Army Action Plan: Standard Operating Procedures for Vaccinations

VACCINATIONS SOP:141 Page 1 eV
DETAINEE HOSPITAL SOP NO: Ni GUANTANAMO BAY, CUBA
Title: VACCINATIONS
_ Pap 1 of 7
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Meth* Date: 15 Oct 2113
SCOPE: Detention Hospital
L REVERENCES:
(1)
Prevention and Control of infections with Hepatitis Viruses in Correctional Setting. MMWR, January 24, 2003. vol 52, RR-1. SOP Enclosure Hepatitis

(2)
Mendes, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps. MMWR, May 72, 1991, vol 47, No. RR-1. SOP Enclosure MMR

(3)
Prevention and Control of Influenza MMWR, 2003, vol 52. RR-011. E112121inkfteem

(4)
Prevention of Pnewnocoocal Disease, MMWR, 1997, vol 46, RR -08. figE &clones Pnetnnocoxid Vaccing

(5)
Vaccine Management Recommendations for Handling and Storage of

Selonted Biologicah, Owen for Disease Control and Prevention, Jan 2001.EzEgismigivErauradminmEd

(6)
Recommended Adult ha:nu:A:ration Schedule — United States, 2002-2003, JAMA 2002, vol 21111, p 2251-60.

IL BACKGROUND:
Detainees arrive from areas in which childhood vaccinations may not have been received, making them susceptible to several infectious diseases, including tetanus, diphtheria, measles, mumps and rubella. In addition, within the close living conditions of a detention environment, detainees may be at risk for the aforementioned diseases as well as hepatitis, influences, and pneumococcus. These diatoms can cause outbreaks in non­immune populations making the need for mass immunization in important public health
mattes...
PURPOSE:
To define policies and procedures for detainee vaccinations, both during in-processing
Y. and during their time within the camp.
VACCINATIONS SOP: 041 Page 2 of 7
IV. PROCEDURES:
A. Tetanus-diphtheria:
1.
Each detainee will receive a single dose of Tetanus-diphtheria (Td) upon arrival, which will occur during the in-processing evolution (See SOP 037: In-processing Afedkar Eraloadan).

2.
Two additional doses of Td will be given so detainees at 1-2 months miter the first shot and then again 6-12 months later.

3.
Dose is administered IM (innarnuscolatly).

4.
Detainees deficient in the ntmtber of Td injections (3 doses obtained) will be given a dose of Td during out-processing if the vaccine is due at dot time.

S. Detainees sustaining a tetanus prone wound will be assessed by medical per SOP 024: Teraina Prophylaxis lxJTFDetalnser.
•
6. A Td booster every 10 yeas will be offered for those completing the 3-dose primary aeries.
B. Hepatitis:
I. Immunity to hepatitis A and B for each detainee will be ascertained
chain in•ptomains by drawing a Hepatitis A IgG level and Hepatitis --B core and imam antibody testa
Those found to be immune to both hepatitis A and B will not receive
hepathis vaccination.
3.
Those immure to hepatitis A, but non-immune to hepatitis B will felleiv. the 3-dose hepatitis B vaccine series given at 0, I. and 6 months. This will be given in an involuntary manner to protect detainees from

acquisition of hepatitis B.

4.
Those immune to hepatitis B, but non-immune to hepatitis A will receive the 2•dose hepatitis A vaccine series given at 0 and 6 months. This will be given in an involuntary manner to protect detainees from acquisition of hepatitis A.

5, Those non-immune to both hepatitis A and hepatitis B will receive the 3-dose hepatitis A and B vaccine (twirebt) series given at 0. 1, and 6 month-ft. This will be given in an involuntary Manner to protect detainees from acquisition of both hepatitis A and B.
6.
Hepatitis B vaccine is given by IM injection into the deltoid (not in buttocks). He otitis A vaccine and twinrix (combined Hepatitis A and B vaccine) are also given IM.

7.
Then for response will not routinely be checked.

•

8.

