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 displaced children and adults. 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.
If
immunization records are not available:
Children
aged <6 years
of age should be forward vaccinated. They 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 if no history of chickenpox
- 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). www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
- 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:
- Adult
formulation tetanus and diphtheria toxoids and acellular pertussis vaccine
(Tdap)
- Meningococcal
conjugate vaccine (MCV (ages 11-12 and 15 years only)
- Influenza
vaccine if in Tier 1* (MMWR 2005;54:749-750) www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
Adults
(aged >18 years) should
receive the following recommended immunizations:
- Adult
formulation tetanus and diphtheria toxoids (Td) if >10 years since
receipt of any tetanus toxoid-containing vaccine
- Pneumococcal
polysaccharide vaccine (PPV) for adults ≥65 years or with a high
risk condition (MMWR 1997;46(No. RR-8):12-13)
- Influenza
vaccine if in Tier 1*(MMWR 2005;54:749-750). www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
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 displaced person living in crowded
group settings:
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.
Varicella
Everyone >12
months of age and born in the United States after 1965 should receive one done
of this vaccine unless they have a history of chickenpox.
MMR
Everyone >12
months of age and born after 1957 should receive one dose of this vaccine.
Hepatitis
A Everyone >2 years of age should receive one dose
of hepatitis A vaccine unless they have a clear history of hepatitis A.
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 Gulf States, and there is no vaccine against cholera licensed for
use in the United States.
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). www.cdc.gov/mmwr/preview/mmwrhtml/mm5434a4.htm
Tier 1 recommendations include the following priority
groups:
- Persons
ages >65 years with comorbid conditions
- Residents
of long-term care facilities
- Persons
aged 2-64 years with comorbid conditions
- Persons >65
years without comorbid conditions
- Children
aged 6-23 months
- Pregnant
women
- Healthcare
personnel who provide direct patient care
- Household
contacts and out-of-home caregivers of children aged <6 months.
This
document is also available online at http://www.bt.cdc.gov/disasters/hurricanes/katrina/vaccrecdisplaced.asp
