Required basic immunizations include tetanus and diphtheria (Td) toxoid, inactivated (IPV) poliomyelitis vaccine, and measles, mumps, and rubella (MMR) vaccine. A Mantoux tuberculin skin test for tuberculosis is mandatory for all students¹. Also, all health occupations training (HOT) students and health services staff must be offered the hepatitis B immunization series, and all individuals who may have been occupationally exposed to potentially infectious material(s) must be offered the vaccination post-exposure. In addition, immunizations are recommended against influenza, pneumococcal infection, and Haemophilus influenzae type b infection for persons with special health problems². Routine polio vaccination is not recommended for persons 18 years of age and older who reside in the United States.

Since most students have been immunized previously in a health department, clinic, private office or in a school setting, they may already be fully immunized or require only boosters. A primary immunization series is only required for certain groups and under certain conditions.

In accordance with The National Childhood Vaccine Injury Act (NCVIA) of 1986, anyone who administers DTP (DTaP, Td, DT), MMR, hepatitis B, Haemophilus influenzae type b, varicella, and/or polio vaccines must provide detailed patient education information on the potential benefits and side effects of these immunizations before they are administered. A vaccine information statement (VIS) must be issued every time a vaccine (to include each dose of a multi-dose series) is administered.

Center health providers are not required to obtain the signature of the student or the student's parent/guardian (if a minor) acknowledging receipt of the VIS. However, to document that the VIS was issued, center health staff should note in the student's medical record the date the VIS is given to the vaccine recipient. To ensure that parents/guardians of minors are provided with vaccine information statements, centers may elect to send the statements as part of the student's pre-arrival packet with a note explaining that vaccines will be given as indicated by the student's medical/vaccination history.

The NCVIA requires all health care providers who administer vaccines to maintain permanent vaccination records [see Immunization Records] and to report occurrences of certain adverse events specified in the Act [see Adverse Reactions].

The NCVIA establishes an alternative to civil litigation and specifies vaccines covered by the program, conditions for which compensation may be paid without proof of causation, and the time period during which symptoms must first appear. Recorded information is available 24 hours per day by calling (800) 338-2382, or at the National Vaccine Injury Compensation Program website. Centers should call (202) 219-9657 for claims information.

• Pre-Immunization Procedures
  • Evidence of Prior Immunization
  • Sensitivity Precautions
  • Reaction Precautions
  • Contraindications
  • Immunization Intervals
  • Mixing of Immunizing Agents
  • Expiration Dates
  • Mass Immunization
  • Exemptions and Waivers
• Immunization Schedules
  • Indications for Primary Series
• Adverse Reactions

Pre-Immunization Procedures

Evidence of Prior Immunization

To avoid immunizing students unnecessarily, center health staff must make a strong effort to obtain evidence of prior immunization. Job Corps admissions counselors are encouraged to have the applicant obtain such documentation from family, school, or health department/clinic and bring it to the center at the time of enrollment. Centers are encouraged to include a reminder of immunization documentation in pre-arrival letters or phone calls to applicants. The center must receive an official statement within 14 days after the student's arrival that attests to the current immune status of the individual by noting date(s) and dose(s) of immunization(s) [ see Records for Personnel Other than Students].

Sensitivity Precautions

Prior to the injection of any biological product, center health staff will determine whether the individual has previously shown a significant sensitivity to a foreign protein. Individuals reporting a history of sensitivity to an immunizing agent usually should be exempt from that immunization. Persons with significant allergy to eggs or fowl should not be given vaccine prepared by cultivation in eggs (e.g., influenza vaccine).

Reaction Precautions

Prior to the administration of any immunizing agent, center health staff will make provisions for immediate first aid and medical care for any anaphylactic reaction that may occur. The center physician is responsible for establishing, in writing, appropriate emergency procedures including the use of any drugs (with dosages) in case of immunization reactions.

Contraindications

Immunizations may be contraindicated during pregnancy because of theoretical concerns about effects on the fetus. Live virus vaccines (MMR, varicella) will not be administered during pregnancy. When possible, inactivated vaccines and toxoids should be delayed until the second or third trimester.

