In addition to the basic immunizations the following immunizations are suggested for certain students and staff, as indicated. They are:

• Influenza
• Pneumococcal Polysaccharide
• Haemophilus Influenzae Type B (Hib)
• Varicella
• Hepatitis A
• Immunization/Prophylaxis to be Used at the Time of Exposure to Certain Diseases
  • Meningococcal Infection
  • Tetanus Prophylaxis in Wound Management
  • Rabies Prophylaxis: Treatment of Persons Bitten by Animals

Influenza Vaccine

Annual vaccination for influenza is strongly recommended for students who are at increased risk of adverse consequences from infections of the lower respiratory tract. All other students may be considered for vaccination to minimize the disruption of routine activities during outbreaks or epidemics.

Considerations involving the use of influenza vaccine are as follows:

• Vaccination should be done annually, using the vaccine prepared for the current year. Each year's vaccine contains three virus strains most likely to circulate in the upcoming winter.
• Adults and children over 9 years need only one 0.5 ml IM dose of vaccine. The recommended site of vaccination is the deltoid muscle.
• Vaccination of HIV-positive persons is considered a prudent precaution against more serious illness and complications arising from influenza infection.
• Influenza vaccine is generally considered safe for pregnant women. Administering the vaccine after the first trimester is a reasonable precaution to minimize any concern over the theoretical risk of teratogenicity.
• Individuals with a history of sensitivity to eggs or chick protein should not be given the vaccine.
• Centers may elect to vaccinate all consenting students and staff in an effort to reduce the incidence, lessen the severity, and shorten the duration of cases which may be expected to occur during the influenza season.
• The vaccine may be offered to persons presenting for care beginning in October (but not until the new vaccine is available), and continuing through the influenza season.

In the case of a widespread outbreak or community epidemic, center health staff may consider the use of amantadine or rimantadine for prophylaxis and/or treatment of influenza. In a nationwide epidemic, the National Office will provide current recommendations and instructions.

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Pneumococcal Polysccharide Vaccine

The recommended immunization is a single IM dose of the currently available polyvalent pneumococcal vaccine. This vaccine can be given at the same time as the influenza vaccine. Re-vaccination is advisable 5 years after initial vaccination because of declining antibody levels.

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Haemophilus Influenzae Type B (HIB)

Most healthy persons are not at increased risk of invasive Hib disease. Invasive disease occurs primarily among adults with chronic disease and persons with underlying conditions that predispose to infections with encapsulated bacteria, especially persons with HIV infection. Because of this risk, immunization with the Haemophilus influenzae type b conjugate vaccine (HbCV) is recommended for students with HIV infection.

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Varicella

Approximately 20 percent of U.S. adolescents are susceptible to varicella infection (chickenpox). The complication risk from varicella is greatest for individuals age 15 and older. Varicella vaccine is administered in two 0.5 ml doses subcutaneously (SC) 4 to 8 weeks apart for persons age 13 and older. Contraindications include pregnancy and immunosuppression as this is a live, attenuated viral vaccine.

Centers may elect to offer varicella vaccine as an option for all students with no reported history of chickenpox in locations where the vaccine is available at no cost from public sources. Serologic screening is not cost effective in this circumstance.

Outbreaks of varicella on center should be managed with initial isolation, followed by medical leave at home until all lesions have crusted and dried, usually within 1 week.

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Hepatitis A

Indications for hepatitis A vaccine among Job Corps students include chronic liver disease, administration of clotting factors, illicit drug use, and homosexually active males. The vaccine is available in a two-dose regimen, given 6 to 12 months apart. Postexposure immunoprophylaxis is available with immune globulin 0.02 ml/kg deep IM.

Centers may elect to offer hepatitis A vaccine as an option for all students in locations where the vaccine is available at no cost from public sources.

