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December 8, 2000
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4 Approved For ReleaseQP01/06/09: CIA-RDP79-00639A000100$6002-8 CONTINUATION OF DISPATCH p1,PA IC.11 SYMII'IL ANU NO. _-~ ATTAMIM1 I TO 1)001( I)T3Pi1T(11 A. KUBARK has reviewed its immunization policies with those of ODEARL 25X1A2g and with-used by ODACD) and non-official cover individuals. All of the usual immunization media have been included, and have arbitrarily been divided into three possible factors for considera- tion. These arez 2. Booster intervals or the maximum interval which may be permitted to elapse before the basic series must be repeated. 3. Special considerations, such as areas with a high endemic incidence of the disease, or areas with known epidemics, in which even more frequent utilization might be necessary. B. There are only minor and essentially insignificant differences. in requirements for completion of the underlying basic series among ODYOKE programs reviewed. Booster i.ntervala are essentially the same. The differences lie in the a e~ cial column, most notably, and are represented by such differences as the fol.l,owing. ODEARL is using a combined (adult) tetanus-diphtheria toxoid, and so is KUBARK in some instances. There is a slight danger in this, and KUBARK is avoiding its use in those who are past 38 years of age, those who are obese, or those who are known to have sensitivity to diphtheria toxin. The booster interval for utanus toxoid is academically known to be somewhat greater than 10 years, but operating with a margin of safety, ODEARL and insist upon a booster interval of 4 years. KUBARK is accepting one of 10 years, but boosting the individuals who have not had an injection during the past year and who are going FJS overseas or TRY with extensive air travel. On typhoid, typhus, and cholera, KUBARK is insisting on a booster within 2 years of any ap- propriate overseas travel, and a much smaller interval in particular areas. Thus Headquarters is making most of its deviations from the normal fall upon the side of conservatism, and operating when possi- ble 2 years ahead of acceptable standards. C. Some criticism of this approach is the inconvenience of having the appropriate shots performed at the requisite intervals, and oc- casional morbidity which follows the use of the various media. How- ever, for reasons to be explained below, KUBARK proposes to continue the present policy, which in essence states that all individuals departing Headquarters must be current in all foreseeable immuniza- tion needs. serve maximum protection. D. In attempting to assess the various groups which KUBARK is immunizing, and to see if any changes were advisable, the following were considereds 1. TDY personnel will continue to follow the current immuni- zation policies. These individuals are, on occasion, as- signed to PCS status in the field, are obligated to meet world-wide requirements if on standby, and therefore de- 2. PCS personnel serving overseas in areas where KUI3ARK does not maintain a medical facility, will be regarded in the same fashion ap(} Ve made current in immunizations upon each trip through Hea,Neartera, whether it be in preparation for F9VM 1Q-57 53a (49( .. (IASSU IC ATION USE PREVIOUS fDli l(lN RFREACES FORMS ~~. 5128, 51-78A AND Y 79 C%I L3i1 ""~'l! WIIkCII ARF OUS011 11. Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Approved For Release Q901/06/09: CIA-RDP79-00639A0001001 002-8 CONFIDE~V11T1 L CONTINUATION OF DISPATCH ATTAC an entirely new assignment, or TDY through Head- quarters, returning to the same station. 