Title: Overview of the NC Smallpox Vaccination Plan A Component of the Public Health Smallpox Preparedness
1Overview of the NC Smallpox Vaccination Plan A
Component of the Public Health Smallpox
Preparedness and Response Plan
- James W. Kirkpatrick, MD, MPH
- Bioterrorism Coordinator
- North Carolina Division of Public Health
- Raleigh, NC
2Warning
- The NCSVP is a confidential document containing
specific details of a public security plan and is
therefore exempt from the NC public records law
according to G.S 132-1.7. The Executive Summary
and Press Release contain non-classified
information regarding the NCSVP and are
considered public documents.
3Phases of the NC Smallpox Preparedness and
Response Plan
- Phase I Baseline
- Phase II Heightened Threat
- Phase III Post-event, limited outbreak
- Phase IV Post-event, large outbreak
- Phase V Recovery
4Components of the NC Public Health Smallpox
Preparedness and Response Plan in each Phase
- Surveillance
- Vaccination
- Outbreak investigation
- Quarantine and isolation
- Mass care
- Mass fatality
- Public information
- Command/Control/Communications
5Assumptions
- Liability and indemnification of state and local
vaccine providers will be resolved at the federal
level. - CDC will provide smallpox vaccine, diluent and
bifurcated needles for each vaccination stage. - State and local government will provide all other
vaccination supplies. - NC will use CDC forms Surveillance, Contact
Tracing, Epidemiological Investigation
Vaccination Guidelines for State and Vaccine
Adverse Event Reporting. - Counties may request assistance through
multi-county assistance compacts NC may request
assistance through the multi-state Emergency
Management Assistance Compact. - In large-scale vaccination, federal government
will provide additional resources National
Pharmaceutical Stockpile (NPS), Vendor Managed
Inventory (VMI) and National Disaster Medical
Service (NDMS).
6Assumptions-continued
- One-fourth to one-half of those offered pre-event
vaccination will decline. - Patient care personnel that decline vaccination
will be required to sign an indemnification and
liability release form to continue to work in
patient care positions. - Costs to travel to vaccination sites, hours
and/or salary lost are the responsibility of
vaccinees or their employers. - Costs of adverse vaccine reactions are covered
under employment policies and workers
compensation laws. - Local Public Health Directors have primary
responsibility for requesting smallpox vaccine
and vaccination resources and for ensuring
vaccinations within their respective counties. - Vaccinations will be provided on a voluntary
basis only. - Advisory Committee on Immunization Practices
guidelines will be followed.
7Assumptions-continued
- State and county emergency operations centers
will be activated and assist with post-event
vaccination in accordance with existing state and
local emergency operations plans. - The State Epidemiologist, Public Health
Preparedness Response Bioterrorism Coordinator,
Public Health Regional Surveillance Team
physician or Local Health Department Medical
Director will provide standing orders for all
vaccination scenarios, as necessary. - NCPH, PHPR, PHRST, and LHD staff will use CDC
systems for tracking and reporting of vaccination
activities. - Adequate amounts of Vaccinia Immune Globulin and
Cidofovir will be made available. - CDC personnel/specialists will be available to NC
as needed and requested.
8Smallpox Vaccines(current as of December 2, 2002)
- DryVax (15.4M doses)
- Re-licensure of vaccine is complete, (diluent is
pending) - Oct 25--1.7M doses to DOD
- Upon Presidential Decision--500K for civilian
vaccination - Aventis-Pasteur (85M doses)
- IND
- Licensure not being pursued
- Acambis and Baxter (200M doses)
- In production
- Currently an IND
- Licensure projected
- Late 2003 to early 2004
9Scenarios for Vaccination Planning
- Pre-event Scenario
- Pre-event vaccination
- Post-event Scenarios
- Ring vaccination - small number of cases and
contacts identified - Mass vaccination - large number of cases and
contacts identified (or projected)
10Pre-event Vaccination Stages(current as of
December 2, 2002)
- CDC recommendations (tentative)
- Stage One (500,000 US vaccinees)
- Epidemiology investigation/response teams
- Medical, nursing and ancillary staff in selected
facilities - Stage Two (10,000,000 US vaccinees)
- First responders EMS, fire/rescue, police, etc.