Possible side effects of hepatitis A vaccination include soreness at the
injection site headache, and malaise; no serious reactions have been
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VACCINATIONS SOP: 041 Page 3 of 7
reported. Giving the vaccine to a person who is already immune to hepatitis A don not appear to increase the risk of side effects.
9.
Contraindications for hepatitis A vaccination Include art adverse reaction to prior hepatitis A vaccination.

10.
Possible side effects of hepatitis B vaccination include soreness at the intend= site, fever, and imaphylaxis (1/600,000). No deaths have been reported. Giving the vaccine to a person who is already immune to hepatitis B does not appear to blame the risk of side effects.

11.
Contraindications for hepatitis B vaccination Include an adverse reaction to prior hepatitis B vaccination

12.
Those with a serious adverse reaction to vaccination will be reported to Vaccine Adverse Events Reporting System (VAERS) and the vaccine series will be discontinued.

13.
For Anther informed= regarding hepatitis vaccinations see End 1.

C. Measles•Mumps-Rubella (MMR):
1.
Detainees from de‘nloping am:tries am unpredictably vaccinated and documentation of prior natural infortices is not available; hence, detainees may remain at risk for these infectious diseases unless vaccinated. The CDC recommends that adults without documentation of ieceipt of MMR vaccine should receive one dose of MMR vaccine.

2.
Each detainee who does not have a contraindication for vaccination will receive a single-dose of MMR (0.3m1 subcutaneously) on an involuntary basis for protection of mules, mumps and rubella. This it important for the individual protection of detainees as well as the public health of the Camp.

3.
The MMR vaccine is a live-virus vaccine and is cootraindicated in pregnant females and the Immunocompromised. Additional . considerations for this vaccine are as follows:

a) Each detainee will be screened for HIV upon arrival using a HIV ELISA test. Those who are seronegative and do not have other contraindications for vaccination (immunosuppressed, chemotherapy, steroids or other immunosuppressants) will receive a dose shortly after entrance into -the camp.
b) Any detainee who received immune globulin or blood .traneltalon should wait 3-I I months for vaccination since these products may blunt the immune response to MMR.
• PPD's should be placed prior to or simultaneously as vaccination
. with MMR. since the MMR can interfere with the immune response to PPD. Otherwise, the PPD should not be placed for4-6 weeks after MMR vaccination.
00Slip2,

VACCINATIONS SOP: 641 Page 4 of 7
(1) Allergies to neomycin or gelatin are contraindications to MMR vaccination; each detainee abould•be asked about previous severereactions to vaccinations.
4. Potential adverse events to vaccination may include local pain or edema in the area of the vacchudion, fever, nab, or local temporary lymphadenopathy. Uncommon reactions would be joint pain or reactions such as a seizure caused by fever. Earamely rare reactions may include ansphybutis (1 arse per 1 million domes adminiataed), low platelets (1:100,000), or mmingitislencephalids (1 case in 2 milliondoses). See End 2.
S. Each medics! pasoimel should be aware of these potential side effects when assessing detainees during the 1-2 weeks after vaccination. Serious reactions will be reported to the chain of command and to
VAERS. •
D. Infiuenza:
•
1. Each detainee will invohmtarily receive a single-dose of influenza
vaccine during in-processing. .
2.
Each detainee will also involuntarily receive annual vaccinations duringthe months of October-December.

3.
-Dose is 0.5m1 RA.

4.
Side of include local pain or swelling; fever and myalgias may occur. Very rarely aniphyhmis has been reported. Allergic reactionsare uncommon and may be related to an allergy to eggs.

5.

Contraindication to vaccination includes significant adverse reactions toa prior influenza vaccine or allergy to eggs. •
6.
For Anther information, RC Encl 3 and the CDC Influenza vaccine
information attremcdcbsextuggs.
E. Pneumococcal:
1.
Those detainees meeting the Advisory Committee on Immtmizadon Practices (ACIP) criteria to receive the.pneumococcal vaccination willbe offered this vaccine on a voluntary basis.

