SAFETY--Water Resources Division Immunization Program

To: "A  - Division Chief and Staff",
        "B  - Branch Chiefs and Offices",
        "S  - Special Distribution for Research",
        "FO - State, District, Subdistrict and other Field Offices",
        "PO - Project Offices"
cc: "  WRD Archive File, Reston, VA ",
        "Karen T Ray, Contractor, Stennis Space Center, MS ",
        "Cheryl P Nelson, Act. Chf., Information Mgt.Sec, Stennis Space Center, MS ",
        "William G Shope Jr., Chief, Br. of Oper. Support, Reston, VA ",
        "Melvin Lew, Hydrologist, Reston, VA ",
        "Michele D Fanning, General Services Clerk, Reston, VA ",
        "Carole Nethaway, Secretary (OA), Reston, VA "
Date: Fri, 23 Jan 1998 18:35:50 -0500
From: "Carole Nethaway, Secretary (OA), Reston, VA "

In Reply Refer To:                              
Mail Stop 405
                                                January 22, 1998


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.  Immunization programs for 
Hepatitis B, Tetanus, Typhoid, Rabies, and Hepatitis A are summarized

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 
no symptoms; 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 can be transmitted by exposure to a 
medium such as water which contains blood and other body fluids 
contaminated with hepatitis B virus.  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
ensure continued immunization.  There are little to no side effects from
the series of three vaccinations given over a 6-month period.

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.  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.  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 within 24 hours 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 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.  The 
Department of the Interior 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 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.  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.

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.  Pre-exposure
vaccinations and post-exposure treatments for Hepatitis A are 
available.  The Advisory Committee on Immunization Practices and the
USPHS have recommended their use in travelers to foreign countries.  The
Hepatitis A vaccination will be made available to WRD employees who 
are at risk of occupational exposure.  Hepatitis A post-treatment as
prescribed by local health officials, is to be administered to affected
employees within 2 weeks of exposure to the Hepatitis A virus.

If you have any questions, please contact your Regional Safety Officer.


                                 Catherine L. Hill
                                 Assistant Chief Hydrologist 
                                 for Operations

Distribution: A, B, S, FO, PO

"This WRD Memorandum supersedes WRD Memorandum No. 96.29 and the
 Branch of Operations Technical Memorandum (OP)86.03, Pre-Exposure
 Rabies Immunizations."

(This memorandum is being distributed via electronic mail only.)