BUMEDINST 6230.15B - Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases Flashcards by Orlie Crisostomo

Who will prescribe specific immunization and chemoprophylactic requirements for their units per requirements established by this publication and additional guidance provided by the appropriate surgeon general or United States Coast Guard (USCG), Coast Guard, Director of Health and Safety (CG-11)?

Command medical authority

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The DoD policy concerning immunizations follows what recommendations in addition to the Advisory Committee on Immunization Practices (ACIP) and the prescribing information on the manufacturer’s package inserts, unless there is a militarily relevant reason to do otherwise?

Centers for Disease Control (CDC)

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What licensed by the Food and Drug Administration (FDA) or the Department of Health and Human Services (DHHS) may be used, as well as immunizing agents compliant with applicable DoD investigational new drug (IND) or emergency use authorization (EUA) process?

Any immunizing agent

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What will not be used beyond the manufacturer’s potency expiration date, unless the appropriate surgeon general or Director of Health and Safety (CG-11), United States Coast Guard (USCG) authorizes extension in exceptional circumstances?

Immunizing agents

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Recommended immunization schedules will not be what?

Compressed

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Immunizations given at an interval shorter than the recommended interval may not provide adequate immune response and should not be counted as part of a primary series, unless part of what schedules accepted by the Centers for Disease Control (CDC)?

“Catchup”

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In general, to minimize injection-site discomfort, not more than how many vaccine injections will be given on the same day?

5 vaccines

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Live-virus immunizations typically are given simultaneously or at an interval of how many or more weeks?

4 weeks

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What agents are requisitioned in accordance with medical supply procedures?

Immunizing and Chemoprophylaxis

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With regard to smallpox (vaccinia) vaccine, a specific pre-immunization screening form that assess the date of last menstrual period is required. For women whose last menstrual period was more than how many days, a pregnancy test is recommended?

28 days

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Breastfeeding women may be immunized in accordance with what current guidelines?

Advisory Committee on Immunization Practices (ACIP) Guidelines

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There are 2 types of exemptions from immunizations. What are they?

Medical and Administrative

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Cases warranting what type of medical exemption due to a vaccine-related adverse event will be reported to the Vaccine Adverse Events Reporting System (VAERS)?

Permanent

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Air Force: military members with permanent medical exemptions require a medical evaluation board and/or a flying waiver in accordance with what instruction?

Air Force Instruction (AFI) 48-123

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Within how many days before separation or retirement, Service personnel may be exempt from deployment (mobility) immunizations if certain conditions are met?

180 days

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Exemptions apply to civilian employees and contractor personnel who will leave a position subject to immunization with how many days or less?

30 days

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For Service personnel, immunizations exemptions for religious reasons may be granted according to Service-specific policies to accommodate doctrinal religious beliefs. Whose decision is this ultimately?

Command decision made with medical and chaplain advice

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Permanent exemptions for religious reasons will not be granted in what branch?

Air Force

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For military personnel, civilian employees, and other health care beneficiaries, the DoD-approved what is preferred record for immunization data, including date, immunization given, dose, and identification of the person administering?

Electronic immunization tracking systems

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Electronic Immunization Tracking Systems (ITS) must incorporate DoD-directed levels of security, certification, and redundancy, and the requirements of what act to preclude unauthorized access to personal medical information and to survive hardware or software malfunction?

Health Insurance Portability and Privacy Act of 1986

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A printed report from the electronic Immunization Tracking System (ITS), in PHS Form 731, SF 601 (Health Record-Immunization Record), or DD Form 2766C (Adult Preventive and Chronic Flowsheet) (Continuation Sheet) format, accompanied by an official clinic stamp and the authorized signature and printed name of an authenticating official, will qualify as what type of immunization report?

Official paper

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What form is prepared upon request for each member of the Armed Forces and for non-military personnel receiving immunizations, including date, immunization given, dose, and initials of person administering. The form contains valid certificates of immunization for international travel and quarantine purposes in accordance with World Health Organization (WHO) international health regulations?

PHS Form 731

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Entries based on prior official records will include what following statement?

