SAFETY--Water Resources Division Immunization Program

In Reply Refer To:
Mail Stop 405                                                   June 11, 1996


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,
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.  


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

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

                                        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