BUMEDINST 6230.15B

Question 1

Describe the appointment for the IMMS director

Answer 1

Each commander for installation will appoint in writing a priviliged physician as medical director of immunizations. Must complete appropiate training in immunization science or via distance learning. Not required to be there during immmunization but be available for questions.

Question 2

At a minimum those that administer imms must be trained in what

Answer 2

at a minimum they must be trained in CPR and the administration of epinephrine

Question 3

How often must standards be reviewed

Answer 3

review standards annually and revise as necessary

Question 4

the DOD policy on imms follow recommendations of what governing authority

Answer 4

the CDC and the advisory comittee of immunization practices

Question 5

Why is giving a dose of imms at a shorter dosing interval not good

Answer 5

at shorter than recommended intervals may not provide an adequate immune response

Question 6

How long is sufficient time to wait after giving the max 5 injections in site on the same day.

Answer 6

1 week for inactivated vaccines. Live imms typically given simultaneously or at an interval of 4 or more weeks

Question 7

In what case would it not be necessary to complete a series of immunizations that were previously started?

Answer 7

If a medical contraindication exists or the person is no longer susceptible or likely to be exposed to the pathogen in question.

Question 8

When prioritizing immunizations, which microbes would you consider to be a long standing risk if encountered. (Name the 5 microbes)

Answer 8

Hepatitis B, Tetanus–Diphtheria–Pertussis, Poliovirus, Varicella, Measles–Mumps–Rubella (MMR)

Question 9

For potentially pregnant women smallpox vaccines require a specific pre–immunization screening that assesses the date of the last menstrual period. Women are recommended to take a pregnancy test if their last menstrual period is beyond how many days?

Answer 9

28 days

Question 10

What is BUMEDINST 6230.15B?

Answer 10

IMMUNIZATIONS AND CHEMOPROPHYLAXIS FOR THE PREVENTION OF INFECTIOUS DISEASES

Question 11

What diseases represent an imminent risk in close quarters during initial entry training and basic military training?

Answer 11

These immunizations include: influenza; meningococcal; MMR; tetanus-diphtheria-pertussis; and varicella.

Question 12

Ensure live virus vaccines are given on the same day or at least 28 days apart (see ACIP guidelines for exceptions). pg 16

Answer 12

Pregnancy screening or testing for female accessions must be verified prior to administration of any live virus vaccines.

Question 13

Before immunizing what test must be conducted?

Answer 13

Serologic test

Question 14

During advanced training or upon arrival to first duty station what immunizations are given to protect against travel and other military risks?

Answer 14

hepatitis A, hepatitis B, influenza (if not administered in first cluster), and poliovirus. pg16

Question 15

Typically, aviation personnel are grounded for 12 hours (Air Force: access to medical care 4 hours post vaccination unless operational needs dictate otherwise; Navy: refer to “Aeromedical Reference and Waiver Guide” (ARWG) for vaccine specific information) after immunization.

Answer 15

Personnel who previously experienced
urticaria, hypersensitivity phenomena, or other unusual phenomena after an immunization are restricted from flying
duty for an appropriate interval (for example, 72 hours) as determined by the flight surgeon. pg 17

Question 16

Employees, including volunteers, who have contact with or potential exposure to human blood or blood products (whether from patient care, laboratory, or other health care
settings) are provided what vaccine?

Answer 16

Hepatitis B vaccine pg18

Question 17

Adenovirus types 4 and 7

Answer 17

Direct contact and fecal oral transmission of the virus may result in a respiratory disease infection or outbreak of disease among an unvaccinated recruit population.

Question 18

Anthrax is caused by what spore forming bacterium?

Answer 18

Bacillus anthracis. pg20

Question 19

Direct exposure to anthrax spores may result in what symptoms?

Answer 19

cutaneous, gastrointestinal, or inhalational infection

Question 20

Haemophilus influenza disease and infection of many organ systems
caused by what bacterium?

Answer 20

Haemophilus influenzae serotype b (Hib). pg20

Question 21

Hib is transmitted via respiratory droplets.

Answer 21

The most common types of invasive Hib disease are: meningitis, epiglottitis, pneumonia, arthritis, and cellulitis.

Question 22

Hepatitis A

Answer 22

A, an acute infection of the liver that is acquired by consuming food or
water contaminated with hepatitis A virus, particularly during deployment or travel to areas with poor food, water, and sewage sanitation.

Question 23

Hepatitis B

Answer 23

an acute or potentially chronic infection of the liver that is acquired through percutaneous, sexual, and other mucosal exposure to blood and body fluids from people infected with hepatitis
B virus. Chronic infections may result in cirrhosis or cancer of the liver. pg 20

Question 24

Influenza

Answer 24

an acute febrile respiratory viral infection that can cause epidemics
within military populations, especially under conditions of crowding, such as initial entry training, aboard ships,
extended air transport, or deployment settings. widespread transmission through person to person contact and fomites (vaccine(s) annually or as indicated)

Question 25

Japanese encephalitis

Answer 25

a mosquito-borne viral disease, during deployments and
travel to endemic areas in Eastern Asia and certain western Pacific Islands, an acute infection of the brain, spinal cord, and meninges with high rates of complications, chronic disability, and death.