“Transcribed from official records”

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The DoD and United States Coast Guard (USCG) withdrew needle-free multi-use nozzle jet injectors (MUNJIs) capable of 600 or more injections per hour, formerly identified within DoD supply systems as “hypodermic injection apparatus jet automatic: 115 volt or foot operated,” in what year due to safety concerns?

1997

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Whenever vaccines are administered, at least how many people present must be trained and current in basic Cardio Pulmonary Resuscitation, oralpharyngeal airway management, and recognition and initial treatment of anaphylaxis with epinephrine?

The Advisory Committee on Immunization Practices (ACIP) general recommendations suggest that person be observed for how many minutes after being immunized?

15-20 minutes

Aviation personnel typically will be grounded for how many hours after immunization, or as specified by their flight surgeon?

12 hours

Health care personnel must report adverse events resulting in hospitalization, a life-threatening event (for example, anaphylaxis), time lost from duty more than HOW MANY HOURS, an event related to suspected contamination of a vaccine vial, and an event warranting permanent medical exemption (that is, a contraindicating event)?

24 hours

Military treatment facilities and commands storing health records will review immunization and chemoprophylaxis practices at least how often to ensure compliance with current standards of care and documentation and as a measure of medical readiness and health promotion?

Annually

Military treatment facilities and commands will conduct a review of the adequacy of immunization coverage among supported populations at least how often?

Annually

Enlisted accessions may be scheduled for immunizations in how many or more clusters as long as all appropriate immunizations are administered?

Two

Typhoid and Yellow Fever immunizations are required for alert forces defined by Forces Command (FORSCOM) as division -ready brigades, including attached command and control packages, combat support packages, combat service support packages, and other units approved by the FORSCOM commander for what branch?

Army

Yellow fever immunization is required for all Marine Corps personnel and for all Navy personnel assigned to Marine Operating Forces. Additionally, yellow fever immunization is required for Navy personnel assigned to Navy units subject to deployment within how many days of notification into land areas where yellow fever is endemic?

10 days

In accordance with what instruction, emergency-essential employees will be notified that they may be required to take immunizations as a condition of employment?

DODD 1404.10

Who will receive country-specific immunizations without charge at military activities upon presentation of official orders or authorization?

Federal civilian employees

Immunizations of civilian employees and contracted workers for biological warfare defense are addressed in what instruction?

DODI 6205.4

When what Food and Drug Administration (FDA), licensed vaccines are available, administer to military basic trainees as they arrive to prevent febrile respiratory disease, disease outbreaks resulting from person-to-person transmission, and lost training time?

Adenovirus

What is almost uniformly fatal once symptoms develop?

Inhalation anthrax

Hepatitis A, is an acute infection of the what? Acquired by consuming food and water contaminated with hepatitis A virus during development or travel to areas with poor food, water, and sewage sanitation. Hepatitis A is endemic worldwide.

Liver

Hepatitis B, an acute or potentially chronic infection of the what? Acquired through percutaneous, sexual, and other permucosal exposure to blood and body fluids from people infected with hepatitis B virus.

Liver

Influenza A and B, which are acute viral infections of what type? That can cause epidemics within military populations, especially under conditions of crowding, such as initial entry training, aboard ship, extended air transport, or deployment settings. Influenza A has the potential for pandemic spread.

Febrile repiratory

Japanese encephalitis, which is a viral disease of what type? During deployments and travel to endemic areas in Eastern Asia and certain western Pacific Islands. Japanese encephalitis virus can cause an acute infection of the brain, spinal cord, and meninges with high rates of complications, chronic disability, and death.

Mosquito borne

Administer Japanese encephalitis virus (JEV) to military personnel, civilian personnel, contracted workers, and other beneficiaries who are or will be stationed at least how many days in rural areas of Asia where there is substantial risk of exposure to the virus, especially during prolonged field operations at night?

30 days

Measles, mumps, and rubella (MMR) Persons born in 1957 or earlier are presumed to be immune through infection. Ensure military personnel born after 1957 have received how many lifetime doses of MMR vaccine or have positive serologic test results?

Administer meningococcal vaccine to military personnel traveling for more than how many days to regions subject to meningococcal outbreaks, if not administered within an appropriate booster interval?

15 days

What causative agent of plague has been identified as a potential biological warfare agent?

Yersinia pestis

What is acquired by person-to-person transmission through the fecal-oral route?

