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Occupational Health Requirements

General Information

  • Information on this page applies to all student affiliates (trainees).  Student affiliates consist of civilian/military medical students, rotating residents, fellows, practicums, nursing students, student volunteers and students from other health and administrative disciplines and shadowing.
  • Immunization requirements should be submitted no later than 50 days prior to start of training/shadowing.
  • All students/trainees/shadowers must be pre-cleared by Occupational Health prior to the start of your training/shadowing.
  • All immunization records are PHI (protected health information) and must be submitted via DoD SAFE (a secured website).  Instructions on the submission process is noted on the website.
  • Laboratory titers and verifiable clinical reports are the preferred documentation for immunizations.  A summary or list of immunizations without verifiable clinical documentation attached is not acceptable and may result in a cancellation or a delay in the start of your training/observation.
  • Submit only what is being requested.  Do not include outdated records.
  • Reminder that Hawai'i is a high threat area for certain diseases and that we have additional requirements than most places.
  • Proponent for this is Tripler Army Medical Center Regulation 40-27, Pre-Placement Medical Immunization Requirements for Military and Civilian Students/Trainees/Observers, 25 February 2022.

Educational Coordinator/Sponsor Responsibilities

  • Will ensure that all students/trainees/shadowers are registered through Patient Administration before training/shadowing starts
  • Will provide student/trainee/shadowers immunization records to Occupational Health Services for review per instructions contained in Tripler Army Medical Center Regulation 40-27. 
  • If any discrepancies in Occupational Health Services review, educational coordinator/sponsor will notify the student/trainee or shadower to provide necessary documentation to correct such and resubmit for review and approval of pre-clearance requirements 

Immunization Requirements

Individuals without history of Latent or Active Tuberculosis.
1. Documentation of two (2) consecutive annual negative Tuberculin Skin Tests with the most recent negative test within the past 365 days. 
2. In the absence of the above, then 2-step testing will be required; OR
Documentation of a negative Interferon Gamma Release Assay result within 365 days of the start of the rotation.
3. In the absence of the above, then 2-step testing will be required.
Measles, Mumps and Rubella (MMR)
Documentation of two (2) Measles, Mumps and Rubella vaccinations are required.  If two (2) are documented, no titers for Measles, Mumps and Rubella are not necessary, OR
Positive antibody titers for Measles, Mumps and Rubella.
Documentation of annual, influenza vaccine.
Tetanus-Diphtheria-Pertussis (Tdap)
Documentation of one dose of Tdap regardless of time interval since last Td only vaccine.
Hepatitis B
Documentation of completed three (3) dose vaccine series with positive Hepatitis B surface antibody titer post vaccination, OR
Positive Hepatitis B surface antibody titer after reported history of vaccination.
1. Student/trainee health care workers frequently train in areas of the hospital at highest risk of blood/body fluid exposures.  Therefore, documentation of a positive Hepatitis B surface antibody titer before rotation is preferred.
2. If documentation of three (3) doses of Hepatitis B vaccine (in compliance with current CDC guidelines for minimum dosing intervals) has been received by Occupational Health Services, but an antibody titer performed before rotation is negative, the student shall be allowed to rotate. 
3. The educational institution where a civilian student is enrolled will be notified that the applicable student/trainee should see a provider to receive booster vaccination and repeat Hepatitis B surface antibody testing.
4. Individuals with a continued negative antibody titer after six (6) total doses of vaccine (two (2) completed series) should be tested for evidence of Hepatitis B infection before assuming there is solely a lack of vaccine response.
Varicella (Chicken Pox)
Documentation of two (2) varicella vaccinations are required.  If two (2) vaccinations are documented, no titers for Varicella is necessary, OR
Positive antibody titer; OR
Diagnosis or verification of a history of Varicella disease by laboratory results or documentation from a health-care provider; OR
Diagnosis of a history of Herpes Zoster (Varicella Zoster) by a health-care provider.
Meningococcal – MCV
Documentation of completed two (2)-dose series with doses administered eight (8) to twelve (12) weeks apart.
Required only if:
Known anatomic or functional asplenia, OR
Known persistent complement component deficiencies in individuals younger than 55 years old or HIV+.  (TAMC Regulations 40-56 & 40-27).
1. Documentation of completed 2 dose series or single dose version of an mRNA vaccine + 2 weeks AND
Booster of the associated mRNA vaccine.
2. Additional requirements as advised by the CDC.  (CDC Interim Clinical Considerations for use of COVID-19 Vaccines).


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