BUMEDNOTE 6230, IMMUNIZATION REQUIREMENTS AND RECOMMENDATIONS

Question 1

BUMEDNOTE 6230

Answer 1

Immunization requirements and recommendations

Question 2

Yellow Fever

Answer 2

$212 per vial

Question 3

Meningococcal

Answer 3

$450 per vial

Question 4

Typhoid Vi

Answer 4

$750 per vial

Question 5

live vaccine

Answer 5

mmr, yellow fever, smallpox, varicella,Flu mist, opv and oral typhoid

Question 6

Inactivated Vaccines

Answer 6

Anthrax, Hep a and hep b , twinrix, ipv, influenza, tetanus, typhoid menningococcal/pneumococcal, JEV, and rabies

Question 7

Vaccine Rules

Answer 7

ASK about ALLERGIES, most live vaccines can be given on same day, if not on same day, separate by at least 30 days.

Question 8

Vaccine Rules

Answer 8

No more than 5 vaccines given per day. Separate inactivated vaccines by at least a week

Question 9

Vaccine Rules 2

Answer 9

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).

Question 10

Vaccine Rules 3

Answer 10

Administrative vs. Medical Exemption,VAERS Form and VIS availability

Question 11

Storage Life

Answer 11

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

Question 12

anthrax

Answer 12

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

Question 13

Algorithm for Severe Allergic Reactions to Anthrax Vaccine

Answer 13

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.

Question 14

Hepatitis A

Answer 14

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

Question 15

Hepatitis B

Answer 15

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

Question 16

Twinrix (Hep A & Hep B)

Answer 16

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)

Question 17

Human Papillomavirus (HPV

Answer 17

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

Question 18

Influenza

Answer 18

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.

Question 19

smallpox

Answer 19

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.

Question 20

Tetanus (Td)

Answer 20

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

Question 21

Typhoid Vi

Answer 21

Inactivated vaccine
Dose/Route: 0.5 mL, IM
One dose confers immunity; booster every 2 years.

Question 22

Varicella

Answer 22

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

Question 23

Yellow Fever

Answer 23

Live vaccine
Dose/Route: 0.5 mL, SC
One dose confers immunity. Boosters are given every ten years.

Question 24

Cholera/Plague

Answer 24

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.

Question 25

PPDs

Answer 25

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.

Question 26

PPDs CONT.

Answer 26

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

Question 27

Refrigerator Temperatures

Answer 27

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).

Question 28

Pregnancy

Answer 28

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.