Interim Immunization Recommendations for Individuals Displaced by a Disaster

Note: Current (2017-2018) influenza vaccine recommendations are available on the influenza website.

The purpose of these recommendations is two-fold:

1. To ensure that children, adolescents, and adults are protected against vaccine-preventable diseases in accordance with current recommendations.Paper immunization records are unlikely to be available for a large number of adult and child evacuees. It is important that immunizations are kept current if possible.
2. To reduce the likelihood of outbreaks of vaccine-preventable diseases in large crowded group settings.

I. Recommended Immunizations

For the 2017-18 influenza season, routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications (MMWR 2017 Aug 25;66[2]:1-20).

If immunization records are available:

Children, adolescents, and adults should be vaccinated according to the recommended child, adolescent, and adult immunization schedules.

See the following:

• Children (birth to 6 years old)
• Preteens and Teens (7 through 18 years old)
• Adults (19 years and older)

If immunization records are not available:

Children aged 10 years and younger should be treated as if they were up-to-date with recommended immunizations and given any doses that are recommended for their current age. This includes the following vaccines:

• Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) for all children through 6 years of age; tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) for children 7 through 10 years of age if they did not complete the DTaP series
• Inactivated Poliovirus vaccine (IPV)
• Haemophilus influenzae type b vaccine (Hib)
• Hepatitis B vaccine (HepB)
• Rotavirus vaccine
• Pneumococcal conjugate vaccine (PCV13)
• Measles-mumps-rubella vaccine (MMR)
• Varicella vaccine (VAR)
• Hepatitis A vaccine (HepA)

Children and adolescents (aged 11-18 years) should also be treated as if they were up-to-date with recommended immunizations and given any doses that are recommended for their current age. This includes the following vaccines:

• Adolescent/adult formulation tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)
• Meningococcal serogroup A,C,W,Y vaccine (MenACWY) (recommended first dose at ages 11-12 and a booster dose at 16)
• Human papillomavirus vaccine (HPV) (recommended first dose at ages 11-12) (MMWR. 2016;65(49);1405-8)
• Meningococcal serogroup B vaccine (MenB) for person 10 years and older with certain underlying medical conditions (MMWR 2015 Jun 12;64[22]:608-11 )

Adults (over 18 years of age) should receive the following recommended immunizations:

• Adolescent/adult formulation tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) if not previously received; no matter when last dose of Td was given.
• Adult formulation tetanus and diphtheria toxoids (Td) if 10 years or more since receipt of any tetanus toxoid-containing vaccine or as indicated for wound management (MMWR 2006 Dec 5;55[RR-17]:1-37 ) .
• Pneumococcal polysaccharide vaccine (PPSV23) and Pneumococcal conjugate vaccine (PCV13) for adults 65 years of age or older (MMWR 2014 Sept 19;63[37]:822-25 and MMWR 2015 Sept 4;64[34]:944-47) 
• Pneumococcal conjugate vaccine (PCV13) and PPSV23 for adults 19 years of age or older with an immunocompromising condition (MMWR 2012 Oct 12;61[40]:816-9)

School requirements
It is not necessary to repeat vaccinations for children displaced by the disaster, unless the provider has reason to believe the child was not in compliance with applicable state requirements.

II. Crowded Group Settings

In addition to the vaccines given routinely as part of the child and adolescent schedules, the following vaccines should be given to evacuees living in crowded group settings, unless the person has written documentation of having already received them:

• Influenza: everyone 6 months of age or older should receive influenza vaccine. For additional information see (MMWR 2017 Aug 25;66[2]:1-20).
• Varicella: everyone 12 months of age or older should receive one dose of this vaccine unless they have a documented record of immunization or documentation of health care provider diagnosed of chickenpox or shingles.
• MMR: everyone 12 months of age or older and born during or after 1957 should receive one dose of this vaccine unless they have a documented record of 2 doses of MMR or other evidence of immunity.

The following vaccine should not routinely be necessary to evacuees in living in crowded group settings:

• Hepatitis A: Although hepatitis A vaccine is recommended for all children in the U.S. aged 12-23 months, evacuation itself is not a specific indication for hepatitis A vaccination of previously unvaccinated children per se unless exposure to hepatitis A virus is suspected. Persons who evacuate their homes under orderly conditions at the advisement of state or local officials to a congregate setting where sanitary conditions prevail should not require hepatitis A vaccine, unless they have been evacuated from an area where exposure to hepatitis A virus is likely or have been exposed to persons with suspected or proven hepatitis A infection.

Immunocompromised individuals, such as persons with severe immunosuppression associated with HIV infection, pregnant women, and those on systemic steroids or other immunosuppressive medications, should not receive the live viral vaccines, varicella and MMR. Screening should be performed by self-report.

Documentation

It is critical that all vaccines administered be properly documented.  Ideally vaccine administration should be documented within the jurisdiction’s immunization information system (IIS).  For more information on IIS in your jurisdiction, please see https://www.cdc.gov/vaccines/programs/iis/contacts-registry-staff.html).

Immunization records should be provided in accordance with the practice of the state in which the vaccine is administered. Immunization cards should be provided to individuals at the time of vaccination.

Standard immunization practices should be followed for delivery of all vaccines (https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html), including provision of Vaccine Information Statements.

Diarrheal diseases

Vaccination against typhoid and cholera are not recommended. Both diseases are extremely rare in the United States.

Rabies

Rabies vaccine should only be used for post-exposure prophylaxis (e.g., after an animal bite or bat exposure) according to CDC guidelines.