- Health care workers
- Stage Three
- Following licensure of Acambis/Baxter vaccine
- General vaccination of the population
11NCSVP Pre-event Vaccination Stage One
- Planning processes
- PHPR refines plan in response to CDC comments
- Immunization Branch completes training
- PHPR and PHRSTs assist with coordination and
planning - Identify vaccinees
- Coordinate with Wake County HD and host LHDs for
vaccination dates - LHDs
- Identify vaccinees and provide names to PHRSTs
- Coordinate with PHRSTs for vaccination dates
- Hospitals
- Identify vaccinees and provide names to LHD and
PHRST - Coordinate with LHD and PHRST for vaccination
locations/dates
12NCSVP Pre-event Vaccination Stage One-continued
- Who will be vaccinated?
- State DPH personnel (20)
- PHRST personnel (35)
- LHD personnel (4-50 each)
- Health Director
- Nursing Supervisor
- Vaccinator(s)
- Disease Investigation Specialist(s)
- Hospital personnel in 54 facilities
- Medical Treatment Team (ca. 100-125 each)
- When will vaccination begin?
- Within 30 days of Presidential announcement
- Where will vaccination occur?
- State personnel Wake County HSC
- PHRST personnel Host HD
- LHD personnel Countys pre-event Vaccination
Center - Hospital personnel Option
- Countys pre-event Vaccination Center
- Hospitals occupational medicine clinic
13NCSVP Pre-event Vaccination Stage One-continued
- How will vaccinations be performed?
- IAW current federal guidelines and procedures
- On standing order of NC-licensed physicians
- By NC-licensed, IB-trained and -certified nurses
- Vaccine logistics
- PHPR Pharmacist will coordinate
- Receipt and storage of vaccine at Bath Building
- Division into seven (7) regional packages
- IB personnel and PHPR personnel will deliver
vaccine to PHRSTs - PHRSTs will coordinate
- Storage of regional vaccine supply
- Scheduling to minimize vaccine wastage
14NCSVP Pre-event Vaccination Stage One-continued
- Management of vaccination program
- PHRSTs and Regional Immunization Coordinators
(RICs) will schedule vaccination locations and
dates - LHDs (and hospitals where requested) will
- Set up vaccination centers
- Identify personnel to staff centers
- Identify personnel to be vaccinated
- PHRSTs and RICs will operate Mobile Vaccination
Teams (MVT) - Transport vaccine and supplies to vaccination
centers - Attend and support vaccination centers during
vaccination - Visit each location every 1-2 weeks
- Target 10-15 of eligibles per visit
- Carry out record-keeping using the SISS and PVS
systems - LHDs (and hospitals where requested) will
- Conduct vaccination
- Monitor vaccination sites for take and reaction
- Report vaccine reactions
15Current ACIP Recommendations for HCWWho in Stage
One
- Hospital based smallpox health care teams
- To provide in-room care for the first smallpox
patients presenting to ED or requiring hospital
admission - 24/7 care for 7-10 days using 8-12 hour shifts
16Current ACIP Recommendations for HCWWho in Stage
One (cont) Total ca. 45 - 125?
- ED staff including physicians and nurses 15
- ICU staff (adult and pediatric) 15
- Physicians
- Nurses
- General medical unit staff in hospitals where
they provide the bulk of primary care 15 - Internists
- FPs
- Obstetricians
17Current ACIP Recommendations for HCWWho in Stage
One (cont)
- Subspecialists
- Infectious disease specialists
- Dermatologists
- Ophthalmologists
- Pathologists
- Surgeons
- Infection Control Professionals
- Vaccinators and site care clinic workers
- Respiratory therapists
- Radiology techs
- Security
- Housekeeping/transport
18Current ACIP Recommendations for HCWWho in all
Pre-Event Stages (cont)
- Contraindications
- In HCW OR their immediate family
- History of atopic dermatitis or eczema
irrespective of disease severity or activity - HCW with burns, impetigo, varicella, herpes,
severe acne, or psoriasis should wait until
condition is not active - Pregnancy (offer testing)
- HIV or other immunocompromising state (offer
testing)
19Current ACIP Recommendations for HCWHow for all
Pre-event Stages
- Administrative leave
- Not routinely recommended
- Up to 1/3 may become too ill to work
- Other considerations
- Start with previously vaccinated, if possible
- Stagger same unit personnel to minimize number
simultaneously out of work
20NCSVP Pre-event Vaccination Stage Two
- Planning processes
- PHPR and PHRSTs assist with coordination and
planning - Collect regional vaccination requirements
- Coordinate with LHDs for vaccination dates
- Plan MVT activities
- LHDs
- Collect county vaccination requirements
- Collect and provide names to PHRSTs
- Coordinate with PHRSTs for vaccination dates
- Establish secondary vaccination locations if
required - Employers
- Identify vaccinees and provide names to LHD and
PHRST - Coordinate with LHD for vaccination
locations/dates - Request on-site or occupational medicine clinic
vaccination, if desired
21NCSVP Pre-event Vaccination Stage Two-continued
- Who will be vaccinated?
