Immunization program Flashcards
What are the 13 immunizations that are under BUMEDINST 6230.15A?
- Anthrax
- Cholera
- HEP A
- HEP B
- JE
- MMR
- Meningococcal
- Plague
- Polio
- Rabies
- TDAP
- Typhoid
- Yellow Fever
Who sets the policy for implementing Anthrax vaccine immunization program?
DOD or USCG
Dosages for Anthrax:
0.5ml IM @ 0 4 weeks 6 months 12 months 18 months Yearly boosters
Dosages for Cholera:
when required by host country, 0.5ml sub q/ IM
X6 months in highly endemic areas
Dosages for HEP A:
IM deltoid
Havrix (SmithKline Beecham)
Vaqta (Merck + company)
Dosages for Havrix:
1-18y/o 1st dose 720 el.u/0.5ml, booster720 el.u/0.5ml
19y/o and older 1st dose 1440 el.u/1.0ml
booster 6-12 months since 1st dose 1440 el.u/1.0ml
Dosages for Vaqta:
1-18y/o 1st dose 36 u/0.5ml, booster 25u/0.5ml 6-18 months after 1st dose
19y/o and older 1st dose 50u/1.0ml
booster 50u/1.0ml 6 months after 1st dose
Dosages for HEP B:
3 doses: 1st dose, 2nd at least 1 month, 3rd at least 5 (6 months from 1st dose)
*no max interval
When should immunity be checked for HEP B?
1-6months after 3rd dose
if failure to demonstrate protective level of anti-HBs f/u with possible further immunizations
Dosages for JE:
prior to going to endemic areas or have started series
3 doses 1.0ml sub q on days 0, 7, and 30
periodicity: every 3 years
Dosages for MMR:
live virus, all DOD/CIV
0.5ml sub q, one time only
What are the exceptions for administering MMR?
documented of 2 MMR doses
Serological immunity on MMR
Pregnant
How many days should women be advised to avoid of becoming pregnant?
28 days
Who is required to get HEP B?
high risk personnel, occupational exposure to blood, healthcare workers, all students in hospitals, persons in contact to sexually transmitted diseases, high-risk HEP B endemic areas
Dosages for meningococcal:
freeze dried, bacterial polysaccharides of serotypes
all AD traveling to endemic areas, 0.5ml sub q
Dosages for plague:
deploying to endemic areas,
- 0ml IM
- 2ml 1 month later
- 2ml 3-6 moths after 2nd dose
Dosages for polio:
inactivated poliovirus 0.5ml sub q
singled dose no booster
Dosages for rabies:
1.0ml IM human diploid cell on 0, 3, 7, & 14 days
Human rabies immune globulin (HRIG)
What are the species for consideration of post exposure prophylaxis (rabies vaccine)?
wild and tamed
What incident/circumstances is considered for administration of rabies vaccine?
provoked and unprovoked
bite, non bite (scratch/abrasion), exposure to saliva
Dosages for TDAP:
0.5ml IM all AD, every 10yrs
Dosages for typhoid:
overseas and deployed to endemic areas
0.5ml IM every 2yrs
Dosages for yellow fever:
live virus, all alert forces/AD traveling to endemic areas
0.5ml sub q every 10yrs
When should you discard yellow fever vaccine?
multi-dose vial after 1hr of reconstitution
How should you store yellow fever vaccine?
32-41F (0-5C)
What are the storage requirements for MMR?
46-58F, store in dark place, discard if not in use within 8hrs of reconstitution
What are the requirements for immunizations for members that deploy to an endemic area on very short notice?
administer 1st dose
make arrangements to complete series
Yellow fever immunization is required for Navy personnel assigned to units within how days of notification to deploy to yellow fever endemic areas?
10 days
Who is required to receive typhoid immunization?
alert forces: fleet units deployed scheduled or situational basis to foreign country
What are alert forces?
fleet units deployed scheduled or situational basis to foreign countries except Canada
What immunization is required for alert forces such as Navy + military sealift command + CIVMAR?
Typhoid
What immunization is required for medical department personnel assigned to Mobile Medical Augmentation Readiness Teams and others, including reservists subject to deploy? and within how many days of notification?
Typhoid
10 days
What is required to be provided information regarding certain immunizations prior to receiving it?
VIS- Vaccine Information Sheet
When should you provide VIS?
Immediately before the immunization or days before
What will providers use to provide patients information regarding immunizations prior to receiving it?
VIS only
Who are VIS prepared by?
Dept. of Health and Human Services, CDC + Prevention
What should you check for prior to administering immunizations?
allergies and hypersensitivities
If patients are hypersensitive to eggs what vaccines should you not administer?
vaccines prepared by cultivation:
Influenza
Yellow Fever
MMR (anaphylactic)
If a patient is Prego what is required prior to administering vaccines to include live vaccines?
if Prego exclude and refer to PCM
ask females if pregnant, pregnancy test not required
may administer live virus vaccines only if specified by provider, usually for traveling
When can Polio and yellow fever be administered to Prego patients?
when risks of contracting illness outweigh potential complications
What is the necessary equipment to treat anaphylactic shock?
O2 Administration apparatus Airways IV fluid apparatus Appropriate medications ACLS Defibrillator/cardiac monitor
In order to treat anaphylactic shock at an immunization site, what is required for a Physician, IDC, PA, Dentist, and Nurse to have?
BCLS required, ACLS preferred
May administer vaccine
Where should immunization clinics be located?
near ER or sickbay, or ready ambulance available with MTF Physician <10min away
Who selects members of the ACIP committee and what guidance do they use?
Secretary of Dept. of Hlth + Human Services
Under guidance to Ass. Secretary for Health + CDC Prevention on control of vax preventable diseases
What is the role for the Advisory Committee on Immunization Practices (ACIP)?
provide advice to reduce incidence of vaccine preventable diseases in the US and increase safe use
What is included in the ACIP written recommendations?
age for vaccine administration
# of doses and dosing interval
precautions + contraindications
When is it ok for Navy Immunization Programs to not follow recommendations from CDC and ACIP?
when there’s a militarily relevant reason to do otherwise
What instruction governs immunizations not to be given while underway?
COMNAVSURFORINST 6000.1 Sec. 5606
Why are routine immunizations not given while underway?
may lead to anaphylactic reactions
When can immunizations be given when at sea or ashore?
@ discretion of MDR and concurrence of CO
Which immunization can only be conducted in port during normal working hours and concurrence of local ISIC / RSG/Group MO/ or presence of an MO?
Yellow fever
What are the provisions of medical exemptions for specific vaccines?
contraindication relevant to a specific vaccine
may be temporary (up to 365 days)or permanent
PCM grants exemption
What are some medical exemption examples? and what is immunity evidence based off of?
underlying health condition
individuals clinical case is complex/not readily definable
immunity is evidence based on serologic test + documented infection
What are some types of immunization administrative exemptions?
separation/retirement within 180days if not deployed or mission essential
religious reason with CMD + medical/chaplain advice
What form is adult health record immunization record?
NAVMED 6230/4
What form is International Certificate of Vaccination?
PHS or CDC 731
What identifies and notifies personnel due for required/specific vaccinations?
IMMZ roster
Where do you record evidence of prior immunization or serological immunity for recruits?
NAVMED 6230/4
PHS 731
Electronic database
