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Hurricane Information Series


Recommended Vaccinations After A Disaster

The purpose of these recommendations is two-fold: First, 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. Second, 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 United States, but post-exposure prophylaxis in these settings would be logistically difficult and so vaccination is recommended.

 

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:

  • Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP)

  • Inactivated Poliovirus vaccine (IPV)

  • Haemophilus influenzae type b vaccine (Hib)

  • Hepatitis B vaccine (HepB)

  • Pneumococcal conjugate vaccine (PCV)

  • Measles-mumps-rubella vaccine (MMR)

  • Varicella vaccine unless reliable history of chickenpox

  • Influenza vaccine for all children 6-59 months of age, and all children 6 months through 10 years of age with an underlying medical condition that increases the risk for complication of influenza (MMWR 2006 Jul 28;55[RR10]:1-42).

  • As of May 2006, Hepatitis A vaccination is recommended for children 1 year of age and older in the United States (MMWR 2006 May 19;55[RR07]:1-23).

Children and adolescents (aged 11-18 years) should receive the following recommended immunizations:

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

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

  • Influenza vaccine for all children 6-59 months of age, and all children 6 months through 10 years of age with an underlying medical condition that increases the risk for complication of influenza (MMWR 2006 Jul 28;55[RR10]:1-42)
     

Adults (over 18 years of age) should receive the following recommended immunizations:

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

  • Pneumococcal polysaccharide vaccine (PPV) for adults 65 years of age or older or with a high risk condition (MMWR 1997 Apr 4;46[RR-08]:12-13)

  • Influenza vaccine (MMWR 2006 Jul 28;55[RR10]:1-42)
     

School requirements

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.

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 ( Public Shelters), unless the person has written documentation of having already receive them:

  • Influenza: everyone 6 months of age or older 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 (MMWR 2006 Jul 28;55[RR10]:1-42).

  • Varicella: everyone 12 months of age or older should receive one dose of this vaccine unless they have a reliable history of chickenpox or a documented record of immunization.

  • MMR: everyone 12 months of age or older and born during or after 1957 should receive one dose of this vaccine unless they have a documented record of 2 doses of MMR.

  • Hepatitis A: everyone 1 year of age or older 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.

Diarrheal diseases

Vaccination against typhoid and cholera are not recommended. Both diseases are extremely rare in the United 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  prevention or protection (e.g., after an animal bite or bat exposure) according to CDC guidelines.

Questions and Answers About Immunization Recommendations Following a Disaster

How will evacuation centers receive adequate vaccine to immunize evacuees?

CDC will work with immunization program and other public health staff in each state where there are evacuation centers to coordinate with staff at the evacuation centers, staff deployed from CDC, and others, about administering vaccine in the evacuation centers.

Why vaccinate individuals in crowded group settings with hepatitis A vaccine but not the emergency responders?

For PERSONS RESPONDING TO THE DISASTER, the risk of getting the disease is extremely low, and so the vaccine is not recommended for them.

For PEOPLE LIVING IN THE IMPACTED AREAS, the issues are different. For example, people will likely live together in crowded conditions for a long time. In such conditions, hepatitis A may be transmitted from person to person.

In addition, persons living in evacuation centers will continue to circulate in the community and might be exposed to hepatitis A during daily activities. Vaccinating in evacuation centers may lessen the scope of a possible outbreak and save on post-exposure treatment for persons exposed to cases.

Will persons who have not completed the entire hepatitis B vaccine series be protected against the virus?

About 75-80% of adults who have received 2 valid doses of vaccine have developed a protective antibody level. Standard precautions to protect against exposure to blood or blood-containing fluids should be used. If a responder who is not fully vaccinated comes into contact with blood or body fluids, post exposure precautions  should be taken according to previously published recommendations http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm .

Is it okay to get the hepatitis A vaccine around the same time as the hepatitis B vaccine?

Hepatitis A vaccine and hepatitis B vaccine do not interfere with each other and are often given together. However, hepatitis A vaccine is not one of the vaccines routinely recommended for responders.

What vaccines are recommended for evacuees of a disaster?

The major concern for anyone exposed to unsanitary conditions is that they be up to date with tetanus-containing vaccine, because if they are injured (as is common in disaster settings) the injury is likely to be contaminated. Routinely recommended vaccines are recommended for evacuees, just like they are for everyone else.

What immunizations should be offered/administered to a person who was displaced by a disaster and was not able to recover their original vaccination records?

Providers seeing persons displaced by a disaster should follow CDCís recommendations issued in September 2005 for those persons who were not able to recover documentation of immunizations.

Thus:

  • Children aged 10 years and younger should be treated as if they were up-to-date for their age and given any doses recommended for their current age and not received in the interim. (This guidance applies to any child except when there is information, e.g., parental report, that the child was not up-to-date.)

  • Children/adolescents aged 11-18 years should receive recommended vaccines (Tdap, MCV, and influenza if indicated) if not already received.

  • Adults should receive Tdap, PPV, and influenza vaccines (if indicated)

  • In addition, any displaced person living in a crowded group setting should receive influenza, varicella, MMR, and hepatitis A vaccines. Immunocompromised persons in these settings should not receive the live virus vaccines MMR and varicella.
     

I evacuated before a hurricane struck but hope to go home soon. Are there any special vaccination recommendations for me?

There are no special vaccination recommendations for persons returning to their homes in the disaster area. However, you should get a booster dose of tetanus-diphtheria toxoid (Td) if you have not had a booster dose within the last 10 years. Td boosters every 10 years are recommended for all adults routinely; the concern in this setting is that clean-up and repairs present an increased risk of injury and tetanus from such injuries is preventable by vaccination. Children and adolescents 11-18 years should receive the new pertussis-containing Tdap rather than Td if this is available.

What if I do not know if I ever received any tetanus-diphtheria toxoid?

Persons who did not receive DTP or DTaP as a child, or whose tetanus vaccination history is not known should receive a primary series of three doses of adult Td. The first two doses should be separated by 4 weeks and the third dose should follow the second by at least 6 months. For persons 11-64 years of age Tdap may be substituted for ONE of these doses, preferably the first dose. Tdap should be substituted for ONE of these doses for persons 11-18 years of age.

What is the immunization guidance for child evacuees entering school?

As a result of a disaster, many school-age children may be displaced from their schools to other schools away from home. To facilitate school enrollment for child evacuees, some states may opt to waive their school entry immunization requirements for these children. CDC has indicated its support for these actions and ASTHO encourages states to consider waiving school entry requirements as the situation warrants, consistent with state laws.

Information Courtesy of the CDC

 

 




 

 

 


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