3. The third category, personnel stationed at overseas facilities-where KUBARK has a medical officer will. continue handled as at present. E. In sulmnary, the field must modify the "special" column as area policies and/or cover requirements dictate, with Headquarters providing sug- gestions and guidance periodically. II. PEDIATRICS A. Pediatric dosages are presented for typhus, cholera, plague, etc. For other media, either adult dosages and schedules are followed, or in the case of DPT and typhoid paratyphoid, alternate programs are outlinedo should be given intramuscularly; all others may be given subcutaneously. C. Avoid fat necrosis along the needle tract by removing antigen from the outside of the needle and by following the injection with 0.1 to 0.2 cco of air. D. Egg yolk base vaccines (typhus, influenza, yellow fever) may induce allergy in susceptible individuals and should be used with caution. E. The danger of contact of any recently vaccinated individual with an unvaccinated eczematous child cannot be over emphasized, with the possibility of eczema vaccinatum. F. When time permits, immunizations for viral diseases should be at least 2 weeks separated one from another, and also from bacterial immuniza- tions to provide maximum immunologic response. The same consideration is not equally important in bacterial immmunizationso tal may be used prophylactically in such instances. III. SUMMARY A. Immunization needs by area are unchaged from the publication of November 1957, as disseminated to the field. Deviations from this will be at the discretion of the senior area medical representatives. B Generally speaking aluminum precipitated or absorbed medications B. It should be noted that there is a slight change from previous policy on typhus, cholera, and plague dosages in children. C? It should be emphasized that typhoid is given to a total of l.0 cc* in children less than 3. year, and to 1.5 cc* in all others. Consider- able latitude is allowed in size and number of injections, based on the reaction to the last shot, provided the desired total is reached. It is recognized that the dosages of this media as outlined herein differ from the currently advised ODEit?II pediatric dosages* KUBARK has been assured that there will be in the near future a change in the ODEARL schedule, and the American Academy of Pediatrics schedule is preferable, immunologicul.1y speaking. D. The use of salicylates in weight-adjusted dosages for a 2k-hour period after all morbidity-producing in! ctions is important in the pediatric group* E. Further fractionation of dosages should be done in infants with a history of febrile convulsions. A weight-adjusted dose of phenobarbi- USE PREVIOUS EDITION REPLACES FORMS 51 2B, 51.79A AuD 51 29 WHIr11 API nrdII FF IONI 11111111111 Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Approved For Release-wW1/06/09: CIA-RDP79-00639A000100b OO2-8 CONTINUATION OF DISPATCH *WM D SPATCH SYM601 AND NO TTTACHMI;NT TO BOOK DISPATCH NO.~ 2 X1A 0. No attempt has been made to advise a chronological program in the overall basic immunization of children or adults. Specific areas, time' available, disease incidence, and judgment of the area medical representative,,.-should all be determining factors in questionable cases. L (~~l WHI(II AR[ 0111)LEIE FORM R meviva n... REPLACES FORMS 10-57 53a 1 A - CONTINUED 5 !d 5138A AND 51.79 Approved For Release 2001/06/09 : CIqI!015ib7`9=D0639A000100030002-8 Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 L .RING BASIC SERIES MAXLMUhi INTEHIALSM SPECIAL C ONS A (3) 0.5 cc. injections at 4-6 wk. 4 years ONLY if Schick positive intervals after Schick and t loney Be-Schick before boosting testing. 