Volume , Issue

An article posted in this magazine several years ago stressed the importance of receiving travel vaccines, both recommended and required, but also reminded travelers to be current on routine vaccines. Vaccines have been a pillar of public health since the first vaccine for smallpox was administered over 200 years ago. Certain vaccines are mandatory for children to enter school (requirements vary by state), a number of vaccines are recommended for healthcare workers and may in fact be mandatory as a condition of employment, and others are recommended in particular age groups, such as the elderly, for underlying medical conditions, or in the general population because of easily transmissible circulating pathogens, such as influenza. COVID-19 easily falls into the latter category because of its effective transmissibility, especially the delta variant. Vaccines have been shown to significantly decrease healthcare costs.

Vaccine Preventable Risks in Wilderness Medicine

These are the types of risks for wilderness medicine practitioners for which there are available vaccines.

Other recommended vaccines for children and adults for which there may not be a specific risk in wilderness medicine include: H. influenzae type B (Hib), HPV, and herpes zoster (shingles).

The Newest Vaccine for Wilderness Medicine Providers: COVID-19

COVID-19 can be considered a risk for wilderness medicine providers. It is easily transmissible with close contact, especially for the unvaccinated, unmasked, and un-socially distanced. It’s prevalent throughout the world, so you’re at risk no matter where you’re recreating or working. Fully vaccinated persons have been shown to have a decreased incidence of infection (especially with the delta variant), hospitalization, and death compared to those who are unvaccinated.

Imagine you’re in the backcountry and a member of your hiking party falls and sustains an open midshaft femur fracture. You’re able to evacuate them to the nearest hospital, only to be turned away at the ED entrance because the hospital doesn’t have any beds. This is what is happening in the country (and other parts of the world) right now: Some hospitals with low vaccination rates and high numbers of COVID-19 cases are starting to ration care, something unthinkable in recent times. And what if the injured party needs a blood transfusion? The nation is experiencing a blood shortage, not caused by COVID-19, but still putting seriously injured trauma victims and others who need blood at risk.

Although not 100% effective, a COVID-19 vaccine can protect the wilderness medicine provider from contracting the disease. Although not 100% effective, a COVID-19 vaccine can decrease the chance that a wilderness medicine provider can transmit COVID-19 to a patient they are caring for.

COVID-19 vaccine mandates are becoming more prevalent for healthcare providers (note that the following information is for the U.S.).

  • In December 2020, the FDA granted Emergency Use Authorization (EUA) for the Pfizer-BioNTech and Moderna COVID-19 vaccines (2 dose series), and in February 2021 for the J&J/Janssen vaccine (1 dose). Distribution and administration of the vaccines began soon thereafter.
  • On August 23, 2021, the FDA approved the Pfizer-BioNTech COVID-19 vaccine, marketed as Comirnaty, for persons 16 years and older for the prevention of COVID-19 ; it is also still available under an EUA for 12-15 year olds and for a third dose in individuals with certain immunocompromising conditions.
  • President Biden announced a more comprehensive national COVID-19 vaccine mandate plan on September 9, 2021. In addition to mandating vaccination for all federal agencies and armed services forces, the plan also focuses on health care workers in Centers for Medicare & Medicaid Services (CMS) settings.
  • On July 26, 2021, the Council of Medical Specialty Societies, of which there are 60 co-signatories, issued a joint statement calling “for all health care and long-term care employers to require their employees to be vaccinated against COVID-19.”
  • With Pfizer-BioNTech’s COVID-19 vaccine approval, 166 health systems now require mandatory vaccination for their workforces.

The American Academy of Emergency Medicine (AAEM), the American College of Osteopathic Emergency Physicians (ACOEP), the Air Medical Physician Association (AMPA), the American Paramedic Association (APA), the National Association of EMS Physicians (NAEMSP), and the National EMS Management Association (NEMSMA), agree that it is critical for all EMS clinicians including paramedics, EMS physicians, and other emergency medical services providers without a religious or medical exemption, to be fully vaccinated against COVID-19 in order to slow the spread of the disease and prevent needless deaths of vulnerable persons. EMS personnel are essential workers responsible for the health and safety of our families, patients, and communities. Being vaccinated is a professional ethical obligation.

There are three COVID-19 vaccines available for administration in the U.S. The Pfizer-BioNTech and Moderna vaccines, both mRNA vaccines, are given as a two dose series. The J&J/Janssen vaccine, a viral vector vaccine (adenovirus), is given as a single dose. On September 17, 2021, an FDA advisory committee recommended a booster dose of the Pfizer-BioNTech vaccine for those at high risk of severe COVID-19 and for people older than 65. The booster should be administered at least six months after the second vaccine shot.

With regard to boosters and healthcare workers, on September 24, 2021, the CDC recommended:

People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

Note: At the time of posting of this article, only patients who received the initial vaccine series with the Pfizer-BioNTech vaccine may receive a booster. Moderna and J&J are planning to submit data for their vaccines so they may eventually be authorized for a booster dose.

Note that a booster dose is different from an additional, or third dose of one of the mRNA vaccines, which is currently being recommended for certain immunocompromised people who may not have mounted a full response to the original two dose series.

Receiving Other Vaccines With a COVID-19 Vaccine

If a provider has received or will be receiving any COVID-19 vaccine (Pfizer-BioNTech, Moderna, J&J), what impact does this have on other vaccines that have to be administered for employment, routine medical care, or for travel?

The CDC has issued a general statement regarding receipt of a COVID-19 vaccine and other vaccines: [see website for complete information]

COVID-19 vaccines and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 vaccine and other vaccines on the same day, as well as coadministration within 14 days. It is unknown whether reactogenicity of COVID-19 vaccine is increased with coadministration, including with other vaccines known to be more reactogenic, such as adjuvanted vaccines or live vaccines. When deciding whether to coadminister an(other) vaccine(s) with COVID-19 vaccine, vaccination providers should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines.

If multiple vaccines are administered at a single visit, administer each injection in a different injection site. For adolescents and adults, the deltoid muscle can be used for more than one intramuscular injection administered at different sites in the muscle.

Note that COVID-19 vaccines are not interchangeable; the same vaccine should be given for the second dose.

Wilderness medicine providers can do their part to keep themselves and others protected against potentially serious diseases by getting vaccinated. Doing so will also lessen the burden on healthcare resources that are becoming increasingly limited in the grip of the ongoing COVID-19 pandemic.

You Might Also Be Interested in

This is Your Brain Off Drugs

Nancy Pietroski, PharmD, NR-EMT, FAWM, CTH1/15/2024

Exploring the potential place of the placebo effect in wilderness medicine

Brother, Can You Spare a Tylenol?

Nancy Pietroski, PharmD, NR-EMT, FAWM, CTH11/29/2023

The critical issue of drug shortages in the US

Wilderness Medicine Pharmacy

Nancy Pietroski, PharmD, NREMT, FAWM, CTH8/17/2023

A New Frontier or Black Hole?

Please Wake Me Up Before I Go: Naloxone for Opioid Overdoses

Nancy Pietroski, PharmD, NR-EMT, FAWM, CTH4/14/2023

Drug overdose is the leading cause of accidental death in the US