From February 25, 2021, the occupational health services can vaccinate certain employees.
Following the recommendation of the Haute Autorité de Santé (HAS) of February 2, 2021 entitled “Vaccination strategy against Covid-19 - Place du Covid-19 Vaccine Astra Zeneca” (https://www.has-sante.fr/upload/docs/application/pdf/2021-02/strategie_de_vaccination_contre_la_covid-19_-_place_du_covid-19_vaccine_astrazeneca_synthese.pdf), the Directorate General of Labor published on February 16, 2021 a Protocol for vaccination by occupational physicians using the AstraZeneca vaccine ( AZ).
Reminder of the HAS opinion of February 2, 2021
The Directorate General of Labor (DGT) begins by recalling an extract from the HAS opinion of February 2, 2021, recalling that:
"The AZ vaccine is preferentially recommended to professionals in the health or medico-social sector under 65 and to people under 65, starting with people aged 50 to 64 and who present with comorbidities.
These populations correspond to the populations prioritized in phase 3 of the vaccination strategy which also includes 18 - 49 year olds with co-morbidities and the essential operators and professionals in sectors essential to the functioning of the country who must therefore also be vaccinated as soon as the doses are available ”( https://www.has-sante.fr/upload/docs/application/pdf/2021-02/strategie_de_vaccination_contre_la_covid-19_-_place_du_covid-19_vaccine_astrazeneca_synthese.pdf).
Reminder of the list of pathologies presenting risks of co-morbidities
The General Directorate of Labor provides in the appendix the list of pathologies presenting risks of co-morbidities:
o Cardiovascular pathologies: complicated arterial hypertension (hypertension) (with cardiac, renal or vascular complications), history of stroke, history of coronary artery disease, history of cardiac surgery, NYHA stage III or IV heart failure;
o Unbalanced or complicated diabetes;
o Chronic respiratory pathologies liable to decompensate during a viral infection: obstructive pulmonary disease, severe asthma, pulmonary fibrosis, sleep apnea syndrome, cystic fibrosis in particular;
o Obesity with body mass index (BMI) ≥ 30;
o Progressive cancer under treatment (excluding hormone therapy);
o Child Pugh score stage B cirrhosis at least;
o Congenital or acquired immunosuppression;
o Major sickle cell syndrome or history of splenectomy;
o Motor neuron disease, myasthenia gravis, multiple sclerosis, Parkinson's disease, cerebral palsy, quadriplegia or hemiplegia, primary cerebral malignancy, progressive cerebellar disease;
o Cancers and malignant haematological diseases during treatment with chemotherapy;
o Severe chronic kidney disease, including dialysis patients;
o People with solid organ transplants;
o People transplanted by allogeneic hematopoietic stem cell transplantation;
o Chronic poly-pathologies with at least two organ failure;
o Certain rare diseases and particularly at risk in the event of infection (list drawn up by the rare diseases health networks);
o Trisomy 21.
Employees aged 50 to 64 with these pathologies are therefore the target audience for this phase of the vaccination campaign.
1) Launch of a new phase of the vaccine strategy
The DGT first recalls that “in accordance with the recommendations of February 2, 2021 from the High Authority for Health (HAS), it was decided that as of February 25, 2021, the AstraZeneca vaccine would be used for the vaccination of people aged 50 to 64 included with co-morbidities ”.
In addition, "the health authorities have decided to make this possibility available to occupational physicians, who will be able to vaccinate volunteer employees from member companies that are part of the aforementioned target".
The DGT asks occupational physicians to respect the recommendations of the health authorities regarding the prioritization of target audiences in the vaccination campaign and to respect the ethical rules applying to any act of vaccination (respect for the consent of the person, medical confidentiality , etc ...)
Indeed, for all medical data collections, screenings or even here vaccination, respect for consent and medical confidentiality remain in place, even in these times of Covid-19.
See our article Collective screening for Covid-19 in a company: how does it work? (https://www.village-justice.com/articles/depistage-collectif-covid-entreprise-comment-marche,37689.html).
