Recommended Immunizations for Campers

Spring 2009

Dear Children's Camp Operator:

The purpose of this letter is to discuss vaccine-preventable diseases and vaccination in the camp setting. There has been an increase in the number of cases of vaccine-preventable diseases in the U.S. that are linked to foreign travel or importation. There is also a growing presence of international staff working at summer camps in New York State. These individuals provide a valuable contribution and enhance the camping experience. However, they may introduce vaccine-preventable diseases that are endemic in their country of origin. The best protection against vaccine-preventable diseases is broad vaccination coverage. Therefore, vaccination of all individuals who will be working in or attending summer camps is recommended.

This letter will discuss how to report a vaccine-preventable disease to the local health department, and which vaccines are recommended for both campers and staff.

Reporting Details

Most vaccine-preventable diseases are reportable by law, and often even one case is considered an outbreak. The camp health director or other healthcare provider should discuss with staff the symptoms of vaccine-preventable diseases, especially pertussis, measles and mumps. The need to report the first sign of illness to the director should be stressed. The local health department should be notified immediately of any suspect case. (Camp operators must report to the permit-issuing official. Medical providers should refer to Attachment 1, New York State Department of Health Communicable Disease Reporting Requirements.)

Recommended Immunizations for Campers

The children's camp code, Subpart 7-2 of the State Sanitary Code, requires that the camp maintain immunization records for all campers. It does not, however, specify which vaccines are required for camp attendance. Individual camp policy may choose to recommend or require specific immunizations of their campers and employees. For the optimal health and safety of all campers and camp staff, the New York State Department of Health strongly recommends that all campers meet the same immunization requirements as school-aged children as indicated in PHL Article 21, Title 6, Section 2164. (Refer to Attachment 2, New York State Immunization Requirements for School Entrance/Attendance.) In New York State, PHL Article 21, Title 6, Section 2167 also requires the notification of campers and parents about recommendations for and the availability of meningococcal vaccine (meningococcal conjugate vaccine or meningococcal polysaccharide vaccine) for all campers attending overnight camps for a period of 7 days or more.

The Advisory Committee on Immunization Practices (ACIP) recommends that 2 doses of mumps vaccine be required to confer immunity for mumps. Most U.S. residents receive 2 doses of mumps vaccine in the form of the combined measles, mumps, and rubella vaccine (MMR), first at age 12-15 months, and a second dose upon primary or post-secondary school entrance. Experience with outbreaks has shown two doses of mumps vaccine to be more effective than one dose. Two MMR vaccinations will likely ensure maximal protection from measles, mumps and rubella.

Recommended Immunizations for Employees

The following immunizations should be considered for all summer camp employees, including international staff. The recommendations are based on the current recommendations of the ACIP.1 For further details and special circumstances, consult ACIP publications or the National Center for Immunization and Respiratory Diseases (NCIRD) of the Centers for Disease Control and Prevention (formerly the National Immunization Program).2

Recommendations for administration of vaccines for summer camp counselors and seasonal camp workers are organized into three broad disease categories:

  1. The following immunizations are strongly recommended:
    • Measles, mumps, and rubella vaccines for people born on or after January 1, 1957, because these vaccine-preventable diseases are highly communicable and the risk of exposure is high. The recommended form of administration for all three vaccines is the trivalent MMR vaccine.
      At a minimum this would require:
      • 2 doses of measles containing vaccine, 2 doses of mumps containing vaccine and 1 dose of rubella containing vaccine (MMR), with the first dose administered no more than 4 days before the 1st birthday and with the two doses given at least 28 days apart; or
      • History of having had measles or mumps disease (not rubella) diagnosed by a physician, physician assistant, or nurse practitioner; or
      • Demonstrated serological evidence (blood test) of measles, mumps or rubella IgG antibodies.
    • Tetanus toxoid vaccine because the camp environment increases the risk of exposure to C. tetani spores.
      • 1 booster dose of tetanus-containing vaccine within the past 10 years.
      • Tdap (adolescent and adult tetanus, diphtheria and acellular pertussis) vaccine is the preferred immunization for everyone between 10 to 64 years of age; however, Td (adult tetanus and diphtheria) may be used.
  2. The following immunizations may be indicated in certain circumstances (for complete recommendations see the NCIRD website http://www.cdc.gov/vaccines/):
    • Hepatitis B -- for health workers and lifeguards.
    • Meninogococcal vaccine -- for 11-12 year olds, high school and first year college students that live in dormitories, and travelers.
  3. The following immunizations are recommended for all adults:
    • Varicella (chickenpox) – in the absence of disease history; and
    • Poliovirus – if not previously vaccinated with either inactivated or live oral vaccine.

Additional Information

For additional information on immunizations given in other countries or on immunizations in general, please call your local health department or the NYSDOH Bureau of Immunization Program at 518-473-4437. More information can also be obtained at the CDC's National Center for Immunization and Respiratory Diseases (NCIRD) website at http://www.cdc.gov/vaccines/.

Thank you for your efforts to keep camps free of vaccine-preventable disease.

Sincerely,

Debra Blog, M.D., M.P.H.
Director
Bureau of Immunization

1MMWR 54(51,52):Q1-4 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5451-Immunizationa1.htm), MMWR 54(40):Q1-4 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5440-Immunizationa1.htm)

2 Accessible at http://www.cdc.gov/vaccines/recs/acip/default.htm

Enclosures:

Attachment 1: New York State Department of Health Communicable Disease Reporting Requirements

Attachment 2: New York State Immunization Requirements for School Entrance/Attendance

Attachment 3: Preventing Measles Importation at Children's Camps 2009