March 2018. Stockholm: ECDC; 2018.Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/Measles-rapid-risk-assessment-European-Union-countries_0.pdf
  11. European Centre for Disease Prevention and Control (ECDC). Risk assessment for seasonal influenza, EU/EEA, 2017-2018 – 20 December. Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/RRA%20seasonal%20influenza%20EU%20EEA%202017-2018-rev_0.pdf
  12. FINLEX. Suomen sosiaali- ja terveysministeriö: Sosiaali- ja terveysministeriön asetus rokotuksista 149/2017. [Decree of the Ministry of Social Affairs and Health on vaccinations]. Helsinki: FINLEX; 2017. Finnish. Available from: https://www.finlex.fi/fi/laki/alkup/2017/20170149
  13. Arbejdstilsynet. Stik- og skæreskader - At-vejledning 10.1.1 – Arbejdstilsynet. [Guidance on risk of sharp injuries]. Copenhagen: Arbejdstilsynet. [Accessed 3 Oct 2018]. Danish. Available from: https://at.dk/regler/at-vejledninger/stik-skaereskader-10-1-1/
  14. Arbejdstilsynet. Bekendtgørelse om biologiske agenser og arbejdsmiljø – Arbejdstilsynet. [Executive Order on biological agents and working environment]. Copenhagen: Arbejdstilsynet. [Accessed 3 Oct 2018]. Danish. Available from: https://at.dk/regler/bekendtgoerelser/biologiske-agenser-arbejdsmiljoe-1652/
  15. Valtioneuvoston asetus terävien instrumenttien aiheuttamien tapaturmien ehkäisemisestä terveydenhuoltoalalla. [Government decree on the prevention of sharps injuries in the healthcare sector]. FINLEX 2013 Finnish.Available from: https://www.finlex.fi/sv/laki/alkup/2017/20170149
  16. FINLEX. Sosiaali- ja terveysministeriön asetus biologisten tekijöiden luokituksesta (921/2010). [Decree of the Ministry of Social Affairs and Health on classification of biological agents: transposition of Directive 2000/54 / EC of the European Parliament]. Helsinki: FINLEX; 2010. Finnish. Available from: https://finlex.fi/fi/laki/alkup/2010/20100921
  17. Arbetsmiljöverket. Arbetsmiljöverkets föreskrifter och allmänna råd 2018:4 om smittrisker. [Provisions on contagious risks from the Swedish Work Environment Authority AFS 2018: 4]. Stockholm: Arbetsmiljöverket; 2018. Swedish. Available from: https://www.av.se/globalassets/filer/publikationer/foreskrifter/smittrisker_afs_2018_4.pdf
  18. Arbeidsdepartementet. Forskrift om utførelse av arbeid, bruk av arbeidsutstyr og tilhørende tekniske krav (forskrift om utførelse av arbeid) (FOR 2011-12-06 nr 1357), §6-12, FOR 2011-12-06 nr 1357. [Regulations concerning the performance of work, use of work equipment and related technical requirements]. Oslo: Arbeidsdepartementet; 2013. Norwegian. Available from: https://lovdata.no/dokument/SF/forskrift/2011-12-06-1357
  19. Ministry of Welfare. Iceland. Act on Health Security and Communicable Diseases, No. 19/1997.:7. Reykjavik: Ministry of Welfare; 1997. Available from: https://www.government.is/library/04-Legislation/Act%20on%20Health%20Security%20and%20Communicable%20Diseases%20as%20amended%202018.pdf
  20. Finnish Ministry of Social Affairs and Health. Tartuntatautilaki 21.12.2016/1227. [Infectious diseases act]. Helsinki: FINLEX. [Accessed 3 Oct 2018]. Finnish. Available from: http://finlex.fi/fi/laki/ajantasa/2016/20161227?search%5Btype%5D=pika&search%5Bpika%5D=21.12.2016
  21. Directorate of Health. Iceland. Dreifibréf 3/2011. Bólusetning heilbrigðisstarfsmanna. [Recommendation no. 3/2011. Vaccination of healthcare professionals]. Reykjavik: Directorate of Health. [Accessed 3 Oct 2018]. Icelandic. Available from: https://www.landlaeknir.is/gaedi-og-eftirlit/heilbrigdisstarfsfolk/dreifibref/nanar/item14859/Dreifibref-nr--3/2011--Bolusetning-heilbrigdisstarfsmanna
  22. Folkehelseinstituttet. Yrkesvaksinasjon Om vaksiner som kan være aktuelle for ulike yrkesgrupper og beskrivelse av ansvarsforholdene som gjelder ved vaksinasjon av arbeidstakere. [Occupational vaccination]. Oslo: Folkehelseinstituttet. [Accessed 12 Oct 2018]. Norwegian. Available from: http://www.fhi.no/nettpub/vaksinasjonsveilederen-for-helsepersonell/yrkesvaksinasjon/yrkesvaksinasjon/
  23. Arbejdstilsynet. Arbejdsrelaterede smitterisici ved hepatitis, meningitis, polio, tetanus og Tickborne Encephalitis (TBE) [Occupational risk of hepatitis, meningitis, poliomyelitis, tetanus and Tickborne Encephalitis (TBE). Copenhagen: Arbejdstilsynet. [Accessed 27 Jan 2021]. Danish. Available from: https://at.dk/media/5967/smitterisici-ved-hepatitis20pdf.pdf
  24. Leino T, Hannu T, Taskinen H, Hovi T. Rokotukset työelämässä. [Occupational health vaccinations]. Helsinki: Finnish Institute of Occupational Health; 2006. Finnish.
  25. Socialstyrelsens. Socialstyrelsens föreskrifter och allmänna råd om ledningssystem för systematiskt kvalitetsarbete (SOSFS 2011:9). [National Board of Health and Welfare’s national guidelines]. Stockholm: Socialstyrelsens; 2011. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/foreskrifter-och-allmanna-rad/2011-6-38.pdf
  26. Alfonsi V, Montaño C, Rota MC, Declich S. Promotion of immunization for health professionals in Europe: State of the art report: Overview of health-care workers immunization status in Europe. Athens: HPro Immune; 2012. Available from: http://www.hproimmune.eu/downloads/HProImmune_State_of-the-art-report.pdf
  27. European Parliament. Parliament Regulation (2016/679) of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation) (Text with EEA relevance). Official Journal of the European Union. Luxembourg: Publications Office of the European Union 04.05.2016:L119/1. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32016R0679&from=EN
  28. Parliamentary ombudsman of Finland. Ombudsman decision 3050/2018 Työnantajan oikeus käsitellä rokotustietoja. [Employer’s right to process vaccination information]. Helsinki: Parliamentary ombudsman of Finland; 2019. Finnish. Available from: https://www.oikeusasiamies.fi/r/fi/ratkaisut/-/eoar/1678/2018

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error