601 1 TETANUS TOXOID For either medium use (3) 0.5 cc. 10 yearmilitary) OR shots at 4-6 wks intervals OR (2) (4 in A TEMANUS- at same interval and booster 1 - IT ITT=A year later. TMODS S?9AI?,LPOX (1) Primary take Succeg 3 FacC7s1ai n every 3 years 0 z= 0 as 7 0. zLn z 0 YELLOW FED (1) shot of 0.5 cc. 6 years Boosters are given to most Head- quarters departees who have not had a shot within the past year. Also used as booster in appropriate injury- Contraindicated for those over 40, obese, or those known to be sensi- tive to Diph. toxoid. Preliminary ,Schick testing not routinely nec- essary. DO NOT USE PEDIATRIC TYPE FOR THIS USE IN ADULTS. Intervals down -tb 6 months in special areas. Four-year intervals in individuals going to appropriate areas. ~YPROID (3) 0.5 cc. shots at 1-4+ wk. 10 years intervals down to annual in appro- P OID intervals (4 in military) priate areas. May use 0.1 cc. intracutaneous as booster CE PI AGUE (2) shots of 0.5 cc. and 1.0 cc. 4 years at-7-10 day intervals. Twice annually in epidemic areas. 0 06 Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 0 z Z Z 0 V Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 ADULTS (cmITn unn ) N4!MaZi INTERVALS BE'r' BASIC SERIES Ideal y 0-' -7 xc t'ss spat' .g. y one booster currently t~,M AT0E in all persons over 3 months, and advisable to boost Eestart series if over 1 year advised, 1-2 years later. elapses between :ndiviuual shots. mother during last trimester of prency. Very rare penict"min allergy - generally ignored. Icy be boosted at yearly Should contain at least 220 CCA intervals at discretion of units Asian strain. ? edical Officer or upon request. Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Ion Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 00 ZE CHMM: EN PAC TEJA S Dr ''RTA TOKOIDS SMALT-PU FEVER BASIC SERIES (B?WM PERIODS AS FOR ADULTS) Used in pediatric group ideally at 3-4-5-18-36 months of age. For use as booster in 5-12 age agroup, at 3-4 year intervals. Adult type may be substitute for use as booster in children. Usage identical with adults. For appropriate wounds boost with adult tetanus toxoid. Should not ideally be used after 5 because of reactions to to pertussis toxoid. This medium should never be used in adults without Schick testing. POLIO IAFF,U Use on weight adjusted basis as in adults Total of.(3) shots at 1-3 wk. intervals Boost with appropriate dose at intervals 6-mos. - 3 years 0.12 cc. as used in adults. 3 years- 6 years - 0.25 cc. 6 years- ll years 0.5 cc. 12 years Adult dose j Total of (3) shot s at 7 -10 da y interv shot 1/2 of.follo wing o nes in amount. 6 mos. - 3 yrs. 0.06 0.12 0.12 cc. 3 yrs. - 6 yrs. 0.12 0.25 0.25 cc. 6 yrs. - 11 yrr. 0.25 0.5 0.5 cc. Over 12 yrs. Adult dose als with first Boost with appropriate dose at intervals as used in adults. Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Less than 1 year 0.2 0.25 0.25 0.3 cc. suggested and 1-4 wk. intervals OR any combina- tion of injections to total 1.0 cc. Greater than 1 year 0.3 0.6 at 1-4 wk. intervals OR any combination of injections to total of 1.5 cc. Total dose felt to be significant here rather than an age or weight-adjusted dose. Wide latitude in fractionation of dose permissible at discretion of Medica]. Officer. Boosters as in adults, or 0.1 cc. intracutaneously is permissi- ble. Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 Approved For Release ~961/06/09 : CIA-RDP79-00639A0001000`*002-8 CONTINUATION OF DISPATCH V, Tic cL s rAt1 II44UNIZATION POLICY 1. Local Health Department requirements are not listed. However) the immunizations should cover all countries visited during overseas travel. 2. For the salve of brevity) the following system was devised: REQUIPIRMS Smallpox '.Typhoid paratyphoid Tetanus Polio Diphtheria (if indicated by Schick: under 35 years of age) Smallpox Typhoid paratyphoid Tetanus Typhus Polio Diphtheria (if indicated by Schick: under 35 years of age) Smallpox Typhoid paratyphoid Tetanus Typhus Cholera Polio Diphtheria (if indicated by Schick: under 35 years of age) Area 1+-a Smallpox Typhoid paratyphoid Tetanus Typhus Yellow Fever Cholera Polio Diphtheria (if indicated by Schick: under 35 years of age) Smallpox Typhoid paratyphoid Tetanus Typhus Yellow Fever Polio Diphtheria.