Hospitals are notorious for nosocomial infections. Both the outpatient clinics and wards attract and accumulate ailing people, many with infectious diseases. Crowding and cross-infections are quite common in hospitals. Three groups are at risk of hospital-acquired infections. One, hospital clients themselves - they may come with one problem and acquire another in the hospital. second, the attendants of the patients - bystanders and visitors - who may get infected in the hospital premises. Third, health care workers themselves - who are constantly at risk of exposure to a myriad of microbes. Hospital Infection Control Committee (HICC) is required in all hospitals, to monitor and minimize the risk of hospital-acquired infections. It usually pays attention to post-surgery wound infections and to sharp-tool-injury to staff, but tend to ignore risk of infections through other modes of transmission such as droplets, aerosol or touch. Immunization against vaccine-preventable diseases is also neglected often by HICCs.

When health care workers get exposed to pathogens in the work place, the repercussions may be many. Those who are not immune to the agent may develop disease, and are forced to be absent from duty. Some hospital-acquired infectious diseases may be severe and even life-threatening. Anecdotally, I know of doctors or nurses who developed human immunodeficiency virus (HIV) infection, fulminant hepatitis B, progressive primary tuberculosis, varicella, measles or rubella as hospital-acquired infectious diseases. Prevention is always better than cure. Awareness, alertness and systematic procedures guided by hospital policy are essential for prevention.

A very recent report on an outbreak of hepatitis A in and around a medical college in Kerala had the following statement in passing. “Two deaths among the doctors were reported. However, the serum samples were not stored for further analysis”1. This episode illustrates the risk of life-threatening infectious diseases as an occupational hazard to health care staff. The lack of scientific attitude for preserving samples to identify the infectious agent that caused death of doctors is appalling. If nurses or other hospital staff died of hepatitis A at home or in other hospitals or even in the same medical college hospital, the investigators would probably not have been told about them. According to the report, among those who developed hepatitis A “170 were from the members of the medical community” including residents of medical college hostels for men and women students, nurses, house surgeons and postgraduate students, and “a substantial proportion of viral hepatitis patients were care-taking relatives of patients hospitalized for other causes”1. Hospitals should be havens of healing, not departments of disease dissemination.

Hepatitis A virus is unlikely to be transmitted directly from health care worker to others. However, there are several pathogens that may be passed on unknowingly, even before the worker himself/herself develops symptoms or signs of illness. Varicella, measles and rubella come under this category. Thanapal and co-authors draw our attention to the potential of rubella in health care workers in an eye hospital setting in Tamil Nadu, in this issue of the journal2. Although rubella virus infection is very common in children, all adults may not be immune. In the eye hospital, some 11 per cent of staff were non-immune and susceptible to infection and infectiousness2. Among female staff (nurses and counselors) 39 per cent and among physicians 16 per cent were non-immune. Some staff had evidence of recent infection - predominantly among nurses. When non-immune personnel were immunized with rubella vaccine, all developed antibody response2. In adults rubella itself may be mild or inconsequential. The importance of rubella is not the disease itself, but infection during pregnancy and the consequent risk of congenital rubella syndrome (CRS). By the time a baby is born with CRS, who will remember where or from whom the mother got the infection3. For those who do not realize how frequent CRS may be in India, an earlier report from the same eye hospital on rubella as a major cause of cataract in children is an eyeopener4. Among infants with suspected congenital infections in another Tamil Nadu hospital, 10 per cent had CRS5.

The rubella susceptibility of sizable proportions of women of child-bearing age is not confined to south India, but is a recognized problem in north India as well6. In Delhi, some 13 per cent were recently reported to be without detectable rubella antibody6.

Continued rubella susceptibility among health care staff is both risky for themselves and hazardous to ‘innocent bystanders’, particularly women in the child-bearing age groups. All hospital staff deserve to have rubella antibody screening and non immune staff deserve to be vaccinated. Alternatively, as Thanapal and colleagues2 recommend, prescreening for antibody need not be mandatory and health care workers could be vaccinated as they begin employment. Vaccination will protect them and also prevent hospital-based outbreaks2. Perhaps the best time to introduce rubella vaccination is when trainees enter institutions of health care profession. As students they may be more likely to be receptive to the concept than established professionals who tend to neglect such ideas. In many overseas universities, rubella vaccination is mandatory for admission of students. In India we could begin with institutions of training of health care professionals - medical, nursing, dental, pharmacy or paramedical.