TG 300 ATTACHMENT A

IMMUNIZATIONS
Immunizations for Peace Corps Volunteers Indications and Administration
Vaccine Encephalitis, Japanese (JE) Indications All Volunteers serving in endemic areas Primary Series 1.0ml SC day 0, 7, 30 Booster 1.0ml SC every 3 years Precautions † / comments Delayed hypersensitivity may be seen up to 10 days later Local or mild systemic reactions in 20% Encephalitis, Tick-Borne (TBE)
IMMUNO

High risk of exposure to ticks in an endemic area (see text)

0.5ml IM months 0, 1, and 10-12

0.5ml IM every 3 years

Egg anaphylaxis, thimerosol anaphylaxis Immuno (Austrian) vaccine is effective and well tolerated

Hepatitis A

All Volunteers 1.0ml IM months 0, 6 plus IG 2.0ml IM for rapid protection (see text) 5ml (0.06ml/kg) IM repeat every 4 months none after 2nd dose Prior allergy to hepatitis A vaccine, alum, 2phenoxyethanol Occasional local or mild systemic reactions Prior allergy to immune globulin; give more than 3 months before, or 14 days after, MMR Mild local reaction common 1.0ml IM (deltoid): months 0, 1, 6 none Prior allergy to hepatitis B vaccine Occasional local or mild systemic reactions

Hepatitis A vaccine GLAXO-SMITH-KLINE (HAVRIX) MERCK (VAQTA)

Immune globulin (IG) IG use in Peace Corps is limited to rapid protection for 1 month after Hepatitis A vaccination or for persons allergic to Hepatitis A vaccine. Hepatitis B GLAXOSMITHKLINE MERCK PASTEUR

All Volunteers except: Serologic evidence of immunity (see text) Also: if occupational risk of blood exposure, measure antibody level 1-6 months after series Age ≥ 50 Asthma, diabetes, chronic conditions1 1 Health care workers

Influenza

0.5 ml IM annually (Sept/Oct for Northern Hemisphere)

repeat annually

Egg anaphylaxis, prior vaccine-induced GuillainBarre. Local reactions common, occasional mild systemic

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TG 300 ATTACHMENT A

Vaccine

Indications

Primary Series

Booster Give 0.5ml SC to all Volunteers except those meeting criteria listed. no further boosters necessary

Precautions † / comments Pregnancy, immunosuppression, neomycin anaphylaxis, gelatin anaphylaxis, egg anaphylaxis. Fever 5-12 days later in 15%. rash in 5%; arthralgias or arthritis some women 2 delay PPD testing for 4-6 wks, interacts with IG

All Volunteers except: If never immunized and Measlesborn in or after 1957: Mumps-Rubella Age ≥ 50 (MMR) Documented 2 doses of 0.5ml SC months 0,1 MMR Serologic evidence of immunity (see text).

Meningococcal Meningitis A, C, Y, W-135 Pneumococcal Pneumonia 23-valent

All Volunteers in endemic or epidemic areas.

0.5ml SC (1 dose)

every 3 years

Pregnancy (consider risk/benefit) Local mild reactions seen

Age ≥ 65 Surgical or functional asplenia. At risk for infection or complication. 3 All Volunteers: one dose of IPV booster if serving in an endemic area.

0.5ml IM or SC (1 dose) repeat after 5 years if asplenic, or for several other conditions 4

Pregnancy (consider risk/benefit) Local reactions common, occasional mild systemic

Polio

Inactivated Polio Vaccine (IPV)

0.5ml SC months 0, 1, and 2 if prior vaccination in doubt

0.5ml SC once as an adult

Anaphylaxis to neomycin, streptomycin, polymyxin well tolerated

Rabies (preexposure)
HDCV

REQUIRED: 1.0ml IM only: highly endemic areas days 0, 7, 21 and/or inadequate access (or days 0, 7, 28 5 ) to post-exposure series OPTIONAL: developed countries with adequate access to post-exposure series and rabies immune globulin COMPLETED PREEXPOSURE: 2 doses 1.0ml IM: days 0, 3 INCOMPLETE OR NO PREEXPOSURE: HRIG 6 plus 5 doses IM: days 0, 3, 7, 14, 28

PCEC
RVA

Reassess every 2 years. Check antibody titer if risk will be frequent. 1.0 ml IM only if antibody titer <1:5

Egg anaphylaxis for PCEC, anaphylaxis or type II reaction to prior vaccine Steroids and immunosupressives interfere with response

See text for postRabies (postexposure) exposure recommendations
HDCV

N/A

As for pre-exposure vaccine

PCEC
RVA

Clean wound with soap and water

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TG 300 ATTACHMENT A

Vaccine Tetanusdiphtheria (Td) Tetanusdiphtheriapertussis (Tdap) Typhoid

Indications All Volunteers must have received Td or Tdap within 2 years of start of Peace Corps service All Volunteers except in low risk countries

Primary Series Doses given at 0, 1, and 7-12 if prior vaccination in doubt. Tdap can be substituted for any one of the three Td doses in the series.

Booster Dose given if > 2 yrs since last dose (assures maximum protection for at least 3 more years) 7

Precautions † / comments Prior severe hypersensitivity or neurologic reaction Local reactions common. Use Td in adults (not DT or tetanus toxoid alone)

ViCPS (Typhim Vi) Ty21a (oral typhoid vaccine)

0.5ml IM (one dose) 1 capsule with cool liquid on days 0, 2, 4, 6

0.5ml IM every 2 years Hypersensitivity to ViCPS Mild local reactions seen repeat every 5 years Delay if experiencing GI illness or if on antibiotics; give 24 hrs before or after mefloquine or Diamox Infrequent nausea, abd. cramps ENSURE COLD CHAIN; DO NOT FREEZE

Heat/phenol killed vaccine

0.5ml SC days 0, 30

0.5ml SC every 3 years Prior severe reaction to heat/phenol killed vaccine

Yellow Fever

All Volunteers in endemic areas or those requiring vaccination entry into country of service

0.5ml SC (one dose)

every 10 years

Pregnancy, immunosupression, egg anaphylaxis, age <6 mo; do not use within 3 wks of cholera vaccine <5% mild systemic reactions STORE FROZEN- USE WITHIN 1 HOUR

Precautions: Do not administer this vaccine if any of the listed conditions are present. Consult OMS to review the risks and benefits, which may include vaccination after informing the Volunteer of the risks and benefits or transfer or medical separation to avoid exposure to this disease. NOTES ON SPECIFIC VACCINES: 1 Chronic cardiovascular, pulmonary disease, renal, immunologic, or metabolic disorders. 2 Up to 40% of non-immune women may develop arthralgias, sometimes with persistent joint pains, due to rubella vaccine. Does not occur in those already immune to rubella. 3 Chronic cardiovascular, pulmonary disease (but not asthma), renal, immunologic, or metabolic disorders. 4 Chronic renal failure, nephrotic syndrome, or organ transplant. 5 Third dose can be given anytime on or after day 21. 21 day schedule recommended for areas where Trainees may be exposed soon after arrival. 6 Human Rabies Immune Globulin 20IU/kg body weight; as much infiltrated at bite site as possible, remainder IM 7 Generally, Td booster is given every 10 years, however booster indicated every 5 years if a dirty wound occurs.

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TG 300 ATTACHMENT A

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