IMMUNIZATIONS | FAA Medical
there is no published FAA position regarding immunizations, the FAA
has suggested that a wait period of as much as 24 hours be utilized to observe
any adverse effects. While there is no reporting requirements, pilots who have been immunized
may wish to
provide a note from the prescribing physician at the time of their
next FAA exam.
Immunizations and Flying
By Major Donato J. Borrillo,
Immunizations are important tools in preventive medicine and should be
encouraged by the AME. Since vaccines are not reportable upon medical
certification, it is important for the AME to advise pilots regarding
common side effects of the inactive vaccines and how they can affect
folklore describes the tragic death of Lieutenant Sidney J. Brooks from
a delayed vaccine reaction. The unfortunate Cadet, for whom Brooks Air
Force Base is named, reportedly died on his final solo flight after a
series of vaccinations. Several unexplained aspects of Lt. Brooks'
controlled flight into terrain still exist; however, his case
exemplifies why the aviation medical examiner (AME) should be concerned
with immunizations and flying. Furthermore, the recent use of Anthrax
vaccine by the military has unjustifiably concerned pilots.
immunizations are not disqualifying for general aviation flying. And
although the Federal Aviation Administration (FAA) recently expanded Box
17(a) on Form 8500-8 to include "Any Medication," it was not
their intent to include vaccine prescriptions. Pilots do not have to
report receipt of any vaccine on their FAA medical application. It is,
therefore, incumbent upon the AME to counsel the aviator on potential
vaccine side effects and their affect on flight safety.
Vaccines come in
two different forms, live and inactive. Live vaccines utilize weakened
or dead organisms to stimulate an antibody response from the body. They
are typically dosed once during childhood, and this provides long-term
immunization. Examples of live vaccines include the varicella, oral
typhoid, measles, mumps, and rubella vaccines. Pediatricians are usually
concerned about the rare and debilitating side effects of a live
vaccine; however, it is the inactive vaccine that concerns the AME.
have no live organisms and are more stable, but immunologically weaker.
Because of this "weakness," they require multiple dosing.
Examples of inactive vaccines include intramuscular typhoid, tetanus,
influenza, and Anthrax . About 85% of adverse vaccine event reports
concern relatively minor events — ordinary fevers or redness and
swelling at the injection site. The remaining 15% describe serious
events, such as seizures, high fevers, life-threatening illnesses, or
deaths. Inactive vaccines are the type most likely administered to
pilots and tend to have less serious side effects. Unfortunately,
inactive vaccines have more common minor reactions than the live
Childhood Vaccine Injury Act of 1986 (NCVIA) requires health care
providers and vaccine manufacturers to report to the Department of
Health and Human Services (DHHS) specific adverse events following the
administration of vaccines. The DHHS established the Vaccine Adverse
Event Reporting System (VAERS), which is co-administered by the Food and
Drug Administration (FDA) and the Centers for Disease Control and
Prevention (CDC), to accept all reports of suspected adverse events, in
all age groups, after the administration of any US-licensed vaccine. The
primary purpose for maintaining the database is to serve as an early
warning or signaling system for adverse events not detected during
pre-market testing. The AME should be aware of this database and be able
to provide the airman with a general description of side effects from
The most common
minor side effect from parenteral vaccination with an inactive vaccine
is local arm soreness, headache, fever, and fatigue. These seemingly
minor symptoms on land could, of course, distract or physically limit
the pilot in the air. Furthermore, since there is no minimum grounding
period after receiving immunizations, it is incumbent upon the aviator
to anticipate minor symptoms and plan crew rest accordingly. Taking
aspirin or acetaminophen after an immunization may minimize minor side
effects; whereas, more serious side effects may be temporarily
"self" grounding until they resolve or stabilize. As always,
pursuant to the Federal Aviation Regulations, it is the pilot's ultimate
responsibility to be "fit for flight."
One final point:
On 15 October 1999, Federal Air Surgeon Dr. Jon Jordan, posted a letter
formally articulating the FAA policy on pilots receiving the Anthrax
vaccine. The letter confirmed that receiving the Anthrax vaccine does
not affect a pilot's medical certificate and confirmed that receipt of
the vaccine is not cause for grounding for any duration. Individuals who
have been immunized with the Anthrax vaccine are not disqualified from
performing civilian airman duties so long as they do not experience
significant side effects that would otherwise be considered
immunizations play a very important role in preventive medicine and
should be encouraged by the AME. Since vaccines are not reportable upon
medical certification, it is important for the AME to advise pilots
regarding common side effects of the inactive vaccines and their impact
on flight safety.
Dr. Borrillo is
the Chief of Flight Medicine, 352nd Operations Support Squadron, USAF
Special Operations Command, Royal Air Force Base, Mildenhall, England.
He is Board certified in Aerospace Medicine. In addition, he is a
commercial pilot, an AME, and a practicing attorney.
The Federal Air
Surgeon's Medical Bulletin • Winter 2000