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SUPPLEMENT Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices

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SUPPLEMENT Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices SUPPLEMENT Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices The Public Health Service Advisory Committee on The Committee has reviewed all of its statements Immunization Practices has in the last 5 years made within the past several months. Only minor revisions and recommendations concerning the use of vaccines and editorial changes were made. No substantive modifica­ other biologies in the prevention of 16 diseases. Each tions resulted from this annual review. Each of the state­ statement by the AC IP is regularly published in the ments carries the dates of original publication and past Morbidity and Mortality Weekly Report upon com­ revisions. pletion or revision. For the first time, a brief list of selected references is The full series of recommendations has never been appended to each statement. These bibliographies are printed as a single document. However, it was felt that a not meant to be definitive, but are a starting point for supplement to the MMWR incorporating all of the exis­ more extensive review of the pertinent literature on the ting ACIP recommendations would be a useful reference. disease, the vaccine, and its appropriate uses. CONTENTS Page 3 - Cholera Vaccine 4 - Diphtheria and Tetanus Toxoids and Pertussis Vaccine 6 - Immune Serum Globulin for Prevention of Viral Hepatitis 9 - Influenza Vaccine-1969-70 10 - Measles Vaccines 12 - Mumps Vaccine 14 - Plague Vaccine 15 - Poliomyelitis Vaccines 17 - Rabies P rophylaxis 21 - Rubella Virus Vaccine Prelicensing Statement 23 - Smallpox Vaccine 26 - Typhoid Vaccine 27 - Typhus Vaccine 28 - Yellow Fever Vaccine PUBLIC HEALTH SERVICE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES Since its establishment in 1964, the Public Health ences in emphasis have not been felt to compromise the Service Advisory Committee on Immunization Practices goal of achieving immunity in vaccinees. has prepared recommendations on the principal biologies The Advisory Committee on Immunization Practices used in the United States. Some of its earlier statements was established by the Surgeon General of the Public have been modified as the incidence of disease has Health Service to advise him on the status of immunizing changed and as additional information about the bio­ agents and their use for optimal benefit. The Committee logies has been accumulated. The ACIP reviews all state­ is sponsored by the National Communicable Disease ments annually and revises or confirms the recommenda­ Center, and its membership is drawn from the fields of tions according to current findings. public health, medicine, and research. Ex officio mem­ As statements are developed or revised, they appear bership is from government agencies with particular first in the Morbidity and Mortality Weekly Report and responsibility and involvement in licensing biologies and are often reprinted elsewhere. Although intended pri­ in civilian immunization programs. Special consultants marily for use in public health, their broader applicabili­ regularly join the ACIP in its deliberations. Surveillance ty is acknowledged. Therefore, special attention is paid reviews, laboratory and field investigations, and other to the established practices in medical specialties where support are provided by NCDC. immunizing agents are commonly used. Minor differ­ Members of the ACIP at the time of the 1969 review were: Chairman Donald R. Peterson, M.D. David J. Sencer, M.D. Director, Epidemiology and Communicable Director Disease Control National Communicable Disease Center King County Department of Public Health Atlanta, Georgia Seattle, Washington Executive Secretary Jay P. Sanford, M.D. H. Bruce Dull, M.D. Professor o f Internal Medicine Assistant Director Texas Southwestern Medical School National Communicable Disease Center Dallas, Texas Atlanta, Georgia Gene H. Stollerman, M.D. Professor and Chairman Members Department of Medicine Geoffrey Edsall, M.D. The University of Tennessee Superintendent Memphis, Tennessee Institute of Laboratories Massachusetts Department of Public Health Ex officio Boston, Massachusetts Alice D. Chenoweth, M.D. Johannes Ipsen, Jr., M.D. Chief, Program Services Branch Professor of Epidemiology and Medical Children's Bureau Statistics Department of Health, Education, and Department of Community Medicine Welfare University of Pennsylvania Washington, D.C. Philadelphia, Pennsylvania Roderick Murray, M.D. Director David T. Karzon, M.D. Division of Biologies Standards Professor of Pediatrics Medical College National Institutes of Health Vanderbilt University Bethesda, Maryland Nashville, Tennessee Liaison—American Academy of Pediatrics Ira L. Myers, M.D. Margaret H.D. Smith, M.D. State