Thursday, September 8, 2005

CDC Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina

The purpose of these recommendations is two-fold:

  1. To ensure that children, adolescents, and adults are protected against vaccine-preventable diseases in accordance with current recommendations. Immunization records are unlikely to be available for a large number of adult and child evacuees. It is important that immunizations are kept current if possible.

  2. To reduce the likelihood of outbreaks of vaccine-preventable diseases in large crowded group settings . Although the possibility of an outbreak is low in a vaccinated U.S. population, it is possible that outbreaks of varicella, rubella, mumps, or measles could occur. Although measles and rubella are no longer endemic to the United States, introductions do occur, and crowded conditions would facilitate their spread. Hepatitis A incidence is low in the affected areas, but post-exposure prophylaxis in these settings would be logistically difficult and so vaccination is recommended. In addition, the influenza season will begin soon and influenza can spread easily under crowded conditions.
I. Recommended Immunizations
If immunization records are available:
Children and adults should be vaccinated according to the recommended child, adolescent, and adult immunization schedules.
See:

  1. Childhood and Adolescent Immunization Schedule .

  2. Adult Immunization Schedule
If immunization records are not available:
Children aged 10 years and younger should be treated as if they were up-to-date with recommended immunizations and given any doses that are recommended for their current age. This includes the following vaccines:

  1. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP)

  2. Inactivated Poliovirus vaccine (IPV)

  3. Haemophilus influenzae type b vaccine (Hib)

  4. Hepatitis B vaccine (HepB)

  5. Pneumococcal conjugate vaccine (PCV)

  6. Measles-mumps-rubella vaccine (MMR)

  7. Varicella vacci ne unless reliable history of chickenpox

  8. Influenza vaccine if in Tier 1.* This includes all children from 6-23 month and children up to age 10 with a high risk condition (MMWR 2005;54:749-750). See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm

  9. Hepatitis A is not routinely recommended in all states; state immunization practice should be followed.
Children and adolescents (aged 11-18 years) should receive the following recommended immunizations:

  1. Adult formulation tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)

  2. Meningococcal conjugate vaccine (MCV (ages 11-12 and 15 years only)

  3. Influenza vaccine if in Tier 1* (MMWR 2005;54:749-750) See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
Adults (aged >18 years) should receive the following recommended immunizations:

  1. Adult formulation tetanus and diphtheria toxoids (Td) if = 10 years since receipt of any tetanus toxoid-containing vaccine

  2. Pneumococcal polysaccharide vaccine (PPV) for adults > 65 years or with a high risk condition (MMWR 1997;46(No. RR-8):12-13), http://www.cdc.gov/mmwr/preview/mmwrhtml/00047135.htm

  3. Influenza vaccine if in Tier 1 * (MMWR 2005;54:749-750). See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
School requirements
States affected by Hurricane Katrina had immunization requirements for school and daycare and it is likely that children enrolled prior to the disaster would be vaccinated appropriately. It is not necessary to repeat vaccinations for children displaced by the disaster, unless the provider has reason to believe the child was not in compliance with applicable state requirements.
II. Crowded Group Settings
In addition to the vaccines given routinely as part of the child and adolescent schedules, the following vaccines should be given to evacuees living in crowded group settings, unless the person has written documentation of having already receive them:

  1. Influenza. Everyone > 6 months of age should receive influenza vaccine. Children 8 years old or younger should receive 2 doses, at least one month apart . , unless they have a documented record of a previous dose of influenza vaccine, in which case they should receive 1dose of influenza vaccine

  2. Varicella. Everyone > 12 months of age should receive one dose of this vaccine unless they have a reliable history of chickenpox or a documented record of immunization.

  3. MMR. Everyone > 12 months of age and born during or after 1957 should receive one dose of this vaccine unless they have a documented record of 2 doses of MMR

  4. Hepatitis A. Everyone > 2 years of age should receive one dose of hepatitis A vaccine unless they have a clear history of hepatitis A or a documented record of immunization.
Immunocompromised individuals, such as HIV-infected persons, pregnant women, and those on systemic steroids, should not receive the live viral vaccines, varicella and MMR. Screening should be performed by self-report.
Documentation
It is critical that all vaccines administered be properly documented. Immunization records should be provided in accordance with the practice of the state in which the vaccine is administered. Immunization cards should be provided to individuals at the time of vaccination.
Standard immunization practices should be followed for delivery of all vaccines, including provision of Vaccine Information Statements ( http://www.cdc.gov/nip/publications/VIS/default.htm).
Diarrheal diseases
Vaccination against typhoid and cholera are not recommended. Both diseases are extremely rare in the Gulf States, and there is no vaccine against cholera licensed for use in the United States .
Rabies
Rabies vaccine should only be used for post-exposure prophylaxis (e.g., after an animal bite or bat exposure) according to CDC guidelines.
*Influenza Tier 1 (MMWR 2005;54:749-750). See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
Tier 1 recommendations include the following priority groups:

  1. Persons ages > 65 years with comorbid conditions

  2. Residents of long-term care facilities

  3. Persons aged 2-64 years with comorbid conditions

  4. Persons > 65 years without comorbid conditions

  5. Children aged 6-23 months

  6. Pregnant women

  7. Healthcare personnel who provide direct patient care

  8. Household contacts and out-of-home caregivers of children aged <6 months
http://www.bt.cdc.gov/disasters/hurricanes/katrina/vaccrecdisplaced.asp

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