2.
Indications for vaccination include age)-65 years, chronic medicalconditions involving the heart. lung. liver. kidneys (ESRD. nevihrodc

3.
Don is 0.5 •ml subcutaneously as a single date.

syndicate) as well an diabetes, cancer, sickle cell disease,humunadeficialey, and unlade.
w
VACCINATIONS

SOP: S4l • • • Pages et 7
4.
Side efforts are typically nand and may include local soreness, erythuns
or edema Rarely fever nod mysigias may.occur • Very rarely
anaphylmds his beenreported.
S. Revnedrition x jailer 5 yam erthe %bird dont will beeffeeed
to
those who're 'realm den age 65 'vita, imunswocenpment patients with anstomictfunctipad **Ionia, as wall as to immunocoMpromised
_
pumas due in Ff/V-infeether. mains* or DOOM& frOdgOOKk
Cseuntinclication includes prior adverse nation to the pneumoccocal
vaccine.
7. See End 4 fir Anther. ilformetion.
F. Vaccine Advasu Reactions:
I. Medical
Ponosl
inuniallately meals any detainee having a possibleOver* raged°. to vaccination.
2. Serious reactions will ripened to Vaccine Adverse Events ReportingSystem (YAERS) I l400422.-7967] mod the vaccine series will be
discontimed.
3. Reactions to vaccines wilt be dearly recorded within the detabwe's medal record and the diain of commend wilt be nodded of the adverb:
event. •
0. Strategies to fncilitate vaccine adininistration in Camp Delia include:"
•
1.
Deese Wee 1D *gibes° team* required Vaccines for eachdetaineo since not all detainees receive the wine shots at the same times. Included in this database is the dote of administration and lot number of vaccine,which is also recorded in thet medial record. The haesnal Medicine/II:Wines Disease physician maintains this database.

2.
Prior to the =anise, a brief should be perfonued refording the plan,

proper arksInisteationflundUsivatonse of the vnazine, and
effects. potential Me
3. Continuous commodcation should be maintained with JDOO for
orgenbation of the vaccine program in ier1111 of the cloy of thefeminization exercise, her schedded camp activities, movement within the amp. blocks to begin with, appropriate medical escorts, etc.
-4. any brvolvancnt with the linguists to announoe two to three days in advance of the uneonths immunization; emphasizing the reasons for the
vaccine and the benefits offered to esch deudnec.
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VACCINATIONS

SOP: NI Page 6 of 7
5• Supplies inchackc syringes, alcohol swabs. appropriate vaccine storage contain= (ca ice Wcold chain required), 2x2 density, bends situps csontear, gloves, sal an alpha roster of detainer. requiring
intiumization.
6.
hail prier to the enerclee. empastion of syringes with vaccine =bath* appropriate cold clan storey Vindicated.

7.
Following completion of the totercise, the immunizations will beanusibed from the database to the medial mcord.

S. Personnel required for imnruniation exercises
a) A num coordinatcr to organize the corpsman and vaccine
supplies
b) Taunsconstacted donsisting of four individual!" (1-2 to administer vaccines, 1 kr orgabstion of =Wien, and for administrative purposes' to iog immoniationa). Linguists should
be available to insist at needed.
C) An ackapate amnbur of corpsmen and mum Mom Detention hospital, the Joint AM Station. and N1I-Prev Med) to administer Acs amines sod to then record all the shots in both the medical
records and the dumbest,.
F. Reporting Reqtdroments: at the and of mirk month the NCO of the SI Processing
Line in an. di* of •
Disease database. TiteS I is
G. Vaccine Information:
.
1.
CDC, Nations! Immuniation Program: azwa csexage

2.
Retbrence 1.

3.
FDA. Vaccine Adverse Reactions: 1400422-7967 or

4.

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Naiad. Network Immunization Information: S77-3414644 or
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VACCINATIONS • SOP: 941 Pup 7.f 7
STANDARD OPERATING PROCEDURES Detention Hospital Guantwaroo
Cuba
REVIEWED AND APPROVED BY:
Officer In Charge
IMPLEMENTED BY
Director for Administration Date
Senior Enlisted Advisor
Date
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