Potential Infectious Disease Exposures in Municipal Operations

See the accompanying model document below.

This content conveys general information. Do not use it as a substitute for legal advice; consult your attorney for advice concerning specific situations.

The League of Minnesota Cities Insurance Trust (LMCIT) frequently receives questions about infectious diseases in the workplace, and which vaccinations are legally required for various city employee groups including wastewater operators, public works staff, parks and recreation employees, lifeguards, and emergency services personnel. This resource outlines information cities need to know about preventing and dealing with infectious diseases in city workers.

What are infectious diseases?

Infectious diseases are illnesses caused by bacteria, viruses, fungi, or parasites that can be spread from person to person or through contact with contaminated surfaces, bodily fluids, or the environment. City employees may be exposed to infectious diseases while performing job duties that involve close contact with the public, working in confined spaces, handling wastewater or waste materials, providing emergency medical care, or responding to incidents involving blood or other potentially infectious materials.

Required vaccine — hepatitis B

The only vaccination required by law is the hepatitis B vaccine, as mandated by OSHA under 29 CFR 1910.1030. This requirement applies only to employees who are at risk of occupational exposure to bloodborne pathogens as part of their regular job duties or assigned tasks. The employer is required to pay for this three-step vaccination series. The employer must also pay for the surface antigen testing post-vaccination series when it is required, such as for public safety employees.

What job groups need the hepatitis B vaccine?

For municipalities, the job groups required to have the hepatitis B vaccine typically include emergency services personnel — police, fire, medical responders, and lifeguards — who are at risk of contact with bloodborne pathogens as part of their regular job duties. In contrast, wastewater operators, public works, parks and recreation staff, and similar roles are not considered to have routine occupational exposure to bloodborne pathogens, therefore generally do not require the vaccine.

Can an employee decline the hepatitis B vaccine?

The employee has the right to decline the hepatitis B vaccination series. In that case, there is a required hepatitis B vaccine declination form (doc) employees must sign as part of the OSHA standard. If the employee decides later that he or she would like to receive the hepatitis B vaccination series, the employer must provide this at no cost to the employee for those employees in job classifications that are at risk of exposure to bloodborne pathogens as a part of their regular job duties or assigned tasks.

Should the hepatitis B vaccine be offered after an exposure incident?

The hepatitis B vaccine must be offered after an exposure incident as part of OSHA’s required post‑exposure medical follow‑up. If an employee who has not received the hepatitis B vaccination series sustains an injury or exposure to blood or potentially infectious body fluids, the treating medical provider will determine whether the vaccination series is recommended. The city should have a process in place to ensure any employee — public safety or otherwise — is routed promptly to appropriate medical evaluation and care.

Other vaccines to consider (not required)

Influenza

It may make sense to offer the annual influenza vaccine to emergency services employees. Not only do you want to keep this group of people healthy so they are available to work with the public, but you also want to reduce the chance of them transmitting the influenza virus to the sick, elderly, or other individuals with weakened immune systems.

Employers may “campaign” for employees to get their annual influenza vaccination as part of their personal medical benefits plan. To encourage participation, the employer may also work with its health care provider network to set up on-site vaccination clinics at the workplace.

Employees are not required to get the vaccination, and the city is not required to pay for it.

Hepatitis A

Cities sometimes wonder whether the hepatitis A vaccine is recommended for wastewater operators or employees that may respond to natural disasters where the environment is contaminated with raw sewage. It is not. The hepatitis A virus cannot live in the harsh environment of the sewer system or out in the elements of a natural disaster. According to the Centers for Disease Control and Prevention (CDC), there has never been a case of occupationally related hepatitis A in the United States for wastewater operators or for those responding to natural disasters such as Hurricane Katrina.

Meningitis

The meningitis vaccination is recommended where there are congregate living conditions such as in a correctional facility or a college dormitory. These are not (typically) city type operations. The Minnesota Department of Health does not recommend meningitis vaccinations for city employees.

Tetanus

Employers are not required to provide a tetanus vaccination except in the course of treating a workers’ compensation injury. This vaccination is generally part of routine preventative health care.

Tuberculosis

According to the CDC, tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States. TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected. However, not everyone infected with TB bacteria becomes sick. People who are infected, but not sick, have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. Some people with latent TB infection go on to get TB disease.

Find more questions and answers about TB on the CDC website.

What determines risk of exposure for TB?

The Minnesota Department of Health (MDH) explains that the risk of exposure to TB is largely based on “place.” Factors such as having been homeless, incarcerated, having worked or lived in a correctional facility or a long-term health care setting are all higher-risk settings for exposure to the bacteria. The city’s risk level can change over time. MDH prepares quarterly and annual reports summarizing the demographic and clinical characteristics of the cases of TB disease reported in Minnesota.

TB testing

TB testing requirements in Minnesota vary depending on the type of facility and employee classification. Under MN OSHA and guidance from the Minnesota Department of Health (MDH), employees working in correctional institutions (including lockup units), as well as law enforcement personnel who transport suspected or confirmed TB cases, are required to complete a baseline TB test upon hire.

Employees classified by the Department of Corrections (DOC) as working in Level 1–3 correctional facilities must complete a baseline TB test upon hire and annual TB testing thereafter.

For Level 4 correctional facilities located in higher-risk communities — such as Hennepin and Ramsey counties — annual TB testing may also be required. Employers should consult their local county health department to determine the TB risk level in their area.

Health care settings licensed by MDH are not required to conduct annual TB screenings for health care personnel once the initial baseline screening has been completed, unless otherwise indicated by a facility risk assessment or known exposure.

Transporting TB patients or detainees

Close proximity in an enclosed air space of people with suspected or confirmed TB is a risk factor to all job classes of public safety employees that transport patients or detainees including police, fire, emergency medical responders, paramedics, ambulance attendants, etc. Employees can limit their exposure by using ventilation controls during transportation and in some cases wearing an N95 respirator.

Ventilation controls might include transport in an ambulance. Whenever possible:

• Operate ventilation in the non-recirculating mode.
• Use the maximum amount of outdoor air.
• Use the rear exhaust fan if available.
• Use, if available, a supplemental recirculating ventilation unit that passes air through HEPA filters.
• Airflow should be from the front of the vehicle, over the patient, and out the rear exhaust fan.

If an ambulance is not available:

• Operate ventilation in the non-recirculating mode.
• Use the maximum amount of outdoor air.
• If possible, the cab should be physically isolated from the rest of the vehicle.
• Place the patient/detainee in the rear seat.
• Drivers and others transporting people with suspected or confirmed infectious TB should wear at least an N95 disposable respirator.
• Consider having the patient/detainee wear a surgical or procedural mask if possible.

This guidance could also apply to transporting patients with other highly contagious airborne diseases.

Post-exposure testing requirements

Under federal and state OSHA law, 29 C.F.R. § 1910.1030(f)(1), employers are required to pay the cost of diagnostic testing for employees who have been exposed to certain infectious diseases, including:

• Viral or infectious hepatitis.
• Human immunodeficiency virus (HIV).
• Acquired immunodeficiency syndrome (AIDS).
• Tuberculosis (TB).
• Bacillus anthracis (anthrax).

LMC provides coverage for certain post-exposure testing. Please refer to the Workers’ Compensation Coverage Guide for additional details regarding eligibility and benefits.

For more questions, please reach out to Kate Connell, LMCIT loss control field manager at [email protected] or (651) 281-1254. You can also reach out to the Infectious Disease Division at Minnesota Department of Health.

Use this model document with the discussion on “Potential Infectious Disease Exposures in Municipal Operations”:

• Hepatitis B Vaccination Declination, LMC model form (doc)