Recommended Immunizations for Campers

Summer 2018

Dear Children's Camp Operator:

This letter is to remind summer camps in New York State of the importance of:

  • immunization in the camp setting, and
  • immediate reporting of any suspect vaccine-preventable disease (VPD) to the local health department.

There has been an increase in the number of cases of vaccine-preventable diseases (VPDs) in the United States over the last several years, including those which have been linked to foreign travel, spread on school and college campuses, or spread at children's summer camps. Within the last ten years there have been three mumps outbreaks that began in summer camps in New York State; one outbreak resulted in more than 3,500 cases of mumps; another mumps outbreak involved multiple camp staff. Settings, such as camps, where there is prolonged close contact with other individuals can promote the spread of VPDs. There are also a significant number of international campers and staff in New York State. These individuals provide a diverse experience at camp. However, they may introduce VPDs that are endemic in their countries of origin to the camp.

The best protection against vaccine-preventable diseases is broad vaccination coverage. Therefore, age-appropriate vaccination of all individuals who will be working at or attending summer camps is recommended.

Subpart 7-2 of the New York State Sanitary Code requires camps to maintain immunization records for all campers which includes dates for all immunizations against diphtheria, haemophilus influenza type b, hepatitis b, measles, mumps, rubella, poliomyelitis, tetanus and varicella (chickenpox). The record must be kept on file for every camper and updated annually.

The New York State Department of Health (NYSDOH) also strongly recommends that all staff at children's summer camps be fully immunized with all routinely recommended vaccines. Camps should maintain current, complete immunization records for staff. Additionally, camps should maintain a detailed list of staff, campers and other individuals who are not fully immunized and protected against VPDs. The list should clearly identify which disease(s) an individual is vulnerable to contracting. Camps will need this information to quickly identify at-risk individuals if a suspect case of a VPD occurs. Having immunization and health information readily available allows for a timely and appropriate public health response to control illness when required.

In summary, please take the following steps to reduce the risk for an outbreak of a VPD at your camp:

  1. Review the immunization records of all campers and staff; consider requiring additional vaccines for individuals who are not immune.
  2. Maintain up-to-date immunization records for all campers and staff, including known exemptions or individuals who lack immunity.
  3. Develop a policy that includes contact information for the immediate notification of the local health department (LHD) by your medical staff of any suspected cases of VPDs.

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 NYSDOH strongly recommends that all campers meet the age appropriate immunization schedule as set forth by the Advisory Committee on Immunization Practices (ACIP): http://www.cdc.gov/vaccines/schedules/
  • At a minimum, campers should 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, available at: https://www.health.ny.gov/publications/2370.pdf
  • 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 for all campers attending overnight camps for a period of 7 or more consecutive nights. Meningococcal ACWY (MenACWY) vaccine is recommended at age 11 or 12 years, with a booster dose at age 16 years. Please note that the NYSDOH does not recommend that campers receive either dose of MenACWY vaccine before the recommended ages. Students who are vaccinated before the recommended ages may need to have the doses repeated in order to attend school.

Recommended Immunizations for Staff

  • Individual camp policy may choose to recommend or require specific immunizations of their staff. For the optimal health and safety of all camp staff, including international staff, the NYSDOH strongly recommends that all staff meet the age appropriate immunization schedule as set forth by the Advisory Committee on Immunization Practices (ACIP): http://www.cdc.gov/vaccines/schedules/
  • At a minimum, immunizations that are routinely recommended (if not already administered, a history of disease does not exist, or serology has not proven immunity) include:
    • 2 measles, mumps, and rubella (MMR) vaccine doses,
    • 1 tetanus, diphtheria, and acellular pertussis (Tdap) vaccine booster dose within the last 10 years, and
    • 2 varicella vaccine doses.
  • Hepatitis B vaccine is recommended for staff with reasonably anticipated risk for exposure to blood or body fluids (e.g. health care workers, lifeguards).

VPD Reporting Details

  • Most VPDs 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 VPDs. Patients with a VPD are infectious before they feel sick, so disease can be spread rapidly in camp settings. 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, your 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 VPD and are ordering testing, then you should report the case to the LHD at that time and isolate the ill individual.
  • 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 NYSDOH Communicable Disease Reporting Requirements for reporting instructions, available at: http://www.health.ny.gov/professionals/diseases/reporting/communicable/.

Additional Information

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

Sincerely,

Elizabeth Rausch-Phung, M.D., M.P.H.
Director, Bureau of Immunization
New York State Department of Health