BUMEDINST 6230.15b Immunizations And Chemoprophylaxis

Malaria has caused morbidity and mortality in military populations for centuries.  Military operations often occur in areas of the world where malaria is endemic.  Medical commanders will designate trained staff to provide comprehensive malaria prevention counseling regarding mosquito avoidance, personal protective measures, and chemoprophylaxis to military and civilian personnel considered at risk of contracting malaria.

• True

• False

Combatant commanders must request approval from the Secretary of Defense to use Investigational New Drugs (INDs) for force health protection.  If the member's use of an IND is voluntary, the product must be administered with documented informed consent in accordance with a protocol approved by the FDA for IND product use.  A vaccine, antibiotic, or other product in an IND status may be mandatory for military members if the President has approved a waiver of the requirement for informed consent.

• True

• False

Frozen vaccines will be stored at temperatures of __________(insert number) degrees Fahrenheit or lower.

Refrigerated vaccines shall be stored at temperatures 35F to 46F (2C to 8C).

• True

• False

Temperatures of all vaccine refrigerators and freezers will be physically confirmed at a minimum of two times per day.

• True

• False

Federal civilian employees will receive country-specific immunizations without charge at military activities upon presentation of official orders or authorization.

• True

• False

For short notice travel or deployments requiring vaccines given in a multi-dose series, administer the first dose of the basic series.  Administer as many of the subsequent doses as time permits.  Completion before departure is the goal.  If the series cannot be completed before departure, completed before departure, complete it upon arrival.  Inform the patient that in order to obtain optimal immunity, the series must be completed by receiving all the required doses at the recommended intervals.

• True

• False

Which of the following is known as the “International Certificate of Vaccination or Prophylaxis?”

• CDC Form 731

• LAZ Form 731

• POE Form 731

• LRS Form 731

A pre-exposure prophylactic immunization of rabies may be indicated for people with potential occupational risk of exposure to rabid animals, or for forces assigned to locations where access to definitive care likely exceeds 24 hours.

• True

• False

The Department of Defense policy concerning immunizations follows the recommendations of the CDC and Advisory Committee on Immunization Practices (ACIP), unless there is a militarily relevant reason to do otherwise.

• True

• False

In accordance with emergency response requirements, aviation personnel typically will be grounded for 12 hours after immunization.  Flight personnel who previously experienced urticaria, hypersensitivity phenomena, or other unusual phenomena after an immunization will be exempt from flying duties for an appropriate interval (for example, 72 hours) as determined by the flight surgeon.  Further temporary grounding may be necessary until significant side effects resolve.

• True

• False

For patients on short notice travel or deployments that require vaccines normally given in a multidose series, administer the first dose of the basic series and as many of the subsequent doses as possible, as time permits.  If the series cannot be completed before departure, complete it upon arrival.  Completion before departure is the goal.  The patient must be informed that in order to obtain optimal immunity, the series must be completed by receiving additional doses.

• True

• False

Two or more live virus vaccines must be administered simultaneously or separated by at least __________(enter numerals or type in number) days.

The ACIP general recommendations suggest that persons be observed for __________(insert number) to 20 minutes after being immunized.

Reports of mild vaccination expected reactions are not required to be reported.  For example, low-grade, self-limited fever of less than 24 hours, temporary local redness, or minor swelling at the site of immunization.  However, such reports may be submitted if the clinician or patient wishes.

• True

• False

Refrigerated vaccines will be stored at temperatures of 35 degrees to __________(insert number) degrees Fahrenheit.

CDC Form __________(insert numeral) is also known as the “International Certificate of Vaccination or Prophylaxis.” 

VAERS reports and / or MedWatch reports shall be turned in within _______(fill in the blank) days of of an adverse event.

Refrigerated vaccines will be stored at temperatures of __________(insert number) degrees to 46 degrees Fahrenheit.

__________(insert acronym) Form 731 is also known as the “International Certificate of Vaccination or Prophylaxis.” 

Aviation personnel are typically grounded for 12 hours after vaccination.

• True

• False

Medical exemptions from vaccinations are based upon any medical contraindication relevant to a specific vaccine or other medication.  Health care providers will determine a medical exemption based on the health of the vaccine candidate and the nature of the immunization under consideration.  Medical exemptions may be temporary (up to 365 days) or permanent.

• True

• False

Japanese encephalitis is a mosquito-borne viral disease that endangers Sailors and Marines when they travel to endemic areas in Eastern Asia and certain western Pacific Islands.  It can cause an acute infection of the brain, spinal cord, and meninges with high rates of complications, chronic disability, and death.

• True

• False

A pre-exposure prophylactic immunization of rabies may be indicated for people with potential occupational risk of exposure to rabid animals, or for forces assigned to locations where access to definitive care likely exceeds __________(fill in the blank) hours.