(if indicated by Schick: under 35 years of age) NOTE: Salk Vaccine is now required for all personnel. USE PRE VIOI4S.EDITION. REPLACES F'~'RJ~nS 51-28. 51='IItA"AND 5129 WHICII'AWE OBSOLETE. Approved For Release 2001/06/b9 TiA-R6~f9J000639A000100030002-8 Approved For Release 2O1/06/09 : CIA-RDP79-00639A000100GW02-8 CONTINUATION OF DISPATCH Dominica #1 Dominican Republic #1 Ecuador Egypt #4-a Eire #1 Ellice Islands #3 El Salvador #4 The countries are listed in alphabetical order. The number following the name of the country indicates the area. Afghanistan #3 Alaska #1 Albania Algeria Andorra Anglo-Egyptian Sudan Angola Arabia, Saudi #3 Argentina #4 Aruba #4 Ascension Island #4 Australia #1 Austria #2 Azores #l Bahamas #1 Bahrein #2 Barbardost H.W.I. Basutoland #4 Bechuanaland #4 Belgian Congo #4 Belgium #2 Bermuda #1 Bhutan #4-a Bolivia #4 Bonaire, N.W.I. Borneo #3 Brazil #k #4 #4 British Somaliland #4 Bulgaria Burma #3 Cameroons #4 Canada #1 Canal Zone #4 Ceylon, #4-a Chile #4 China #3 Cocos Island #1 Colombia #4 Corsica #2 Costa Rica #4 Cuba #1 Curacao #4 Cyprus #3 Czechoslovakia #2 Dahomey Denmark FORM 1057 53a (40) Eritrea .#4 Estonia Ethiopia #4 Fiji Islands #2 Finland France #2 French Equatorial Africa #4 French Establishment in India French Guinea #4 French Indochina #3 French Somaliland French West Africa 1/4 Ghana #4-a Gamiba Germany J /2 Gibraltar #2 Gilbert Islands Granada, B.W.I. Greece #2 Greenland #1 Guam #1 DISPAICM SYMBOL AND Ho. AT]ACRMT TO BOOK DISPATCH #1 #l Guatemala #4 Guiana,, French #4 Guiana, British #4 Guiana,, Netherlands #4 Haiti #1 Hawaiian Islands #1 Honduras #4 Hong Kong #4-a Hungary Iceland #1 India #4-a Indonesia #3 Iran 3 Iraq #3 Ireland #1 Israel #3 Italian East Africa USE PREVIOUS L1)11 ION. REPLACES FORMS 51 ~28, 51 28A AND 51 29 WHIG II ARL OBSOLLIE. 1x__1 CONTINUED 0 Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 ,Approved For Release 2Q41/06/09 : CIA-RDP79-00639A0001000- 02-8 CONTINUATION OF DISPATCH DISPATCH SYMBOL AND NO AL1ACIIMi VTR( r0 r 71153a Philippines #4-a Poland #2 Portugal #4 Peru #1 #1 Liechtenstein #2 Lithuania #2 Luxembourg 2 Macaa Madagascar ?4 Malaya #4-a Malta #2 Manchuria #3 Marianas #3 Martinique, F.W.I. #4 Mauritius #2 Mexico #2 Monaco #2 Mongolia #3 Morocco #2 Mozambique #4 Nepal #3 Netherlands West Indies #4 Netherlands #2 New Caledonia #3 Newfoundland #1 New Zealand #1 Nicaragua #4 Nigeria #4 Norway #2 Nava Scotia #1 Nyasaland #4 Okinawa #3 Pakistan #4-a Panama #4 Paraguay #4 Labrador #1 Latvia #2 Lebanon #4-a Levant States Liberia #4 Libya Italy #2 Ivory Coast #4 Iwo Jima #1 Jamaica #1 Japan #3 Johnston Islands Jordan #/4-a Kenya # !~I Korea #3 Kwajalwein #1 Italian Somaliland 11-4 , USE PREVIOUS EDITION REPLACES FORMS 5128, 51 78A AND 5129 WHICH ARE OBSOLETE Portugese Nast Africa Portugese Guinea #3 Puerto Rico #1 Reunion #4 #4 Rhodesian North and South #4 Rio do Oro #/2 Rio Muni #/"I+ Romania #3 Russia #2 Ryukyus ##3 St. Pierre and Miquelon #1 Saipan #f3 Samoa #1 Santa Lucia, B.W.I. #1 Sarawak ##3 Sardinia #2 Scotland #1 Senegal. # Seychelles Islands #3 Siam #3 Sierra Leone Africa #4 Singapore #1-4-a Southwest Africa Spain #2 Swaziland, Africa Sweden #2 Switzerland #2 Syria #4-a l:niti #4 Tanganyika #~F Tibet #3 #4 #p+ Togoland, British #/4 Togoland, French #4 Transjordan #3 Trieste #/2 Trinidad, B.W.I. #4 Tripoli #3 Tunisia Turkey Uganda Union of South Africa #4-a United States of America #1 Uruguay #4 Venezuela Virgin Islands #1 Wales #1 Windward. Islands #4 Yemem #4-a Yugoslavia #2 Zanzibar #4-a Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 AREA CT OCEAN T~LJO SOUTH PACIFIC OCEAN SOUTH ATLANTIC YYY I I ~ I I WORLD AREAS FOR WHICH CERTAIN IMMUNIZATIONS ARE REQUIRED AREA R AREA Y w uo w .+a ee ioe ae se to aa* o raar Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8 TAREA T AREAC,T Approved For Release 2001/06/09 : CIA-RDP79-00639A000100030002-8