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Spacing out the shots may get harder look

by Deborah Funk
Army Times

Services usually ‘overvaccinate’ now, doctors say

A group of civilian medical experts says multiple simultaneous vaccinations are safe, but nevertheless advises the Pentagon to look for ways to reduce the number of shots given to troops at one time.

The goal should be to “minimize discomfort” to troops and prevent possible lost work time and unnecessary vaccination while still protecting the force against diseases, the Armed Forces Epidemiological Board said in a April 2004 memo to senior health officials in the Defense Department and the services.

The board recommends spreading vaccinations out over time during initial entry training and subsequent service, and investigating whether someone has immunity against a particular disease before vaccinating.

“What we see consistently is overvaccination,” said Dr. Stephen Ostroff, president of the board and assistant surgeon general of the U.S. Public Health Service. “We don’t see solid, scientific, well-documented information that suggests there’s any particular reason you can’t give multiple vaccinations. However, we need to take a hard look at what we’re doing because [vaccines] may not be needed by that particular individual.”

In mapping out specific approaches, service officials will have to consider how many people are immune to a disease against which they might vaccinate; the costs and logistics of selective versus universal vaccination; and the risk of missing vaccinating someone who may be susceptible to a particular disease, the memo said.
While decades of experience show no serious or long-term health problems from vaccinating against more than one disease at the same time, there is evidence of short-term soreness and illness that resolve on their own but increase with multiple simultaneous vaccinations and may lead to missed work time, according to the board’s memo.

One way to avoid this for recruits, the board said, would be to administer shots for flu, measles, mumps, rubella and other kinds of vaccines that would have “immediate potential” for keeping people healthy at the beginning of training, then giving the remaining required shots closer to the end of boot camp.

To avoid unnecessary shots, the services could screen blood to check for immunity against disease troops may have encountered naturally or may have been inoculated against during childhood, such as chickenpox or hepatitis B.

The board said vaccination against diseases that are a threat only in certain geographic areas, such as yellow fever, could be limited to people who are likely to travel to those areas of the world. The Air Force, for example, has reduced its use of yellow fever vaccine by 81 percent after requiring vaccination based on risk of exposure, the board noted.

Beyond basic training, the services should more closely track which vaccinations troops have received, to include presuming that those who graduated from boot camp got the standard vaccines given during that period.

National Guard and reserve members also should be required to bring vaccination records with them when they are mobilized or assessed for medical readiness, the board said.

These groups are more likely to require updated vaccinations than other troops, so more frequent medical readiness reviews could help cut the number of vaccines they must be given at one time.

“DoD procedures should minimize just-in-time delivery of preparatory countermeasures,” the board wrote.

The Air Force has adopted many of the board’s suggestions. For example, it stores shot records electronically and checks blood for existing immunity. Vaccinations are spread out as training schedules allow, and vaccinations needed for specific geographic regions are held off until just before deployment, according to Lt. Col. (Dr.) Michael Snedecor, chief of preventive medicine for the Air Force surgeon general.

The Navy is looking at how it might reduce vaccinations among Navy and Marine Corps trainees while still keeping them healthy and ready, said Capt. Edward Kilbane, director of preventive medicine and occupational health in the Navy’s Bureau of Medicine and Surgery.

The Navy has done studies of recruits’ immunity to diseases like chickenpox and hepatitis B to see if those vaccinations were needed, and is also developing ways to screen health histories to avoid repeating vaccinations people may have received prior to joining the Navy.

The Army tries to spread out vaccinations when possible, and its clinics de-emphasize measles-mumps-rubella and polio vaccines after initial entry training.
Army officials also say they are paying closer attention to individual health records to reduce the number of shots given prior to deployment when possible.