Poliomyelitis

In what year did the World Heath Organization (WHO) declare the global eradication of naturally occurring smallpox?

1980

What is an acute illness caused by an exotoxin of Clostridium tetani, a bacteria that grows at the site of wounds contaminated with its spores?

Tetanus

What have been shown to increase survival when used after exposure to anthrax and before onset of symptoms?

Antibiotics

What is spread by the bite of infective larval mites and may be a source of morbidity in populations encountering primitive field conditions?

Scrub typhus

Within how many days of receiving the validated and prioritized biological warfare threat list from the Chairman of the Joint Chiefs of Staff, the DoD Executive Agent, in consultation with the Secretaries of the military departments and the President of the Armed Forces Epidemiological Board, provides recommendations to the Assistant Secretary of Defense for Health Affairs (ASD(HA)) on vaccines and immunization protocols necessary to enhance protection against validated biological warfare threat agents?

Combatant Commanders must request approval from who to use Investigational New Drugs (IND) for force health protection?

Secretary of Defense

A vaccine, antibiotic, or other product in an Investigational New Drugs (IND) status may be mandatory for military members, if who has approved a waiver of the requirement for informed consent?

President of the United States

Under what section of the Food Drug and Cosmetic Act (21 USC 360), some drugs, vaccines, or devices that have not been approved or licensed by the FDA through the regular drug approval process (or not approved for an intended use) may be used as medical countermeasures to chemical, biological, radiological, or nuclear (CBRN) agents or threats if the FDA grants an emergency use authorization (EUA)?

Section 564

In general, the FDA may grant an emergency use authorization (EUA) for up to how many months, with potential renewal?

12 months

Who may decide that potential recipients of a drug under an emergency use authorization (EUA) should have the option to refuse it? The President may waive the option for military personnel.

The FDA

What is the Executive Agent for the Military Vaccination Program?

Army

What provides medical services for the U.S. Marine Corps?

Navy

Medical exemptions from immunizations are considered temporary if they are up to how many days?

365

What style of refrigerators are not authorized for vaccine storage?

Dormitory

At least how often should vaccine storage alarms be tested?

Monthly

What publication contains the Army's religious accommodation policy for immunizations?

AR 600-20

Vaccine storage alarm test records should be maintained for at least how many years?

At what temperatures should refrigerated vaccines be stored at?

35-46 degrees F

How far should injections be separated by when simultaneous vaccine injections are necessary and different anatomical sites are not possible?

1 inches

How long should vaccine storage unit documented temperature logs be kept?

5 years

Vaccine doses in an initial series administered how many or more days earlier than the minimum interval should not be counted as valid doses?

14 days

When using a Styrofoam cooler for transporting vaccines the container walls must at least how many inches thick?

Discarded needles and syringes if vaccines are not administered before the end of the clinic day or vaccination session in accordance with the manufacturer's package insert. If no time line is provided, discard after how many hours?

8 hours

TB testing if not done simultaneously with the live virus vaccines should be done how many weeks after administration of live virus vaccines?

4-6

What is usually recommended or required to increase immunity back to protective levels for vaccines that do not provide lifetime immunity?

Booster dose

Vaccinia Immune Globulin is only available by ordering through what office?

MILVAX

Two or more live virus vaccines must be administered simultaneously or separated by at least how many days?

28 days

At what temperature or lower should frozen vaccines be stored?

5 degree F

What typically represent the most imminent threat in military training center and are given immunization priority?

Contagious diseases

A minimum of how many adult doses of epinephrine must be immediately accessible on scene for the mid cal management of an anaphylaxis event whenever vaccines are administered?

Three

Permanent immunizations based on Religion are not granted in the Air Force. Who is the designated approval and revocation authority for temporary immunization exemptions?

MAJCOM commander

What form is required for yellow fever documentation and or prepared upon request for each member of the Armed Forces and for non military personnel receiving immunizations, including date, immunization given, dose, and the initials of the person administering the vaccine?

CDC form 731

Individuals preparing paper-based immunization and chemoprophylaxis records will ensure that paper records match the electronic ITS. If paper-based immunization or chemoprophylaxis records are used, electronic ITS will be updated within what time frame?