2) Particularity of occupational health services (OHS)
The DGT recalls that the participation of occupational health professionals in the vaccination campaign is part of the missions of the Occupational Health Services (OHS) under Article L. 3111-1 of the Public Health Code, article 1 of ordinance n ° 2020-1502 of December 2, 2020 and article R. 4426-6 of the Labor Code.
The Ministry of Labor thus aimed to adapt the OHS obligations in order to enable them to participate in the national strategy to fight the pandemic.
As a result, a "temporary adaptation of the deadlines for carrying out medical visits and examinations by the OHS (order 2021-135 of 10/02/21 and decree 2021-56 of 22/01/21) allows OHS to refocus their activity and adapt them to the health crisis ”.
It is again reminded that if vaccination is recommended, it requires the prior informed consent of the employee, who is voluntary.
Thus, no decision of unfitness can be drawn from the sole refusal of the employee to be vaccinated.
Finally, the instructions of the DGT note that "the occupational physicians practice in a salaried mode of practice inducing the necessary adaptations to the working environment":
- The occupational physician must ensure, in conjunction with the management of the service or the company, that he will have within his OHS the material and human resources suitable for carrying out employee vaccinations;
- Everything must be done to respect the confidentiality of vaccinations vis-à-vis employers. Employees identified as vulnerable cannot be "targeted by means of an individual summons under cover of the company manager, this having the effect of reporting to the employer confidential information concerning the health of the employee in question";
- Vaccination should therefore preferably be considered in the premises of the SST and not in the premises of the company itself;
- Consideration should be given to a global reflection within the ESS regarding vaccinations;
- Finally, in addition to entering vaccinations into the dedicated national information system, the OHS will have to ensure "reliable monitoring of the indicators necessary for monitoring" the vaccination activity.
3) Calendar: 3 stages of the vaccination strategy
The DGT foresees three stages in this phase of the vaccination strategy.
The first step is to identify the doctors who volunteer to vaccinate their patients aged 50 to 64 included with comorbidities.
The second relates to the preparation by volunteer doctors of the appointment slots necessary to administer the AZ vaccine.
Finally, the third step is to collect the vaccine from dispensing pharmacies and start the vaccination.
4) Preparation and injection procedures for the AZ vaccine
It is recalled that "the AZ vaccine requires storage between +2 and + 8 ° C" and that it "is packaged in a 10-dose vial".
5) Organization of appointment slots
The instructions of February 16, 2021 provide for two possible options.
The first option, ie "organizing all vaccinations within 6 hours of removing the vial", requires the doctor to be able to transport and store the vial at room temperature if he or she has organized all of the vaccinations in the same room. within 6 hours of removing the vial.
The second option, ie "the organization of vaccinations over 48 hours after opening the bottle" implies that the doctor can schedule his vaccinations over 48 hours, subject to having a qualified refrigerator controlled at + 2 ° + 8 ° C.
In this case, the doctor will have to ensure that the cold chain is maintained throughout the transport to the doctor's office.
6) Vaccination traceability
The DGT affirms that "the vaccinations carried out are recorded on the Vaccin Covid teleservice system accessible via AmeliPro at the address: http://vaccination-covid.ameli.fr/".
7) Waste disposal
The DGT specifies that "empty vials, syringes and needles follow the traditional route of elimination of ICDT.
If the bottle breaks or is splashed on a surface, it is disinfected using a disinfectant active on adenoviruses ".
8) Post-vaccination surveillance
Finally, it is recommended that occupational physicians place the employee under surveillance for at least 15 minutes after vaccination in order to detect "the occurrence of an anaphylactic reaction following administration of the vaccine".
They will also need "to have the appropriate equipment and pharmaceutical products, including injectable adrenaline".
Protocol for vaccination by occupational physicians using the AstraZeneca (AZ) vaccine of February 16, 2021 (pdf)
Recommendation of the French National Authority for Health (HAS) of February 2, 2021 entitled "Vaccination strategy against Covid-19 - Place of Covid-19 Vaccine Astra Zeneca"
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