Recommended Immunizations for Campers

Spring 2011

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 United States over the last several years, many of which have been linked to foreign travel or spread through children's summer camps. From summer 2009 through summer 2010, New York State experienced a mumps outbreak that began at a New York summer camp for boys when a child developed mumps soon after returning from travel in the United Kingdom . Although reports of mumps have declined, mumps is still circulating in New York State. Since spring 2010, there has also been an increase in cases of pertussis (whooping cough) in New York State, particularly among pre-teens and teens. At least one outbreak of pertussis in New York State was spread mainly through a children's day camp.

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 also introduce vaccine-preventable diseases that are endemic in their country of origin. Measles and mumps continue to circulate in European countries, particularly the United Kingdom, due to low levels of vaccination in these countries.

Measles, mumps, pertussis and varicella (chickenpox) spread by direct contact or through coughing and sneezing and can be spread rapidly in camp settings. 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. If one of these diseases is suspected in even one camper or camp employee, or a cluster of people have symptoms that might be caused by one of these diseases, your local health department (LHD) should be notified immediately. Delays in reporting have led to large outbreaks at camps. If you or your health director are considering the diagnosis of a vaccine-preventable disease and are ordering testing, then you should report the case at that time. By notifying the LHD, as required, the LHD can facilitate obtaining rapid test results and institution of control measures, if indicated. (Camp operators must also report to the permit-issuing official. Medical providers should refer to New York State Department of Health Communicable Disease Reporting.

Recommended Immunizations For Campers

The part of the State Sanitary Code that applies to campers is Subpart 7-2, which 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. For the optimal health and safety of all campers and camp staff, the New York State Department of Health (NYSDOH) strongly recommends that all campers meet the same immunization requirements as school-aged children as indicated in Public Health Law (PHL) Article 21, Title 6, Section 2164. (Refer to 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. NYSDOH recommends two doses of MMR vaccine in order to ensure maximal protection from measles, mumps and rubella.

The ACIP also recommends that all persons who have never had chickenpox receive 2 doses of varicella vaccine to confer immunity. In the event of a case of chickenpox at camp, NYSDOH recommends that all campers and staff with less than 2 doses of varicella vaccine and no documented history of chickenpox disease be vaccinated against varicella. Vaccination of unprotected persons within 3-5 days of exposure to a case of chickenpox can prevent further spread of disease and avert a potential outbreak. Campers and staff who receive their first dose of varicella vaccine after being exposed to a case of chickenpox may return to camp immediately following vaccination, but are recommended to receive a second dose at least 4 weeks following the first dose.

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 (CDC) (formerly the National Immunization Program), accessible at http://www.cdc.gov/vaccines/recs/acip /def ault.htm .

Recommendations for administration of vaccines for summer camp counselors and seasonal camp workers are organized into three broad 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 Clostridium 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 10 years of age or older; however, Td (adult tetanus and diphtheria) may be used.
    • Pertussis containing vaccine because pertussis is a highly-communicable disease and the risk of transmission is high.
      • A single booster dose of Tdap (tetanus, diphtheria and acellular pertussis) vaccine is recommended for every employee 10 years of age or older who has not yet received Tdap vaccine.
  2. 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.
  3. The following immunizations may be indicated in certain circumstances (for complete recommendations see the CDC's National Center for Immunization and Respiratory Diseases website http://www.cdc.gov/vaccines/ ):
    • Hepatitis B – for health workers and lifeguards.
    • Meningococcal vaccine – for pre-teens and teens 11-18 years of age, first year college students that live in dormitories, and travelers.

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 at 518-473-4437. More information can also be obtained at the 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

1CDC. Recommended immunization schedules for children, adolescents and adults. Available at: http://www.cdc.gov/vaccines/recs/schedules/default.htm

Vaccine-Preventable Disease Fact Sheets: