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91 Cards in this Set
- Front
- Back
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Commanding Officers purpose
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Comply with quarantine regulations and cooperate with the agencies listed in matters of quarantine
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The quarantinable diseases are
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a. Cholera
b. Plague c. Yellow Fever d. Smallpox |
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CHOLERA DEFINITION
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Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae
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CHOLERA SYMPTOMS
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(1) The infection is often mild or without symptoms, but sometimes it can be severe.
(2) Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. (a) In these persons, rapid loss of body fluids leads to dehydration and shock. (b) Without treatment, death can occur within hours. |
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CHOLERA CONTAMINATION
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A person may get cholera by drinking water or eating food contaminated with the cholera bacterium.
-inadequate tx of sewage/drinking water -shell fish |
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PLAGUE/BUBONIC PLAGUE
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Plague is an infectious disease of animals and humans caused by a bacterium named Yersinia pestis.
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PLAGUE CONTRACTION
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People usually get plague from being bitten by a rodent flea that is carrying the plague bacterium or by handling an infected animal.
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BUBONIC PLAGUE SYMPTOMS
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Lymphadenitis develops in lymph nodes receiving drainage from the site of the flea bite, where there may be an initial lesion.
Fever is usually present. |
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Pneumonic PLAGUE SYMPTOMS
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(1) Extensive involvement of lungs, sputum loaded with causative agent.
(2) Respiratory droplets may serve as source of propagation, leading to outbreaks or epidemics |
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Methods of control PLAGUE
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The basic objective is to reduce the likelihood of people being bitten by fleas, having contact with infective tissues or exudates, or exposure to patients with pneumonic plague
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E. YELLOW FEVER
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a. Yellow fever is a viral disease transmitted between humans by a mosquito
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Yellow fever vaccine is a live virus vaccine and requires a booster Q?
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10 years
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SMALLPOX
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The last naturally acquired case of smallpox in the world occurred in October 1977 in Somalia;
(1) Global eradication was certified two years later by the WHO |
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The instruction which outlines quarantine regulations?
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SECNAVINST 6210.2A - Quarantine Regulations of the Armed Forces
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Shipboard Sanitation Control Certificate?
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BUMEDNOTE 6210
-valid for 6 months -May be extended once for one month by the original issuer |
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Foreign health officials may be received on board for receiving certification compliance but...
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only with the approval of the Commanding Officer
-Foreign officials can not conduct inspections of military vessels |
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U.S. Port - quarantine requirements.
Public health quarantine: in the last 15 days prior to arrival |
-Patient has temperature of 100ºF (38ºC) or greater accompanied by rash, glandular swelling, or jaundice, or which has persisted for more than 48 hours.
-Patient has diarrhea, defined as the occurrence in a 24 hour period of three or more loose stools or of a greater than normal (for that person) amount of loose stool. -Death due to illness other than battle casualties or physical injuries. |
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Time span the Commanding Officer must notify higher authorities of quarantine conditions aboard their vessels prior to arrival in U.S. ports?
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-The Commanding Officer will between 12 and 72 hours prior to entering the port, message/radio the following:
-Senior Naval Officer in command of port to be entered. Inform: Military quarantine inspector. Responsible preventive medicine service in the port area |
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8.15
Instruction for TB Control |
BUMEDINST 6224.8A -Tuberculosis Control Program
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THE PURPOSE OF TB CONTROL PROGRAM
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Provides policy and guidance for controlling tuberculosis (TB) among Department of the Navy (DON) military personnel and Military Sealift Command (MSC) civilian mariners (CIVMAR).
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ELEMENTS OF TB CONTROL PROGRAM;
TB SCREENING |
-TB SKIN TESTING-MANTOUX METHOD
-RADIOGRAPHS |
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ELEMENTS OF TB CONTROL;
PREVENTION OF ACTIVE DISEASE |
-MEDICAL EVALUATION
-CHEMOPROPHYLAXIS |
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ELEMENTS OF TB CONTROL;
MANAGEMENT OF ACTIVE DISEASE |
-TREATMENT
-PREVENTION OF SPREAD TO CONTACTS -MER REQUIREMENTS |
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ELEMENTS OF TB CONTROL;
TB CONTACT INVESTIGATION |
ID OF CONTACTS
FOLLOW UP THROUGH TESTING EARLY DETECTION OF INFECTION MEDICAL EVALUATION/TX |
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APPROVED MATERIAL
Tuberculin, Purified Protein Derivative (PPD). |
Premixed tween-80-stabilized intermediate strength PPD (5tu).
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Describe the Disposable 1 ml tuberculin syringe
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Graduated in 0.1 ml intervals and fitted with a 25-gauge 5/8-inch needle.
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TERM ACTIVE DISEASE TB
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The patient is symptomatic, and/or exhibits laboratory/radiographic evidence of infection
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TUBERCULOSIS INFECTION
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a. The patient is asymptomatic, but exhibits a positive PPD
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Mantoux method
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a. A tuberculin skin test using a syringe and needle to inject Purified Protein Derivative (PPD) of tuberculin
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Define Induration
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An area around the site of tuberculin injection that is raised and firm
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Tuberculin reactor
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A person with a positive TST when read 48 to 72 hours after administration (based on risk factors outlines in table 1 of BUMEDINST 6224.8A
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Tuberculin non reactor
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A person with a negative TST when read 48 to 72 hours after administration (based on risk factors outlines in table 1 of BUMEDINST 6224.8A
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ALTERNATE REGIME FOR INH
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An alternate regimen is INH 15mg/kg (900mg max) twice weekly for 9 months. This may be used only in combination with directly observed therapy (DOT).
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MAIN PREVENTIVE THERAPY
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The antibiotic regimen of choice for tuberculosis preventive therapy is INH in an oral daily dose of 5mg/kg (300 mg max) for 9 months to accomplish 270 daily doses within 12 months
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WHO NEEDS TO BE INITIALLY SCREENED FOR PPD
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-All personnel entering active duty.
-All individual beginning employment as CIVMAR for the MSC. |
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WHEN DO YOU CONDUCT ANNUAL TESTING?
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Annual screening during Periodic Health Assessment (PHA).
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Separation
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A documented tuberculin skin test (or annual clinical evaluation in the case of an old reactor) within six months of separation from the naval service.
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CHEST X-RAYS
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a. New reactor to rule out active disease.
b. Any time active disease is suspected. c. New and previous reactors who are contacts of potentially infectious case of active disease |
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PPD administration
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a. Aseptically prepare skin.
b. Make an intradermal injection of 0.1 mL of intermediate strength (5 tu) PPD on the volar aspect of the left forearm |
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If no wheal appears, the PPD was injected subcutaneously what do you do next
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repeat on other arm
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When do you interepret a PPD?
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48-72 hrs after getting it
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Measuring induration in mm
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at it's widest transverse diameter
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Redness with no induration=
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ignore
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Recording/measuring any induration
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Find margins of the induration by drawing index finger across reaction
Use ball point pen to demarcate induration |
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Record result on
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NAVMED 6230/4 (Rev. 10-2007) or NAVMED 6230/5 under tuberculosis sensitivity tests with the following information
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Failure to return for test interpretation
or (2) Failure to read results |
write "not read"
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SIGNIFICANT NEW REACTOR RATE
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1. The percent of close contacts who are TB reactors or converters is a good indicator of a case's infectivity.
2. If the rate of newly identified converters is two times greater than the expected baseline conversion rate of the command (2% per year for the Navy-Marine Corps), contact the cognizant NEPMU for specific guidance |
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BACILLUS CALMETTE GUERIN (BCG
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BCG causes false positive PPD readings of less than 10 mm induration and wane within 8 years. Disregard history of vaccination and manage accordingly.
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INH INITIAL PREVENTIVE THERAPY
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All TB reactors with an induration of 5 mm or greater must be evaluated and considered for therapy with Isoniazid (INH
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Close INH Monitoring for;
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(a) Obtained at least at 1,2 and 3 months after initiating INH for the following:
1 All 35 y/o or greater. 2 Phenytoin (dilantin). 3 Heavy consumers of alcohol. 4 Chronic liver disease or severe renal dysfunction. 5 Pregnancy. |
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NON COMPLIANCE / EXTENDED DOSES
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1. If treatment has been interrupted for more than two months, patients must be examined to exclude active TB disease.
2. Do not restart the 9-month daily INH regimen if at least 270 doses of INH can be administered within a 12-month period. 3. INH can be given twice weekly 15 mg/kg body weight (up to 900 mg). a. This schedule makes directly observed therapy (DOT) more manageable, when poor compliance is a concern |
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SGOT/SGPT BLOOD LEVELS
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Consider withholding INH if patient’s transaminase levels exceed three to five times the upper limit of norma
-INH therapy may increase the liver enzyme (SGOT/SGPT) blood levels |
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TB CONTACT INVESTIGATIONS
Purpose |
A contact investigation must be initiated upon discovery of an active TB case in an effort to prevent further propagation
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TB CONTACT INVESTIGATIONS Procedure
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Upon discovery of a suspected or confirmed case of active TB, the CO or OIC must notify the cognizant NEPMU, and the local health department as soon as possible
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APPROVED PPD TESTS
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1. Mantoux method
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Prion diseases
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CJD- rapid progressive dementia
kuru mad cow scrapie (sheep) |
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The 3 goals(purposes) of MER
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a. Timely and adequate public health response.
b. Estimation (statistical means) of distribution, trends, and risks. c. Development and assessment of policy and resource allocation for the control of medical events |
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Medical departments providing inpatient/outpatient services must submit a MER for following incidences:
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a. Reportable condition is suspected or confirmed.
b. Notified of a communicable disease outbreak or injury. c. Ships or aircraft quarantined in international travel. d. Suspected or confirmed outbreak of nosocomial infections occur from a single source of morbidity or mortality. e. Condition is unusual in presentation, clinical course, or outbreak potential. |
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PRIORITY MESSAGE REPORTING1. The following communicable diseases are required to be reported within 24 hours
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Anthrax
Botulism Cholerag. E. coli 0157:H7 infection Malaria Measles. Meningococcal disease -Outbreak or suspected outbreak situations reported via priority message. -Food/Water associated illness |
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PREFERRED METHOD OF REPORTING
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a. NDRSi is the preferred method of reporting
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ROUTING AND DISTRIBUTION OF MER
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The MER is assigned the report control symbol MED 6220-3
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Types of MERs
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a. Routine reports.
Report must be submitted no later than the end of each month to the cognizant NEPMU b. Urgent reports. Diagnoses which must be submitted within 24 hours or sooner |
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The primary action addressee on MERs
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is the cognizant NAVENPVTMEDU (NEPMU)
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Responsibilities.
-Navy and Marine Corps Public Health Center |
(1) Perform global surveillance and monitoring of reportable medical events.
(2) Tabulates and analyzes MERs to examine Navy and Marine Corps trends and demographic data. (3) Maintain the NDRSi. (4) Send data to defense medical surveillance system or higher authority |
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RESPONSIBLITIES
OIC, NAVENPVTMEDU |
(1) Provide regional communicable disease surveillance and control.
(2) Provide technical assistance to requesting commands. (3) Validate MERs annually |
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The primary purpose of the Medical Event Reporting are
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Timely and adequate public health response to medical events
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IMMUNIZATIONS INSTRUCTIONS
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BUMEDINST 6230.15 Series - Immunizations and Chemoprophylaxis
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BASIC SERIES REQUIREMENTS
1. For short notice travel or deployments |
administer the first dose in a required basic series.
2. Make arrangements to receive additional doses to complete the series as close to the proper schedule as possible. |
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VACCINATIONS FOR ACTIVE DUTY PERSONNEL
1. Intervals |
a. The prescribed time intervals between individual doses of an initial immunization series will be adhered to as closely as possible.
-If delayed, administer vaccine at earliest opportunity. -Minimum intervals will not be reduced unless approved by BUMED. |
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Anthrax vaccine
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a. Required for all active duty personnel.
b. Dosage: 5 shots over 18 months. (1) 0.5 mL given at: (a) 0. (b) 4 weeks. (c) 6 months. (d) 12 months. (e) 18 months. (f) Yearly boosters |
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HEP A
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IM 1.0ML
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HEP B
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IM 1.0
0,1,6 STD START HEP B SERIES IMMUNITY SHOULD BE CHECKED WITHIN 1-6MTHS AFTER 3RD DOSE |
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Japanese Encephalitis (JEV)
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Dosage - primary 3 doses of 1.0 mL each on day(s) 0, 7, and 30
SQ Periodicity-1.0ml Q 3yrs |
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Measles, Mumps and Rubella (MMR) (live virus).
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Dosage: 0.5ml.
.Route - subcutaneous |
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Plague (sterile suspension) inactivated bacteria
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b. Dosage - 3 doses:
1.0 mL. 0.2 mL 1 month later, and 0.2 mL between 3-6 months after the second dose. Route - IM |
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Typhoid
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(1) Required for alert forces or when deploying to high-risk areas.
(2) Dosage: Two doses of 0.5 mL given 4-8 weeks apart. (3) Route - Subcutaneous (sq) or IM. (4) Periodicity: Booster of 0.5 mL every 2 years |
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Yellow fever (live virus).
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Dosage - 0.5 mL.
Route – Deep Sq or IM Periodicity: (1) Single initial dose. (2) Booster given every 10 years. |
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Storage of all biological products;
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(1) Store between 35.6-46.4ºF (2-8ºC).
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storage Anthrax vaccine
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(1) Store between 36-46ºF
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storage Yellow Fever
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(a) Store between 32 to 41 ºF (0 to 5 ºC)
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Prior to immunization
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check to see if patient has any allergies or hypersensitivities
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If hypersensitive to eggs, do not administer vaccines prepared by cultivation
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(a) Influenza.
(b) Yellow fever. (c) Measles, Mumps (anaphylactic reaction only) |
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-Live virus vaccines should not be routinely administered to any pregnant female if she becomes pregnant within 3 mths
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(1) Reassure her.
(2) Advise her of the small unlikely theoretical risk of complication in the developing fetus. (3) Refer for Medical Officer evaluation |
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Type Commanders will determine
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types of health care personnel and their level of certification in CPR and life support.(1) Minimum qualified in BCLS, but ACLS is preferred
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2. Immunization clinics should be located near ER or sickbay.
a. If not |
a ready ambulance should be available with a physician staffed medical treatment facility (MTF) within an acceptable transport distance of <10 minutes.
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ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP
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1. ACIP is the acronym for Advisory Committee on Immunization Practices.
2. Vaccine administration policies of the Navy Immunization Program must follow current ACIP recommendations. |
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ROUTINE IMMUNIZATIONS UNDERWAY
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1. Routine immunizations given while underway may lead to anaphylactic reactions.
2. All immunizations, except yellow fever, may be given at sea or ashore at the discretion of the MDR with the concurrence of the Commanding Officer. 3. Yellow fever immunizations on IDC ships shall only be conducted in port during normal working hours after prior notification and concurrence of local RSG/Group M.O., unless a Medical Officer is present |
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EXEMPTIONS AND WAIVERS
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The respective Surgeons General or Commandant grant permanent immunization waivers for military or civilian personnel.religious objections to immunization
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Authority to grant temporary waivers is delegated
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to the Chief, Bureau of Medicine and Surgery
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a. NAVMED 6230-4
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adult health record immunization record.
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b. PHS 731
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International Certificate of vaccination (1) Required for each member of the armed forces and for nonmilitary personnel.
2) Remains in custody of the individual |