24 hours

What include Service personnel in enlisted initial training, ROTC, OCS, academy, prep school, Service Academy, Officer Indoctrination School, and officers who are directly commissioned?

Military Accessions

Except in an outbreak setting or for individual clinical purposes, immunization records will not be screened after completions of initial training with regard to measles, mumps, rubella, poliovirus, or what other vaccines?

Varicella

What will employees at occupational risk of exposure to wastewater or sewage receive per ACIP recommendations?

Tetanus-diphtheria toxoids

Family members of military personnel receive immunizations according to what current recommendations?

ACIP

Serologic testing of healthcare workers who have direct contact with patients and those who have potential occupational risk for exposure to bloodborne pathogens must be conducted how many months after completion of the Hep-B vaccine series to determine serologic response according to CDC and ACIP recommendations?

1-2

Unless sero-immune to both measles and rubella, the MMR vaccine must be administered to susceptible basic trainees and accessions within the first how many weeks of training?

Booster doses of Tetanus-diphtheria (Td) must be administered to all personnel every how many years following the completion of the primary three-dose series?

A second dose of the pneumococcal vaccine must be administered to persons without spleens or severely immunocompromised how man years after the initial dose?

In what way is yellow fever infection transmitted?

Mosquito bite

Within the first how many weeks of initial training must the Varicella vaccine be administered to susceptible trainees and other accessions?

Adults and adolescents required two doses of varicella vaccine given how many weeks apart?

4-8

A pre-exposure prophylactic immunization series may be indicated for people with potential occupational risk of exposure to rabid animals, or for forces assigned to locations where access to definitive care likely exceeds how many hours?

The meningococcal vaccine must be administered to personnel who are designated to deploy within how many days of notification?

How often must influenza vaccines be administered to all active duty, reserve, and National Guard personnel?

Annually

The meningococcal vaccine must be administered to basic trainees, cadets, and midshipmen at Service academies within the first 2 weeks of training if there is no evidence of vaccination within the last how many years?

Chemoprophylaxis agents dispensed to individuals must be in unit-of-use packaging or in child-resistant containers consistent with what Act?

Poison Prevention Packaging Act

What is effective in preventing leptospirosis in exposed military personnel during periods of high risk of exposure?

Doxycycline

What is defined as the administration of medication before, during, or after possible exposure to an infectious agent, to prevent either infection or disease?

Chemoprophylaxis

What licensed vaccine is effective against the pneumonic plague?

None

What publication should be consulted for chemical warfare-related chemoprophylaxis?

Medical Management of Chemical Casualties

What has been shown to increase survival when used after exposure to anthrax and before onset of symptoms?

Antibiotics and Immunoglobulin

What is the primary drug used for Group A Streptococcus?

Penicillin

How often at a minimum do combatant commanders provide the Chairman of Joint Chiefs of Staff with their assessment of the biological warfare threats to their theaters?

Annually

The DoD Immunizations Program for Biological Warfare Defense is conducted within how many days after receiving the validated and prioritized biological threat list?

How of ten at a minimum does the President of the Defense Health Board in consolation with the Secretaries of the Military Departments identity to the ASD (HA) the vaccines available to protect against validated biological warfare threat agents and recommend the appropriate immunization protocols and/or chemoprophylaxis?

Annually

For infectious disease threats for which the only available vaccine or chemoprophylaxis product is in an IND status, the IND product must be administered in full accordance with FDA regulations at 21 CFR Parts 50 and 312, as well as 10 USC 1107, Executive Order 13139, and what else?

SDODD 6200.2

A vaccine, antibiotic, or other product in an IND status may be mandatory for military members if who has approved a waiver for the treatment for informed consent?

POTUS

Using the appropriate chain, who must Commanders request approval from to use INDs for force health protection?

SECDEF

What is the Executive Agent for the Immunization Program for Biological Warfare Defense?

Army

Under what act, some drugs, vaccines, or devices that have not been approved or licensed by the FDA throughout the regular drug approval process may be used as medical countermeasures to CBRN agents or threats, if the FDA grants an EUA?

21 USC 564

Requests for possible EUAs for military purposes must be submitted to what for consideration?

ASD (HA)

The FDA may decide that potential recipients of a drug under an EUA should have the option to refuse it. Who may waive this option for military personnel?

POTUS