Question 26

Measles, mumps, and rubella (MMR)

Answer 26

These three acute viral infections are spread by the respiratory route or person-to-person contact.

Question 27

Rubella

Answer 27

causes a mild infection, but infection during the first

trimester of pregnancy puts the fetus at high risk of congenital rubella syndrome and birth defects.

Question 28

Mumps infection.

Answer 28

Young adults may

experience more severe complications from mumps infection

Question 29

Measles, mumps, and rubella (MMR)

Answer 29

administer MMR vaccine to

susceptible basic trainees and accessions within the first 2 weeks of training.

Question 30

Meningococcal is caused by what bacteria?

Answer 30

Neisseria meningitidis serogroups A, C, W–135, and Y

Question 31

Meningococcal: Alert personnel:

Answer 31

Administer meningococcal vaccine to personnel who are designated to deploy within 10 days of notification pg 21

Question 32

Meningococcal:

Answer 32

Administer one dose of meningococcal vaccine to persons who do not have spleens or functional
spleens.

Question 33

Pneumococcal is cause by what bacteria?

Answer 33

Streptococcus pneumoniae

Question 34

Poliomyelitis

Answer 34

a viral infection that affects the central nervous system resulting in
paralytic symptoms, primarily by boosting immunity acquired from childhood immunization. Poliomyelitis is acquired
by person-to-person transmission through the fecal-oral route.

Question 35

Poliomyelitis cont.

Answer 35

Only inactivated poliovirus vaccine (IPV) is available in the US.

Question 36

Rabies

Answer 36

Give booster doses every 2 years or when antibody concentrations indicate.

Question 37

Tetanus,

Answer 37

an acute disease of the nervous system caused by the serotoxin produced by Clostridium tetani

Question 38

Diphtheria

Answer 38

an acute disease caused by a cytotoxin of the bacteria Corynebacterium diphtheriae.
transmitted person-to-person via respiratory droplets and direct contact. Diphtheria can lead to airway obstruction,
and more severe complications may result from toxin absorption into organs and tissues.

Question 39

Tetanus-diphtheria (Td)

Answer 39

every 10
years following the completion of the primary three-dose series. A one-time dose of Tdap in place of a Td booster
during adulthood is required, regardless of interval.

Question 40

Tdap

Answer 40

preferred to Td for adults vaccinated 5 years earlier who require a tetanus toxoid-containing vaccine as part of wound
management and who have not previously received Tdap. pg 23

Question 41

Typhoid fever

Answer 41

a systemic bacterial disease acquired by consuming food or water
contaminated with Salmonella typhi,

Question 42

Varicella (chickenpox)

Answer 42

a generally mild and self-limiting viral infection caused by the varicella zoster virus.

Question 43

Varicella (chickenpox) cont.

Answer 43

Adults and adolescents require two doses of varicella vaccine given 4 to 8 weeks apart.

Question 44

Yellow fever

Answer 44

Yellow fever infection is transmitted via the bite of an infected mosquito. a viral infection that may result in severe systemic disease
and organ failure. pg 23

Question 45

Yellow fever cont.

Answer 45

Areas of greatest risk are sub-Saharan Africa and tropical South America. For Navy, administer to
those assigned to units subject to deployment within 10 days of notification into land areas where yellow fever is endemic.

Question 46

Anthrax

Answer 46

Chemoprophylaxis. Recommended drugs include ciprofloxacin and doxycylcine

Question 47

Group A streptococcus

Answer 47

Chemoprophylaxis. The primary drug used for prophylaxis is penicillin, specifically the long-acting injectable form, penicillin G benzathine. Oral penicillin VK and azithromycin have also been used effectively.

Question 48

Leptospirosis

Answer 48

exposed to contaminated water sources. Chemoprophylaxis. Doxycycline is effective in preventing leptospirosis

Question 49

Scrub typhus

Answer 49

Spread by the bite of infective larval mites. Chemoprophylaxis. Doxycycline has been shown to be effective in preventing scrub typhus

Question 50

B–3. Standard #3: vaccine storage and handling

Answer 50

Implement temperature monitoring processes at any clinic or activity that administers immunizations. All vaccine
storage devices should have a calibrated thermometer and alarm systems that are visually monitored at a minimum of
TWICE A DAY. pg 31

Question 51

The CDC’s National Center for Immunization and Respiratory Diseases strongly recommends that providers draw
vaccine only at the time of administration to ensure that the cold chain is maintained and that vaccine is not
inappropriately exposed to light.

Answer 51

Do not pre-draw doses; draw them when they are needed.

Question 52

Standard #5: immunization recordkeeping
a. Record immunizations accurately in a DOD and USCG-approved electronic ITS according to Service-specific
policy at the time of immunization, or no later than 24 hours after administration of immunization.

Answer 52

Standard #7: adverse events after immunization
a. Epinephrine (such as auto-injectable epinephrine) must be properly stored and readily available at all vaccination
locations along with other supplies determined locally to manage adverse events PG 33

Question 53

*****Report all clinically significant adverse events after vaccination to VAERS.

Answer 53

Internal Control Evaluation Process: Answers that indicate deficiencies must be explained and corrective
action indicated in supporting documentation. These key management controls must be formally evaluated at least
once every 5 years.