SAFETY--Water Resources Division Immunization Program In Reply Refer To: Mail Stop 405 June 11, 1996 WATER RESOURCES DIVISION MEMORANDUM NO. 96.29 Subject: SAFETY--Water Resources Division Immunization Program This memorandum provides information on several immunization programs that have been established in accordance with the Office of Personnel Management, 5 Code of Federal Regulations (CFR), Part 339.205, Medical Evaluation Programs. The purpose of these programs is to safeguard the health of the Water Resources Division (WRD) field and laboratory employees whose work may subject them or others to significant health or safety risks due to occupational or environmental exposure or demands. The determination of a significant health or safety risk rests with the employee's supervisor and should be based on the guidance presented below with assistance as needed from local health officials to include the U.S. Public Health Service (USPHS) and the Centers for Disease Control. All vaccinations, immunizations and treatments given under this program shall be provided by WRD at no cost to the employee. Immunization programs for Hepatitis B, Tetanus, Typhoid, Rabies, and Hepatitis A are summarized below. Hepatitis B The primary disease caused by the Hepatitis B virus is hepatitis, which may manifest itself in a variety of symptoms of severity; from asymptomatic seroconversion; to non-specific symptoms of decreased appetite, nausea, malaise; to clinical hepatitis with jaundice (yellowing of the skin due to build up of biliary pigments); to severe hepatitis resulting in liver failure and death. The disease is transmitted by exposure to blood and other body fluids contaminated with hepatitis B virus or other materials, including water, contaminated with such fluids. Hepatitis B, with a fatality rate of 1 percent and higher for older patients, can be prevented by the Hepatitis B vaccine prior to exposure to the virus. Hepatitis B immune globulin can help prevent infection if it is given along with Hepatitis B vaccine after exposure to the virus. The vaccination is safe and effective for at least 10 years. A follow-up booster shot will insure continued immunization. There are little to no side effects from the series of three vaccinations given over a 6-month period. A cost survey in Northern Virginia indicated a cost range of $35-$40 per shot. The Occupational Safety and Health Administration (OSHA) has issued a final blood borne pathogens standard (29 CFR 1910.1030 -- Occupational Exposure to Blood borne Pathogens). The OSHA standard requires employers to offer, at their expense, voluntary pre-exposure Hepatitis B vaccinations to all employees with occupational exposure and prescribes appropriate medical follow-up and counseling after an exposure incident. Employees who choose not to accept the vaccine must sign a declination form, but may be vaccinated at a later date if they change their minds. In consultation with the Department of the Interior (DOI) Medical Director, the following WRD personnel have been identified as those who have potential risk of occupational exposure to the virus: (1) Employees working at sewers, outfalls, and streams with potential contamination from upstream medical facilities or from human waste. This includes personnel working on National Pollutant Discharge Elimination System (NPDES) programs, and personnel involved in the dissection of aquatic life forms that are potentially contaminated. Employees in this category shall be offered pre-exposure hepatitis B vaccination. Unvaccinated employees who receive occupational exposure shall be offered immune globulin and the vaccine; and (2) Employees must be offered Hepatitis B immune globulin and vaccine after performing first aid as a result of job-related incidents. Pre-exposure vaccination is not necessary if rendering of first aid is not a primary job assignment. Tetanus and Typhoid Tetanus is a neuralgic disease with severe muscle spasms, caused by a neurotoxin produced by the anaerobic bacterium Clostridium tenant from a contaminated wound. Because this bacterium grows best in an environment with little oxygen, wounds which have dead tissue or are deep (such as a puncture wound) pose the greatest risk for harboring this bacterium. Tetanus germs are found everywhere, usually in soil, dust, and manure. The fatality rate is about 30 percent. Typhoid fever is caused by the bacteria, Salmonella typhi, and other Salmonella species. The primary means of transmission for typhoid is from foods of animal origin, including poultry, red meat, eggs, and unpasteurized milk. Other foods have also been vehicles for transmission. Transmission occurs via the fecal-oral route when foods or water are contaminated by animal sources or infected humans. The DOI policy recommends tetanus immunization of employees who work in or around polluted waters, who are in contact with soil and sewage, or who work with samples of polluted water. It recommends that employees should receive a tetanus booster every 10 years following primary immunization. Typhoid immunization depends on risk of exposure and should be given only if recommended by local health officials. Those people working in areas with documented cases should receive the vaccine with a booster. It is important to determine and document which type of vaccine, the parenteral or the oral, has been given to the employee so that appropriate booster vaccine can be given. Rabies Infection with the Rabies Virus results in an acute illness with rapidly progressive central nervous system manifestations of anxiety, difficulty swallowing, paralysis, convulsions, and death. The virus is present in the saliva of infected animals, primarily, skunks, bats, raccoons, foxes, but also domestic animals (dogs, cats, and ferrets) that have been infected (usually by wild animals). Pre-exposure vaccination greatly reduces, but does not eliminate, the need for post-exposure treatment including physical removal of the virus by proper cleansing of the bite wound and administration of rabies immune globulin along with rabies vaccination. The DOI Medical Director has recommended that if, after consultation with the employee's private physician, pre-exposure prophylaxis treatment against rabies is indicated, employees may obtain the treatment at WRD expense in accordance with the procedures outlined in Survey Manual 370.792.1. Hepatitis A Hepatitis A is transmitted by the fecal-oral route. Common-source outbreaks of this disease have been related to contaminated water and food contaminated by infected food handlers. The fatality rate is about 0.1 percent, mostly occurring in older patients. Havrix, an inactivated vaccine, was recently licensed in the United States for use in persons 2 years of age and older. Hepatitis A gamma globulin is also available and, if given within 2 weeks of exposure, can prevent infection. The Advisory Committee on Immunization Practices and the USPHS have recommended their use in travelers to foreign countries. The Hepatitis A vaccination shall be made available to WRD employees who are at risk of occupational exposure and Hepatitis A gamma globulin shall be offered to those who have been exposed to the Hepatitis A virus while performing their jobs. If you have any questions, please contact your Regional Safety Officer or G. J. Hwang, the Division Safety Officer, at (703) 648-5255 or send e-mail to "GJHWANG." Catherine L. Hill Assistant Chief Hydrologist for Operations This memorandum does not supersede any previous WRD memorandum. Distribution: A, B, S, FO, PO cc: WRD General File, MS 402 ACH/O, MS 441 Chron File, MS 405 Operations, MS 405 USGS:WRD:WGShope:bjd:6/6/96:x5364