Jet-injection immunization devices must be used with FDA-approved manufacturer's recommendations.  Only vaccines with FDA approval for jet injectors may be used in these devices.

• True

• False

Hepatitis A is an acute infection of the liver that is acquired by consuming food or water, primarily during deployments or travel to areas with poor food, water, and sewage sanitation.  It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

• True

• False

Which of the following is the Navy's instruction on Immunizations and Chemoprophylaxis?

• BUMEDINST 6230.15

• BUMEDINST 6320.15

• BUMEDINST 6215.30

• BUMEDINST 6315.30

A positive serological test or two doses of the MMR vaccination is required for personnel born after the year __________(insert year).

Once an immunization series has been started, it must be completed, unless a medical or administrative exemption exists.  Restarting an immunization series or adding extra doses is not necessary when an initial series of a vaccine or toxoid is interrupted; instead, give delayed doses as soon as feasible.

• True

• False

Doxycycline may be used as chemoprophylaxis for many diseases, including anthrax, leptospirosis, and scrub typhus.

• True

• False

At present, no immunization products are medically contraindicated in breastfeeding women.  However, smallpox vaccine is withheld from breastfeeding women, except in an outbreak, primarily due to the potential for contact transmission of vaccinia virus to the child.

• True

• False

Immunizing and chemoprophylaxis agents are requisitioned in accordance with medical supply procedures.  However, vaccinia immune globulin - also known as VIG-intravenous - is available only by ordering through the MILVAX Office.

• True

• False

Temperature logs for refrigerators and freezers used to store vaccinations will be kept for at least __________(insert numeral) years.  state and/or local requirements may require longer recordkeeping. 

If different anatomical sites are not possible for multiple vaccination injections, then the injections going into the same limb will be spaced by at least 1 inch.

• True

• False

All vaccines or chemoprophylaxis classified as an Investigational New Drug that are administered to a military member, whether with the member's informed consent or a Presidential waiver of informed consent, must be recorded in the member's permanent health record or other DoD-approved electronic ITS.

• True

• False

Which of the following military personnel are required to be immunized against Hepatitis B?

• Healthcare workers

• Healthcare workers and military law enforcement

• Healthcare workers, military law enforcement, and food workers

• All military personnel

Temperature logs for refrigerators and freezers used to store vaccinations will be kept for at least three years.  State and/or local requirements may require longer recordkeeping.

• True

• False

Unused needles and syringes prepared for vaccination that were unused will be discarded according to the manufacturer's package insert.  If no timeline is provided, discard after 8 hours.

• True

• False

A positive serological test or two doses of the MMR vaccination is required for personnel born after 1957.

• True

• False

Service members may receive an administrative exemption to an immunization if their separation or retirement is within 180 days if they are not currently assigned or deployed to an area where an immunization is indicated and the unit commander has not directed immunization because of mission requirements.

• True

• False

Drugs and vaccines that have not been approved or licensed by the FDA may be used as medical countermeasures to chemical, biological radiological, or nuclear (CBRN) agents or threats if the FDA grants an Emergency Use Authorization (EUA). In general, this EUA may be granted for up to 12 months, with potential renewal.

• True

• False

Two or more live virus vaccines must be administered simultaneously or separated by at least 28 days (4 weeks).

• True

• False

Which of the following is required to be on hand for the medical management of an anaphylaxis event whenever vaccines are administered?

• No specific equipment is required to be on hand

• Antihistamines

• Three adult doses of epinephrine (1:1,000)

• Complete cardiovascular management cart (“Crash Cart”)

Health care providers will report adverse events involving vaccines to which of the following?

• VAERS

• MedWatch

The first cluster of immunizations is administered to enlisted accessions is given, if susceptible, before the beginning of collective training to protect against pathogens that represent an imminent risk of contagious disease in settings of close contact.  Examples of first cluster immunizations are: Adenovirus; influenza; meningococcal; MMR; tetanus-dipthera-pertusis; and varicella.

• True

• False

Hepatitis B is an acute or potentially chronic infection of the liver that is acquired through percutaneous, sexual, and other mucosal exposure to blood and body fluids from people infected with the same virus.  This infection occurs worldwide, and some infected people maintain a chronic carrier state.

• True

• False

Which of the following is NOT one of the requirements of the electronic ITS?

• Incorporate DoD-directed levels of security, certification, and redundancy, and the requirements of the Health Insurance Portability and Privacy Act to preclude unauthorized access to personal medical information

• Be capable of generating printed reports of immunization status and exemption information on both an individual and unit basis

• Comply with the requirements of the National Vaccine Injury Compensation (NVIC) Porgram

• All of the above are requirements of the electronic ITS

Which of the following is NOT a valid medium to document immunization and chemoprophylaxis records?

• POE-782

• CDC-731

• DD 2766

• SF 601