Texas Department of State Health Services Immunization Recommendations for Natural Disasters
What is a Natural Disaster?
A natural disaster is the effect of a natural hazard that affects the environment, and leads to financial, environmental and/or human losses. Hazards include
earthquakes, extreme heat, floods, hurricanes, landslides and mudslides, tornadoes, tsunamis, volcanoes, wildfires, and winter weather.
Outbreaks of communicable diseases after floods are unusual. However, the rates of diseases that were present before a flood may increase because of decreased sanitation or overcrowding among displaced persons. Increases in infectious diseases that were not present in the community before the flood are not usually a problem.
The term ‘first responder’ refers to those individuals who in the early stages of a natural disaster are responsible for the protection and preservation of life, property, and the environment. Examples of first responders include the following:
- Public health and public safety personnel;
- Commissioned law enforcement personnel;
- Fire protection personnel, including volunteer firefighters;
- Emergency medical services personnel, including hospital emergency facility staff;
- A member of the National Guard;
- A member of the Texas State Guard; or
- Any other worker who responds to a disaster in the worker ’s scope of employment; or
- Any related personnel that provide support services during the prevention, response, and recovery phases of a disaster
Immunization Recommendations for Disaster Responders
The Texas Department of State Health Services (DSHS) recommends first responders be vaccinated prior to a response effort. Routinely recommended vaccines are recommended for first responders and disaster evacuees, just like they are for everyone else.
The major concern for anyone exposed to unsanitary conditions is that they be up to date with tetanus-containing vaccine, because if they are injured (as is common in disaster settings) the injury is likely to be contaminated. Children should receive a series of four shots between 2 months and 18 months of age, and booster shots at 4 to 6 years of age and 11 to 12 years of age. Adults should receive booster
shots every 10 years. Td (tetanus/diphtheria) or Tdap (tetanus/diphtheria/pertussis) vaccine can be used; getting the Tdap formula for one tetanus booster during adulthood is recommended to maintain protection against pertussis. While documentation of vaccination is preferred, it should not be a prerequisite to work.
If a person receives a puncture wound or a wound contaminated with feces, soil, or saliva, a doctor or health department should determine whether a tetanus booster is necessary based on individual records.
In general, hepatitis B vaccination is not recommended during floods or other disasters. Hepatitis B is not a risk in floods. However, health care workers and first responders who routinely come into contact with blood and other body fluids should be immunized against hepatitis B.
There is no indication for the following vaccines for disaster responders in
Texas or in the United States:
Hepatitis A vaccination is not recommended during floods or other disasters. Hepatitis A is not a risk in floods. In addition, hepatitis A vaccine takes at least one to two weeks to provide substantial immunity.
There is no indication of increased risk of meningococcal disease among disaster responders.
Vaccination against typhoid and cholera are not recommended. Both diseases are extremely rare in the United States, and there is no vaccine against cholera licensed for use in the United States. Rabies vaccine should only be used for post- exposure prophylaxis (e.g., after an animal bite or bat exposure) according to CDC guidelines.
Evacuees in Crowded Group Settings
If immunization records are available, children and adults should be vaccinated according to the recommended child, adolescent, and adult immunization schedules.
If immunization records are not available, children aged 10 years and younger should be treated as if they were up-to-date with recommended immunizations and given any doses that are recommended for their current age. This includes DTaP, IPV, Hib, Hepatitis B, PCV, MMR, Varicella, Influenza, Hepatitis A, and rotavirus. Children and adolescents (aged 11-18 years) should receive Tdap, MCV, and influenza vaccine. Adults (over 18 years of age) should receive Td/Tdap, Pneumococcal (adults 65+), and influenza vaccine.
In addition to the vaccines given routinely as part of the child and adolescent schedules, the following vaccines should be given to evacuees living in crowded group settings, unless the person has written documentation of having already received them:
- Influenza– everyone 6 months of age or older should receive influenza vaccine. Children 8 years old or younger should receive 2 doses, at least one month apart, unless they have a documented record of a previous dose of influenza vaccine, in which case they should receive 1 dose of influenza vaccine.
- Varicella– everyone 12 months of age or older should receive one dose of this vaccine unless they have a reliable history of chickenpox.
- MMR– everyone 12 months of age or older and born during or after 1957 should receive one dose of this vaccine unless they have a documented
record of 2 doses of MMR.
Hepatitis A vaccine should not routinely be necessary to evacuees living in crowded group settings.
Disaster Recovery Fact Sheet: Questions and Answers About Immunization Recommendations Following a Disaster. Centers for Disease Control and Prevention. http://emergency.cdc.gov/disasters/disease/immunizationqa.asp.
Emergency Preparedness and Response: After a Flood. Centers for Disease Control and Prevention. http://emergency.cdc.gov/disasters/floods/after.asp.
Interim Immunization Recommendations for Individuals Displaced by a Disaster. Centers for Disease Control and Prevention. http://emergency.cdc.gov/disasters/disease/vaccrecdisplaced.asp.
Immunization Recommendations for Disaster Responders. Centers for Disease Control and Prevention. http://emergency.cdc.gov/disasters/disease/responderimmun.asp.