- Clinical and office staff
- Hospital personnel in general care facilities
- First responders
- Law enforcement
- Fire and rescue
- EMS
- Hazardous Materials response teams
- State Medical Response System personnel
- Selected National Guard personnel
- When will vaccination begin?
- Upon direction from federal government
- Upon receipt of adequate vaccine supplies
- Would take 3-6 months to complete
22NCSVP Pre-event Vaccination Stage Two-continued
- Where will vaccination occur?
- As in Stage One
- LHDs may establish additional vaccination
locations - Employers may request vaccination in their own
occupational medicine clinics or on site - How will vaccinations be performed?
- As in Stage One
- Vaccine logistics
- As in Stage One
- Management of vaccination program
- As in Stage One
- Additional locations if required
23NCSVP Post-Event Ring Vaccination
- Planning processes
- Component of Phase III of overall NC Smallpox
Preparedness and Response Plan - Occurs when cases of smallpox or contacts of
cases are identified in NC - PHPR and NCEM will be at full activation
- NC EOP in operation
- HAN will alert all NC public health entities
- Logistical, strategic and operational information
will be transmitted via EM2000 to NCEM and county
EOCs - NCPH and NCEM will request an emergency
declaration from the Governor who may request a
declaration from the President
24NCSVP Post-event Ring Vaccination-continued
- Who will be vaccinated?
- Contacts of smallpox cases identified by disease
investigation - Contacts of contacts
- When will vaccination begin?
- When confirmed contacts are identified
- Where will vaccination occur?
- LHDs will expand existing pre-event Vaccination
Center - LHDs may open additional vaccination locations as
required - Preferably locations identified for mass
vaccination in Phase IV
25NCSVP Post-event Ring Vaccination-continued
- How will vaccinations be performed?
- As in previous phases
- Additional personnel requested through county EOC
to state EOC - Vaccine logistics
- LHDs will compile requests and requirements for
vaccine, supplies, and other resources - Transmit to NCPH
- Provide to county EOC for forwarding to state EOC
- NC will request additional resources from federal
sources - Receipt and distribution procedures will be as in
previous phases - Additional support may be requested from SERT
26NCSVP Post-event Ring Vaccination-continued
- Management of vaccination program
- PHRSTs and Regional Immunization Coordinators
(RICs) from non-impacted regions may be
transferred to impacted regions - LHDs and their countys emergency management
systems may request additional resources from - Neighboring counties
- State EOC
- Tracking of vaccinees, takes, non-takes, adverse
reactions and revaccinations will be IAW CDC
systems
27NCSVP Post-Event Mass Vaccination
- Planning processes
- Component of Phase IV of overall NC Smallpox
Preparedness and Response Plan - Occurs when
- cases of smallpox or contacts of cases exceed
capacities to conduct contact tracing, OR - political decision is made to vaccinate
population. - Ring vaccination continues for identified
contacts - Command and Control policies and procedures from
Phase III remain in effect
28NCSVP Post-event Mass Vaccination-continued
- Who will be vaccinated?
- Identified contacts of cases
- All North Carolinians
- Using most current federal guidance
- When will vaccination begin?
- Upon declaration by the Governor or President
- Upon receipt of vaccine
- Where will vaccination occur?
- LHDs will request their counties to open mass
vaccination centers identified in Smallpox
Vaccination Planning Database - Locations and POC as listed in Chapter VIII of
NCSVP
29NCSVP Post-event Mass Vaccination-continued
- How will vaccinations be performed?
