Department of Health Provides Vaccine Recommendations for Flood Response

The Louisiana Department of Health has provided these vaccine recommendations to health care providers throughout Louisiana.

Background:

• Hepatitis A is a rare disease in Louisiana and has not been transmitted by contaminated water in the US since 1980.
• Hepatitis A outbreaks have not occurred after flooding or hurricanes, however, increased risk of Hepatitis A may occur in crowded conditions such as shelters.
• Influenza vaccine recommendations will be assessed based on the timing of the natural event and will expand as supply is available.
• Overuse of vaccines is to be avoided to ensure a functional vaccine distribution system. Vaccines are useful, but following recommended priorities is the best way to ensure that those at the highest risks of experiencing a vaccine-preventable disease are protected.
• Vaccines will be provided as they become available.
• If there is proof of previous vaccination or immunity, there is no need to revaccinate.

Recommendations Summary:

* Vaccine recommendations may be adapted based on vaccine-preventable disease surveillance activity within shelters or community-at-large and other vaccines may be recommended (i.e., MCV) for administration.

** If immunization records are not available, children aged 10 years and younger should be forward vaccinated. Forward vaccination practice allows individuals to be treated as if they were up-to-date (prior to the current doses) with recommended immunizations and they should be given any doses that are recommended for their current age.

See below for additional explanations regarding specific groups.

General Shelters: Residents (Adults and Children), Volunteers, and Shelter Workers

Shelter residency creates conditions that put the residents at increased risk of infectious disease.

Recommendations:

• Use standard precautions.
• Institute and enforce good personal hygiene. Soap and water are effective at preventing the transmission of all sorts of infectious disease. Hand sanitizers are also very effective means of preventing disease transmission.
• Tetanus/diphtheria (Td /TdaP) vaccination within the past 10 years
• Hepatitis A (HAV) to prevent outbreaks within shelter
• Influenza (Flu) vaccine when available
• Chickenpox, up-to-date as recommended by LA Immunization Schedule
• Measles, Mumps, Rubella (MMR) – as recommended by LA Immunization Schedule

Health care workers who perform medical procedures in a general shelter should follow the recommendations for health care providers /special needs shelters listed below:

Medical Special Needs Shelters: Health Care Professionals

Recommendations for people involved in patient care in any setting, including medical special needs shelters: 

• Use standard precautions.
• Institute and enforce good personal hygiene.
• Follow the recommendations for health care workers that include Td (TdaP), Hepatitis B, MMR, Varicella and influenza (when available).
• For accidental exposure to blood and body fluids (e.g., blood spilled on skin, needle sticks, etc.), follow recommendations for post-exposure prophylaxis.
• If a health care provider is under vaccinated, update for the missing vaccines.

Workers: Rescue and Recovery Workers/Enforcement Agents

General recommendations:

• Use Standard Precautions
• Institute and enforce good personal hygiene
• Tetanus/diphtheria (Td /Tdap)) vaccination within the past 10 years
• NO hepatitis A vaccine is recommended (see below for supplementary indications)

Supplementary recommendations:

• If the worker is likely to be exposed to blood (such as attending to a person with open or bleeding wounds Hepatitis B vaccine is recommended. Administer missing doses to complete a 3-dose series of hepatitis B vaccine to those persons not vaccinated or not completely vaccinated. The second dose should be administered 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose) through their healthcare provider.

Returnees: People returning to flooded or damaged areas

• Use good personal hygiene.
• If persons planning to enter flooded or damaged areas present to a parish health unit or similar facility and request immunization the following vaccinations may be offered:
• Tetanus/diphtheria (Td Tdap) vaccination if not vaccinated within the past 10 years 

This is a voluntary recommendation for returnees to be immunized. No one should be prevented to return to their homes or business if they choose not to have current tetanus/diphtheria vaccine.

Additional Information

• All wounds require immediate cleaning and bandaging. Medical evaluation is recommended. Tetanus/Diphtheria (Td) booster needed for wounds, if last dose was given more than 5 years ago.
• Exposure to animal bite or scratch requires evaluation for prophylaxis for rabies. Call Infectious Disease Epidemiology at 1 -800 256 2748.
• Remember to ask about serious allergic reactions to the components of each vaccine.
• The risk of vaccination during pregnancy and with lactation is vaccine specific. See package insert of each vaccine.
• Historically there have been concerns about hepatitis A vaccination. CDC states that following a hurricane or flooding there is a “low probability of exposure, even under these conditions, in the US. No transmission from contaminated water has been identified in the US since the 1980s. Hepatitis A outbreaks have not occurred following other hurricanes or floods in other parts of the country, including the devastating hurricanes in Florida, and the Midwestern floods of the late 1990s. The Gulf region has had few hepatitis A cases in recent years. Thus, even though the water and sewage systems are damaged or out of operation in many areas along the Gulf coast, the risk of a hepatitis A epidemic is extremely low. Vaccine will take at least one to two weeks to provide substantial immunity.” These considerations do not apply to shelters which constitute a completely different set of circumstances. Hepatitis A transmission in shelters is a concern and recommendations to address this at-risk environment are currently in preparation.
• Immune serum globulin (ISG) will ONLY be recommended for post exposure prophylaxis of close contacts of confirmed cases of hepatitis A (defined as clinical hepatitis A with abnormal liver enzymes and positive IgM antibodies) in accordance with national recommendations.

This information serves as general guidance.  Recommendation may be different for specific professions or required by certain employers.