Center health staff must follow the CDC guidelines with respect to HIV testing when administering immunizations and vaccines to students [see the table below].

Immunization Intervals

The prescribed time intervals between individual doses of an immunization series as outlined in Immunization Schedules are optimal and must be followed as closely as possible. If a delay occurs in the completion of a series, administer the next dose at the earliest opportunity. An interrupted series need not be re-started. Giving immunizations at less than the recommended intervals may lessen the antibody response and should not be counted as part of a primary series. The prescribed optimal intervals between doses will not be reduced without a written order by the center physician.

Multiple immunizations may be administered on the same day at different sites. Simultaneous administration will not result in impaired antibody responses or an increase in adverse reactions. However, there are theoretical concerns that the immune response to one live-virus vaccine might be impaired if given between 1 and 30 days of another. Live-virus vaccines not administered on the same day should be given at least 30 days apart.

Live-virus vaccines can interfere with the response to a tuberculin test. Tuberculin testing can either be done on the same day the live-virus vaccines are administered or 4 to 6 weeks afterwards.

Mixing of Immunizing Agents

Two or more immunizing agents will not be mixed in a syringe for the purpose of administering a single, simultaneous injection unless they are premixed by the manufacturer (e.g., MMR, tetanus and diphtheria toxoid). Mixing of immunizing agents by other than the manufacturer may result in biologically and/or physically incompatible products that are not potent immunologically and/or cause adverse reactions.

Expiration Dates

Immunizing agents will not be used after the stated expiration date.

Mass Immunization

When mass immunization is required, an electric or automatic injection device may be used.

Exemptions and Waivers

• Exemptions—The center physician may grant exemptions for individual students. The medical reasons for the exemption will be clearly written in the student's health record. Exemption will be based on a reliable history of significant sensitivity to an immunizing agent or other medical contraindication.
• Waivers—The center physician may grant waivers of immunization requirements for religious reasons. The waiver must be documented in the student's health record.

Some immunizations require administration of more than one dose for development of an adequate antibody response. In addition, some immunizations require periodic reinforcement (booster) doses to maintain protection. The recommended immunization schedule for persons > 7 years of age (primary series) who were not previously immunized is listed below.

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Immunization Schedules

Indications for Primary Series

In many countries, children and adolescents are not routinely immunized. Students raised outside the United States must provide a record documenting the receipt of required immunizations at appropriate intervals, or laboratory evidence of immunity. If these students are unable to provide this information, they must receive a primary series of immunizations [see the Primary Immunization Series for Persons > 7 Years of Age table above].

Students raised in the United States may not have documentation of prior immunizations. The center must make strong efforts to obtain this documentation [see Evidence of Prior Immunization]. For students without documentation, the center must at least give the required booster doses at enrollment. The center physician may elect to obtain serology for evidence of immunity before administering a primary series of immunizations. Students with evidence of immunity do not require a primary series.

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Adverse Reactions

Centers must discontinue use of a vaccine lot whenever significant manifestations occur that may be due to the use of a biologic product. Centers will (1) report the reaction as a significant medical incident [refer to PRH-5, Section 5.5], (2) notify the Job Corps National Office and the State or local health department, if required, and (3) retain the biologic materials under suspicion, including both open and unopened packages, pending receipt of instructions from the manufacturer regarding disposition of the suspected materials.

Center health staff must record severe individual sensitivity reactions to any biologic agent or drug in the immunization records, indicating the offending substance, its lot number and manufacturer, site of administration, the date administered, and the severity of reaction. Center health staff is also required to report selected adverse events occurring after immunization to the Vaccine Adverse Events Reporting System (VAERS) . VAERS forms and instructions are also available through the VAERS website, in the Physicians' Desk Reference, or by calling VAERS at (800) 822-7967.

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¹ Students with documentation of a positive TB test prior to Job Corps enrollment must produce a chest X-ray report on entry.

² Special health problems include immunosuppressive therapy, conditions that compromise immune response (e.g., lymphoma, leukemia, malignancies, HIV infection), splenic dysfunction, congenital heart disease, sickle cell disease, and chronic illnesses such as diabetes mellitus, cardiovascular, renal, or bronchopulmonary disease.