This section presents immunization procedures for tetanus-diphtheria, poliomyelitis, measles-mumps-rubella, and hepatitis B and testing procedures for tuberculosis. Each immunization or test is described by the following factors, where applicable:

• Restrictions on use of the vaccine or test
• Nature of the vaccine or test
• Recommended procedures for students without documentation
• Recommended procedures for students with documentation
• Recommended procedures for HIV positive students
• Center options on procedures

The following immunizations are detailed:

• Tetanus-Diphtheria (TD)
  • Without Documentation
  • With Documentation
• Poliomyelitis
  • Without Documentation
  • With Documentation
• MMR
  • Without Documentation
  • With Documentation
• Hepatitis B Vaccine (HBV)
  • Students
  • Staff
  • Post Exposure
• TB Testing
  • Without Documentation
  • With Documentation

Tetanus-Diphtheria (TD)

Without Documentation

• For individuals who do not have documentation of prior immunization, give a single booster injection of adult Td at enrollment. The center should proceed with efforts to obtain documentation, and if not received within 30 days, the center physician may exercise the option to administer the primary series.
• For persons raised outside the U.S., who do not have evidence of prior immunization, administer the primary series [see the Primary Immunization Series for Persons > 7 Years of Age table].

With Documentation

• If documentation indicates that immunization was given more than 10 years ago, give a booster injection regardless of whether a complete or incomplete series was administered.
• For students who provide documentation of immunization against Td within the last 10 years, the following is required:
  • If an incomplete series was administered (i.e., one or two doses only) give a booster injection.
  • If a complete series was administered, no further immunization is needed.

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Poliomyelitis

For routine prophylaxis, administer inactivated poliovirus vaccine (IPV) to students under 18 years of age; poliovirus vaccine is not recommended for persons 18 years of age and older.

Without Documentation

• For all students under 18 years of age without documented proof of complete immunization, give an IPV booster at the time of enrollment.
• For students under 18 years of age born outside the U.S., who do not have evidence of prior immunization, give the primary series [see the Primary Immunization Series for Persons > 7 Years of Age table].

With Documentation

For all individuals who provide documentation of vaccination against poliomyelitis, do the following:

• If an incomplete series was administered, administer a booster dose.
• If a complete series was administered, no further immunization is needed.

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MMR: Measles (Rubeola), Mumps, and Rubella (German Measles)

MMR vaccination is indicated for students who have not received two doses after 12 months of age. The dosage is 0.5 ml given subcutaneously. Two precautions apply when administering the vaccine:

• Do not administer the MMR vaccine to any student with an altered immune status (including HIV, agammaglobulinemia, or malignancy) or who are receiving steroid or other immunosuppressive therapy, unless specifically ordered by the center physician.
• Inform non-pregnant females that they should not become pregnant for 28 days after MMR vaccination because of theoretical risk to the fetus. Do not administer the vaccine to pregnant students. Pregnant students should be immunized immediately after delivery or termination of the pregnancy.

Without Documentation

• For individuals who do not have documentation of prior immunization, administer a single 0.5 ml dose of MMR vaccine subcutaneously.
• For persons raised outside the U.S., who do not have evidence of prior immunization, administer the primary series [see the Primary Immunization Series for Persons > 7 Years of Age table].

With Documentation

The following is required for all students who provide documented proof of immunization against measles, mumps, and rubella:

• If only one dose of MMR was given after 12 months of age, give a booster dose of MMR vaccine.
• If two doses of MMR were given after 12 months of age, no further immunization is needed.

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Hepatitis B Vaccine (HBV)

The recommended series consists of three 0.5 ml IM doses of HBV vaccine in the deltoid muscle. The first two doses are given 1 month apart and the third dose is given 5 months after the second dose. This schedule is preferred for adolescents; however, if the vaccine series is interrupted after the first dose, the second and third doses should be given separated by an interval of 3 to 5 months.

Students

Centers are required to offer hepatitis B vaccination to health occupations training (HOT) students, to begin 6 weeks prior to on-site clinical work experience. Each center must decide whether serologic screening is cost effective. Vaccination of individuals who already have antibodies to HBV has not been shown to have adverse effects. Students must sign a consent or declination form, which must be placed in each student's health record.

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

Staff

Centers must offer hepatitis B vaccination to all personnel identified at risk in the center's bloodborne pathogen plan. Again, each center must decide whether serologic screening is cost-effective. Staff must sign a consent or declination form, which must be placed in the employee's personnel record.

Post Exposure

Post-exposure vaccinations will be offered to those individuals who provide health care or render first aid only as a collateral duty. Post-exposure vaccinations must be offered as soon as possible, but no later than 24 hours after exposure. These individuals must also sign a consent or declination form, which must be documented in the employee's personnel record or student's health record.

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Tuberculosis (TB) Testing

Tuberculosis testing is required of all students. The Mantoux method for intradermal testing with intermediate strength purified protein derivative (PPD) tuberculin, 5 Todd Units (TU), will be used for all screening.

Without Documentation

A TB skin test is required for all students without documentation of a negative test within 12 months. The procedure for test administration is as follows:

• Administer 0.1 ml PPD intradermally.
• Read the test 48 to 72 hours after administration. Record induration in mm.
• Repeat testing at 12 months for all HOT students with negative skin tests.

With Documentation

For students with documentation of a TB test within the past 12 months, the following procedures will be followed:

• Retest using Mantoux method if multiple puncture tests (tine) was previously used.
• If the previous Mantoux results were equivocal or positive, arrange for a chest x-ray and evaluate further for preventive or curative therapy.
• If the previous Mantoux results were negative, retest only HOT students after 12 months.

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