feeling very apprehensive and possibly disoriented. The lips, tongue, and eyelids may be swollen; circulatory and respiratory collapse can occur. Treatment must be rapid and exact to stop the progress of shock. Immediately give 0.5 ml of epinephrine 1:1,000 subcutaneously (SC) in any available area without stopping to prepare the immunization injection site. Put a tight tourniquet proximal to the injection site (on the side toward the heart) to prevent further absorption of the material. Start an intravenous infusion using a 5 percent dextrose/saline solution so that access is available for other medications if needed. Make sure the patient is under a physician’s care as rapidly as possible.
Whenever you notice local or constitutional reactions of unexpected severity or frequency, local infection, abscess formation not traceable to errors in techniques of administration, or other significant manifestations that may be due to the use of a biological product, discontinue administration of the lot and request instructions regarding the disposition of the suspected materials. Until you receive a reply, keep all open and unopened packages in the lot under proper storage conditions.
Precaution: Before administering any live virus vaccine to a female, except the oral poliovirus vaccine, ask her if there is any chance that she may be pregnant. If her answer is affirmative, a medical officer will probably grant a temporary exemption, since live virus vaccines are contraindicated during pregnancy.
For further information on waivers and exemptions, consult NAVMED P-5052-15 series, NAVMEDCOMNOTE 6320 (latest issuance), and BUMEDINST 6230.1 series.
Aircrew members shall not fly for a minimum of 12 hours (preferable 24 hours) after receiving any immunization except the oral poliovirus and smallpox vaccines.
INTERVALS
The prescribed time intervals between individual doses of a basic immunization series will be regarded as optimal and will be adhered to as closely as possible. If delays prevent completion of a series within the prescribed time, administer the next dose, or doses, at the earliest opportunity. A new series will not be given. Minimum intervals between doses will not be reduced under any circumstances. When a basic series has been completed, as evidenced by proper entries on an official immunization record, the need for another basic series of the agent is eliminated. A single stimulating (booster) dose will suffice. There should be a minimum period of 30 days between doses of different live virus vaccines, unless a medical officer directs otherwise.
ROUTINE IMMUNIZATIONS
Manufacturer’s inserts in the vial packages will specify the route of administration of the vaccine, e.g., intramuscularly (IM) or subcutaneously (SC). These directions must be followed accordingly.
Do not mix two or more immunizing agents in a vial or syringe for the purpose of permitting a single simultaneous injection; the agents may be biologically or physically incompatible. Always read the package insert before administering any immunizing agent.
When there is insufficient time to permit completion of a required basic series prior to travel, do not delay travel for any dose except the first dose of the series.
Smallpox Vaccine
The naturally occurring disease smallpox has been eradicated around the world. Thus, routine periodic vaccination of military personnel is currently no longer justified. Navy and Marine Corps personnel will be immunized for smallpox only in certain situations when they can be isolated from the general population. Current policy thus limits the administration of the smallpox immunization to the period of time during recruit training and officer indoctrination programs.
METHOD.— To avoid a large lesion with the increased danger of secondary infections, inject the virus by the multiple pressure method (do not cause bleeding) into as small an area as possible. The area should not cover more than one-eighth of an inch in any direction. To avoid infection, use aseptic technique. Cleanse the area with sterile cotton and alcohol or acetone, and permit it to dry thoroughly prior to vaccination. Failure to wait for the antiseptic to dry may result in inactivation of the virus. Allow the vaccine to dry for 3 to 5 minutes without exposure to sunlight, when wipe off the excess with sterile cotton or gauze. A specifically equipped jet injection gun may also 11-3