Health certificate is a document that confirms the compliance of a person’s state of health with the requirements arising from legislation. Health certification requirements are in place to ensure that people who work in a particular field are healthy enough. Regular health examinations for infectious diseases (previously every two years) have been abolished by an amendment to the law that entered into force in 2017. However, the employer has the right to send the employee for an additional medical examination according to the results of the workplace risk assessment. The need for risk assessment and additional health surveillance may arise in case of spread of infection during work processes, contaminated production line or the development of an infectious disease in some employees in the team. In such a case, it is appropriate for the employer to send the employee or employees to an additional medical examination in accordance with the outcome of the risk assessment (1).
In fields of activity where the peculiarities of work may promote the spread of infectious diseases, the employer has to require a health certificate from the employee to pass a health examination for infectious diseases. Health certificate for infectious diseases is required in the following professions: food and drinking water handlers, animal care workers, persons who come in direct contact with animal products, teachers and childcare workers, general care workers, health and healthcare workers, beauty and personal care workers, trainees or practitioners.
What tests and analyzes are needed to issue health certificates?
First of all, the applicant has to fill in a health declaration and confirm it with his or her name and signature. The family doctor or occupational health doctor compares received data with the information in the digital health system and acquires an explanation for any differences. The family doctor or occupational health doctor will prescribe medical examinations for infectious diseases (eg x-ray of the lungs) for the applicant. Based on the collected health information, a health statement is issued.
It is especially important for employees handling food and drinking water to rule out salmonellosis, shigellosis, campylobacter enteritis. For this purpose, appropriate samples (bacteriological inoculation of feces) are taken for the microbes that cause these diseases. According to the need, additional analyzes must be taken, as there are still several contraindications, but the aforementioned are the most common in Estonia.
Contraindications for employees handling food and drinking water:
1. cholera; 2. typhoid fever; 3. paratyphoid fever; 4. salmonellosis; 5. shigellosis; 6. E. coli intestinal infection; 7. Campylobacter enteritis; 8. yersinosis; 9. rotavirus enteritis; 10. Acute enteropathy due to norovirus; 11. giardiasis; 12. cryptosporidiosis; 13. Hepatitis A virus; 14. amoebiasis; 15. listeriosis; 16. helminthiasis; 17. other food and drinking water borne infections.
In case of animal care workers and persons who, as a result of their duties, come into direct contact with farm animals and animal products, the inspection shall exclude salmonella, campylobacter enteritis and pulmonary tuberculosis (eg x-ray of the lungs). According to the need, additional analyzes must be taken, as there are still several contraindications, but the aforementioned are the most common in Estonia.
Contraindications for use in case of animal care workers and handlers of animal products:
1. salmonellosis; 2. E. coli intestinal infection; 3. Campylobacter enteritis; 4. yersiniosis; 5. cryptosporidiosis; 6. listeriosis; 7. tuberculosis M. bovis.
In case of teachers and childcare specialists, it is considered most important that pulmonary tuberculosis will be ruled out, i.e., a pre-employment pulmonary X-ray is needed. Of course, the spread of other diseases is also not allowed, but they are subject to the specific risk analysis.
Contraindications for working with young people or in a childcare institution:
1. respiratory tuberculosis; 2. diphtheria; 3. whooping cough; 4. measles; 5. rubella; 6. mumps; 7. other infectious diseases of the respiratory system.
The caregivers or nurses who come into direct contact with the client, must be checked for tuberculosis. To prevent pulmonary tuberculosis an X-ray of the lungs must be performed before starting work.
Contraindications for caregivers:
1. respiratory tuberculosis; 2. MRSA – carrying; 3. acute hepatitis B virus; 4. acute hepatitis C virus; 5. diphtheria; 6. whooping cough; 7. measles; 8. rubella; 9. mumps; 10. skin abscesses and fungal diseases of hands; 11. other acute respiratory diseases; 12. other blood infections.
Respiratory tuberculosis has been identified as the most important factor to rule out among beauty and personal care service providers who come in direct contact with the client. An X-ray of the lungs is performed for this purpose.
Contraindications for working as beauty and personal care providers:
1. respiratory tuberculosis; 2. acute hepatitis B virus; 3. acute hepatitis C virus; 4. skin abscesses and fungal diseases of the hands; 5. other blood infections.
Used literature:
(1) Ministry of Social Affairs. Changes in the health control of infectious diseases came into force in the new year (only in Estonian): https://www.terviseamet.ee/et/uudised/uuest-aastast-joustusid-muudatused-nakkushaiguste-tervisekontrollis
(2) The Health Board. Instructions for conducting health examinations for infectious diseases (only in Estonian): https://www.terviseamet.ee/sites/default/files/content-editor/vanaveeb/Nakkushaigused/meedikutele/Tervisekontrolli_juhend.pdf
(3) Infectious Diseases Prevention and Control Act: https://www.riigiteataja.ee/en/eli/502062021001/consolide