National Smallpox Vaccination Update Joseph M. Henderson Centers for Disease Control and Prevention

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National Smallpox VaccinationUpdateJoseph M.
HendersonCenters for Disease Control and
Prevention
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Smallpox Preparedness Definition

• Enhance community awareness and clinician
  expertise
• Perform disease surveillance and laboratory
  analysis
• Implement public health interventions
• Provide vaccination
• Provide for the capability to rapidly vaccinate
  greater numbers of responders or the entire
  population

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Strategies

• 1. Surveillance and containment
• 2. Mass Vaccination
• 3. Cadre of workers to facilitate 1 and 2

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The Federal Plan

• Vaccinate civilian smallpox response teams
• Vaccinate Department of Defense personnel
• Vaccinate selected staff in overseas assignments
• Vaccination not recommended for the general
  public at present

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Advisory Committee on Immunization Practices
Supplemental Recommendations, 2002

• Definition of response teams (to follow)
• Vaccination site care
• Administrative leave for vaccinated health care
  workers (not necessary)

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Advisory Committee on Immunization Practices
Supplemental Recommendations, 2002

• Screening for contraindications
• - Atopic dermatitis, eczema screening
• questions suggested
• - Pregnancy
• - Immune suppression, including HIV/AIDS

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Why Vaccinate Health Care Workers?

• Over 50 of tranmission by imported smallpox
  cases in Europe, 1950-71, occurred in health care
  settings
• About 20 of secondary cases were in health care
  workers

Mack J, JID 1972125161-9.
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Why vaccinate Health Care Workers?

• Mathematical models suggest contagiousness of
  smallpox is reduced by about half if health care
  setting transmission is eliminated
• Reason smallpox spreads from very sick persons,
  who are usually in hospitals

Gani R, Leach S. Nature 2001414748-51
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Smallpox Public Health Response Teams

• Public health and medical personnel needed to
  investigate initial suspected cases and initiate
  control measures
• Includes medical, public health, epidemiologic,
  laboratory, and nursing personnel, vaccinators,
  others
• Each state should have at least one team

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Smallpox Healthcare Response Teams

• Healthcare personnel from participating hospitals
  who will be asked to evaluate, manage, and treat
  the initial suspect/diagnosed cases
• Hospitals who choose to participate -- identified
  by state (and local) public health officials.
• Hospitals with assistance from state (and local)
  public health officials will identify
  participating healthcare personnel.

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Suggested Composition of Healthcare Response Team

• ER MDs, RNs
• ICU M.Ds, RNs
• General medical RNs MDs hospitalists,
  internists, pediatricians, FP
• Housestaff primary care

• Subspecialists I.D, smallpox experts,
  dermatologist, ophthalmologist, pathologist
• Infection control staff
• Respiratory therapists
• Radiology techs
• Security
• Housekeeping

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Post-attack Program Guidance

• Guidance issued October 29, 2002
• Plans due to CDC December 2, 2002
• Plans presently under review

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Post-attack Program Guidance Elements

• Isolation, treatment of cases
• Diagnosis
• Vaccination of public health, healthcare
  responders
• Surveillance
• Containment Activities (contact tracing,
  vaccination)
• Epidemiologic investigation
• Large Scale vaccination
• Information Management
• Communications

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Pre-attack Program Guidance

• Guidance issued November 22
• Plans due to CDC December 9
• Supplements plans for smallpox post-attack
  control submitted December 2

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Pre-attack Program Guidance Elements

• Organization and Management
• Identification of public health smallpox response
  teams
• Identification of Healthcare Smallpox Response
  Teams
• Selection of Clinic Sites and Vaccination Teams
• Scheduling

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Pre-attack Program Guidance Elements (continued)

• Vaccine Logistics and Security
• Clinic Operations and Management
• Vaccine Safety Monitoring
• Training and Education
• Data Management
• Communications

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Declaration, Administration of Smallpox
Countermeasures, 1/24/03

• From Secretary, HHS reiterated Presidents
  vaccination recommendations to last one year
• Notes liability protection for those Determining
  who is contraindicated monitoring, management,
  and care of the countermeasures
• Countermeasures include vaccine, VIG, cidofovir
• Covers health care entities, their employees,
  agents, and officials

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Pre-attack vaccination plans status

• Plans approved for all states, D.C., 3 urban
  areas (54/62 CDC cooperative agreement
  recipients 2/3/03)
• Vaccine shipments scheduled for 42 states and
  cities, 213,700 doses (1/31/03)
• 165,900 doses already shipped to 30 states and
  cities (1/31/03)
• 10 states, 1 city have vaccinated 382 people
  (1/31/03)

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Vaccine Safety Monitoring and Response System

• Vaccination site monitoring in hospitals, with
  take checks, summary review at 21-28 days (all
  vaccinees)
• Telephone survey of 10,000 vaccinees re common
  adverse events, work time lost
• Clinician Information Line (1-877-554-4625)
  available 24/7
• - links to CDC for VIG, cidofovir release
• - links to VAERS for reporting
• ACIP workgroup monitors system weekly

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Pre-vaccination Materials

• Cover letter
• Vaccine Information Statement (VIS)
• VIS supplements
• - Reactions after vaccination
• - Vaccination site care
• - Skin conditions/contraindications
• - Weakened immune system
• - Pregnancy

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Pre-vaccination Materials (continued)

• Screening worksheet
• Contacts information sheet
• VIG information
• Cidofovir information
• 11 minute video
• Medical history and consent form
• Post-vaccination followup sheet

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Training and Education

• 19 training and education sessions through
  1/30/03
• Reached an estimated 800,000 health care
  professionals
• Conducted via classroom, satellite broadcast,
  CD-ROM, internet, videotape, audioconference
• 30 different training products available

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To Be Determined

• Process for vaccination of
• - traditional first responders
• - additional health care workers
• - general public

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www.bt.cdc.gov/agent/smallpox