BUMEDNOTE 6230, IMMUNIZATION REQUIREMENTS AND RECOMMENDATIONS Flashcards
BUMEDNOTE 6230
Immunization requirements and recommendations
Yellow Fever
$212 per vial
Meningococcal
$450 per vial
Typhoid Vi
$750 per vial
live vaccine
mmr, yellow fever, smallpox, varicella,Flu mist, opv and oral typhoid
Inactivated Vaccines
Anthrax, Hep a and hep b , twinrix, ipv, influenza, tetanus, typhoid menningococcal/pneumococcal, JEV, and rabies
Vaccine Rules
ASK about ALLERGIES, most live vaccines can be given on same day, if not on same day, separate by at least 30 days.
Vaccine Rules
No more than 5 vaccines given per day. Separate inactivated vaccines by at least a week
Vaccine Rules 2
Live vaccines and PPDs.
Smallpox/MMR and PPDs: 30 day separation.
All other live vaccines can be given on the same day as a PPD.
If not given on same day, separate by at least 4-6 weeks (False negative PPD can result).
Vaccine Rules 3
Administrative vs. Medical Exemption,VAERS Form and VIS availability
Storage Life
Yellow Fever: 1 hour after reconstitution MMR: 8 hours Smallpox: 90 days Varicella: 24 hours Meningococcal (Menomune): Single dose vial = 30 minutes Multi-dose vial = 35 days
anthrax
Who gets it: Given to deploying personnel.
When is it given: must wait until 60 days prior to deployment (Same as smallpox)
0.5 mL
IM, IM, IM.
#1 on day 0, #2 on 4 weeks, #3 at 6 months, #4 at 12 months
#5 at 18 months, followed by annual booster.
NO CHILDREN
Algorithm for Severe Allergic Reactions to Anthrax Vaccine
Mild = erythema less than 50 mm; topical and oral meds offered Moderate = erythema 50-120 mm; topical and oral meds, consider pre-treatment for next dose Large = over 120 mm; consider consultation to next level of care. Submit VAERS (must be submitted for loss of duty greater than 24 hours, hospitalization, or suspected vial contamination), treat symptoms, take picture of site, and consider temporary exemption, pending consult. Pre-treat before next dose.
Hepatitis A
Provided to all recruits at accession point.
Dose: 2 doses confer immunity. 19 years or older, 1.0 mL; <19 years of age, 0.5 mL
IM.
Second dose should be administered 6-12 months after the first.
No current requirement for booster dose
Hepatitis B
Dose: >20 yrs 1.0 mL; <19yrs 0.5mL
IM.
#1 on day 0, #2 30 days after first dose, #3 five months after the second dose.
No current requirement for booster dose
Twinrix (Hep A & Hep B)
Combination vaccine; consists of adult dose of Hep B and pediatric dose of Hep A.
Dose: 3 dose schedule (same as Hep B); 1.0 mL given IM. Can be mixed with Hepatitis Vaccines (Try not to)
Human Papillomavirus (HPV
9 to 26 yr old females (approved for males, not routine use) Dose: 3 dose schedule; 1 at Day 0; 2 at 2 months; 3 at 6 months.
0.5 mL given IM shake vial well to produce a cloudy liquid
Influenza
Contraindicated for personnel with egg allergy 0.5 mL; 0.25 per nostril for Flumist
IM; Intranasal for Flumist
Inactivated vaccine (FluMist live)
Flu is only indicated for active duty during the flu season itself ( 01 Oct - 31 May in N. Hemisphere).
Recommended for pregnant women who will be in their 14th week of gestation during the flu season.
smallpox
Live vaccine (vaccinia virus)
Dose/Route: 15jabs initial vaccination; 15 jabs for revaccinatation; administer over the deltoid/upper arm
Medical screening required!
Check site within 10-14 days and document!
Wound/scab care
Current policy: give the vaccine during the 60-120 day window before deployment.
Not on the flight line
Do not administer with Varicella vaccine.
Tetanus (Td)
Inactivated vaccine
Dose/Route: 0.5 mL, IM
One dose is given at accession. Boosters are routinely given every 10 years.
For wound management: if Td given > 5 years, revaccinate the patient
Typhoid Vi
Inactivated vaccine
Dose/Route: 0.5 mL, IM
One dose confers immunity; booster every 2 years.
Varicella
Live vaccine; offer to personnel who have not had chickenpox.
Dose/Route: 0.5 mL, SC
Schedule: two doses; 4-8 weeks apart.
Primarily given to high risk populations
Healthcare workers
Family members of immune-compromised patients
Yellow Fever
Live vaccine
Dose/Route: 0.5 mL, SC
One dose confers immunity. Boosters are given every ten years.
Cholera/Plague
Currently not recommended
Several oral cholera vaccines are on the market but are not being used by the military at this time.
New plague vaccines are also in the works.
PPDs
Not a vaccine, but a screening test
Dose/Route: 0.1mL, ID; look for characteristic wheal after placement.
If no wheal present, immediately replace PPD in other arm.
Record as 0.1CC strength; write out results.
Read in 48-72 hours after placement
Post Deployment PPDs: given 90 days - 12 months after return
Live Vaccines and PPDs
When opening a vial, mark the date. PPD only good for 28 days after opening due to oxidation.
PPDs CONT.
PPDS are considered positive if 10mm or more of induration is present
Any induration must be accurately measured and documented
If pt has induration of <10mm after the first test but a change of more than 5mm induration present throughout 2 consecutive tests treat as a positive
Refrigerator Temperatures
Maintain between 2-8° C (35-46° F)
Yellow Fever can be stored in refrigerator or freezer.
Do not leave vial(s) out during shotex; keep in cooler.
Use liquid thermometers only (non-mercury)
Log temperatures twice daily.
Recommend that duty personnel perform these checks (at opening and closing).
Pregnancy
Avoid pregnancy for at least 3 months after an MMR.
No live vaccines during pregnancy
Td is not recommended during pregnancy
Flu should be given for pregnant women who will be in their 14th week of gestation during flu season.