Health Officer Professor of Pediatrics Alabama Department of Public Health Tulane University Montgomery, Alabama New Orleans, Louisiana 2 CHOLERA VACCINE INTRODUCTION the usual tourist itinerary through countries reporting Cholera generally occurs in endemic and epidemic cholera and using standard accommodations run virtual­ form only in South and Southeast Asia. In recent years, ly no risk of acquiring cholera. however, it has also been epidemic in certain areas of the Middle East. Primary Immunization Infection is acquired from contaminated water or Injections may be given subcutaneously or intra­ food. It is believed to result from personal contact only muscularly. in rare instances. For travelers vaccinated in the United States, a single 0.5 ml dose of cholera vaccine is considered adequate to CHOLERA VACCINE satisfy the International Sanitary Regulations.The single Various cholera vaccines have been widely used, but dose for children is proportionately smaller (see table until recently their efficacy was unproved. Carefully below). controlled field studies have now clearly demonstrated Two doses of cholera vaccine, 0.5 ml and 1.0 ml, the effectiveness of current vaccines against both the preferably given a month or more apart, are recom­ classical and El Tor strains of cholera vibrios. However, mended for adults traveling or working in areas where severe cases of cholera have occurred in vaccinated per­ cholera is epidemic or known to be endemic and living sons. under conditions in which sanitation is less than ade­ The duration of immunity induced by vaccine is rela­ quate. The doses for children are suggested in the sum­ tively brief. Antibody titers reach a peak within 4 weeks mary table. A two-dose schedule of vaccination is also of vaccination and are maintained for about 3 months. advisable for persons working with cholera vibrios in the Protection against disease seems to last no more than 6 laboratory. months after the primary series or a booster dose. Vaccine available in the United States is prepared Booster Doses from a combination of inactivated suspensions of classi­ Booster injections should be given every 6 months as cal Inaba and Ogawa strains of cholera vibrios grown on long as the likelihood of exposure exists. In areas where cholera only occurs in a 2 to 3 month “season,” protec­ agar or in broth and preserved with phenol. tion is optimal when the booster dose is given at the beginning of the season. The primary series need never VACCINE USAGE be repeated for booster doses to be effective. Vaccination for International Travel A primary vaccination or a booster dose within the Summary previous 6 months is generally required for persons The following table summarizes the recommended traveling to or from countries with cholera.* Vaccina­ doses for primary and booster vaccination: tion requirements are published annually by the World Health Organization and summarized by the Public Dose Age (Years) Health Service in its booklet Immunization Information Number Under 5 5-10 Over 10 for International Travel (PHS Publication No. 384). 1 0.1 ml 0.3 ml 0.5 ml Because cholera sometimes reappears in countries free of 2 & Boosters 0.3 ml 0.5 ml 1.0 ml the disease for several years, travelers should seek up-to- date information to determine the need for a valid Inter­ Reactions national Certificate of Vaccination. Vaccination often results in discomfort at the site of Physicians administering vaccine to travelers should injection for one or more days. The local reaction may emphasize that an International Certificate of Vaccina­ be accompanied by fever, malaise, and headache. tion must be validated for it to be acceptable to quaran­ tine authorities. Validation can be obtained at most city, Contraindication county, and State health departments. Failure to secure Rarely, severe reactions of various kinds follow ad­ validation can cause travelers to be revaccinated oi ministration of cholera vaccine. If one experiences such quarantined during the course of travel. The Certificate a reaction, revaccination is not advisable. Most govern­ remains valid for 6 months. ments will permit such an individual to proceed provided The traveler’s best protection against cholera, as well he carries a physician’s statement of the medical contra­ as against many other enteric diseases, is to avoid poten­ indication. However, any inadequately vaccinated tially contaminated food and water. Persons following traveler coming from an infected area may be quaran­ tined or placed under surveillance for 5 days. *For a current listing, consult the most recent issue of the World Health Organization’s Weekly Epidemiological Record. Published MMWR: VoL 17, No. 20, 1968. 3 SELECTED BIBLIOGRAPHY Mosley, W.H., Benenson, A.S., and Barui, R.A. : Serological Benenson, A.S., Mosley, W.H., Fahimuddin, M.,
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