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Immunization/Prophylaxis to be Used at the Time of Exposure to Certain Diseases

 Meningococcal Infection

Neisseria meningitidis is the leading cause of bacterial meningitis in older children, adolescents, and young adults. Incidence peaks in late winter and early spring, and the case fatality rate is 13 percent with meningitis and 11.5 percent with meningococcemia. Meningococcal antimicrobial prophylaxis should be administered to close contacts within 24 hours of index case identification. Alternatives include rifampin 600 mg by mouth every 12 hours for 2 days (four doses), ciprofloxacin 500 mg by mouth once or ceftriaxone 250 mg IM once. Nasopharyngeal cultures are not indicated, and prophylaxis is of no value more than 14 days after index case identification.

A quadrivalent polysaccharide meningococcal vaccine is available as a single 0.5 ml subcutaneous (SC) injection. Protective levels of antibody are achieved in 7 to 10 days, but antibody titers markedly decline over 3 years. Centers should consult with State/local health authorities before considering the use of meningococcal vaccine in an outbreak or cluster.

Centers may elect to offer meningococcal vaccine as a preventive option for all residential students in locations where the vaccine is available at no cost from public sources.

Tetanus Prophylaxis in Wound Management

The physician often needs to consider active and passive immunization as part of wound management. The decision to immunize should be based on the history of previous tetanus vaccinations and the condition of the wound.

Available evidence indicates that antibodies persist at protective levels for at least 10 years after a primary series of tetanus toxoid immunizations. Therefore, any student who, before entry into Job Corps, received three immunizations of tetanus toxoid does not require a booster injection as part of the management of clean minor wounds unless 10 or more years have elapsed since the last dose.

The Classifying the Tuberclin Reaction table is a guide to active and passive tetanus immunizations following the occurrence of a wound. Attempts should be made to determine whether a patient has completed primary immunization. If passive immunization is needed, human tetanus immune globulin (TIG) is to be given. The recommended prophylactic dose is 250 units of TIG for wounds of average severity.

Rabies Prophylaxis: Treatment of Persons Bitten by Animals

The management of individuals who are bitten by animals has been systematized to ensure adequacy of rabies prophylaxis and to avoid unnecessary treatment. Specific recommendations for treatment of bites by particular animals are shown in the Tetanus Prophylaxis and Routine Management table above.

Two inactivated rabies vaccines are currently licensed for post exposure prophylaxis in the U.S. Only human diploid cell vaccine (HDCV) is generally available. After a potential exposure to rabies, persons who have not previously been immunized against rabies should be treated with a single 20 IU/kg dose of human rabies immune globulin (HRIG) and five 1 ml IM doses of HDCV: one each on days 0, 3, 7, 14, and 28. Only the deltoid muscle is acceptable for HDCV administration.

HRIG should be administered at the beginning of HDCV post-exposure prophylaxis, but can be given through the seventh day after the first dose of HDCV was given. The HRIG dose should be divided; up to half should be infiltrated in the area of the wound, if possible, and the rest should be administered IM.

Rabies pre-exposure prophylaxis may be considered for students at risk of occupational exposure, such as animal control or wildlife workers. Three doses of HDCV are given intramuscularly (1.0 ml IM) or intradermally (0.1 ml ID) on days 0, 7, and 21 or 28. Serologic testing or booster vaccination may be needed every 2 years.

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⁴ All other wounds including, but not limited to: wounds contaminated with dirt, feces, soil, etc.; puncture wounds; avulsions; and recent wounds from crushing, burns, and frostbite.

⁵ Yes, if more than 10 years since last dose.

⁶ Yes, if more than 5 years since last dose (more frequent boosters are not required.)

⁷ The recommendations are only a guide and should be used in conjunction with knowledge of the animal species involved, circumstances of the bite or other exposure, vaccination status of the animal, and presence of rabies in the region. A physician should always be consulted to determine dosages and routes of immunization.

⁸ Discontinue vaccine if fluorescent antibody tests of animal killed at time of attack are negative.

⁹ Begin HRIG and vaccine at first sign of rabies in biting dog/cat during 10-day holding period.