- As in previous phases
- Additional personnel requested through county EOC
to state EOC - Governor may waive NC licensure requirements for
physicians and/or nurses - Using most current CDC procedures for
establishing and operating mass vaccination
centers - Vaccine logistics
- As in Ring Vaccination
- Management of vaccination program
- As in Ring Vaccination
30Post-event Deactivation
- Planning processes
- Component of Phase V of overall NC Smallpox
Preparedness and Response Plan - Initiated when no new smallpox cases had appeared
for one or more incubation periods - Vaccination locations would close as requirements
diminish - Temporary and borrowed personnel would be
released - Vaccine logistics
- Unused vaccine would be stored securely or
returned to CDC - Unused NPS resources may be returned to CDC at
their discretion - Command and Control
- State EOC and NCPH Crisis Center reduce
activities - NCPH, PHRSTs and LHDs conduct after-action
reviews - NCPH and PHPR develop and distribute Lessons
Learned - NCPH conducts a financial audit of the cost of
response for performance analysis and application
for reimbursement
31Delivery of Vaccine to the Local Level Use of
the NPS
- State will contact CDC to request vaccine from
National Pharmaceutical Stockpile - State NPS plan
- Receive vaccine at designated location
- Distribute to counties
- Each county or multi-county LHD should have a
local plan to take delivery from the State - Location
- Contact information 24/7
- Security
- Accountability
- Distribute to VC(s)
In the Smallpox Vaccination Planning Database
32NPS Vaccine Logistics
- First day vaccine supply comes in a
self-contained, self-powered refrigerator called
a Vaxicool - 150,000 doses (maximum)
- Medical supplies
- Diluent
- Bifurcated needles
- Transfer needles
- Forms
- 3 ea. 48-inch pallets
- VIG and cidofovir by separate request
- Localities (or state) provide other
medical-related items - 2X2 gauze
- Air permeable dressings
- Ziplock bags
- Sharps containers
- Medical waste bags
This is not the 50-ton NPS Push Package
33Smallpox Vaccination Training
- State-wide PHTIN Broadcasts
- Oct 17
- Oct 30
- Dec 3
- Dec 5-6 (CDC training event)
- Train the Trainer training for PHRSTs
- 7 scheduled through Dec 18
- All LHDs
- By End of Calendar Year
34Smallpox Vaccination Planning Database(Informatio
n is provided by counties)
- Pre-event Vaccination Center
- Location
- POC
- Projected Vaccinees
- Stage One
- Stage Two
- Trained Vaccinators
- Mass Vaccination Centers
- Location
- POC
- Manpower Available
- NPS Smallpox Vaccine Reception Point and POC
35Smallpox Vaccination Planning DatabaseStatus
ReportDecember 3, 2002
- Reports Received 94 Counties
- Pre-event Vaccination Centers
- LHDs 87
- Others 7
- Total Vaccinees for Pre-event Vaccination
- Stage 1 37,000
- Stage 2 276,000
- Numbers of Vaccinators to be trained 357
- Mass Vaccination Centers 379
- People Available for Mass Vaccination 91
counties reported, all had shortages - Locations for NPS Smallpox Vaccine delivery 67
36What do PHRSTs, LHDs and Hospitals need to do now?
- PHRSTs assist with coordination and planning
- Identify vaccinees
- Coordinate with host LHDs and Wake County HD for
vaccination dates - LHDs
- Complete entries into smallpox vaccination
planning database - Complete vaccinator training
- Recheck Stage One numbers
- Identify vaccinees and provide names to PHRSTs
- LHD eligibles
- Hospital eligibles
- Coordinate with PHRSTs for vaccination dates
- Hospitals
- Identify vaccinees and provide names to LHD and
PHRST - Coordinate with LHD and PHRST for vaccination
locations/dates
37What information do we need to finish pre-event
planning?
- Vaccine
- How many doses will NC be allotted?
- What is the post-reconstitution shelf-life?
- Final Guidelines from US DHHS
- Selection and prioritization of vaccinees
- Screening of individuals for contraindications
- Contact and occupational limitations of vaccinees
- Liability and indemnification
- Workers compensation
38Information Resources
- CDC Interim Smallpox Plan (www.bt.cdc.gov)
- CDC Smallpox Vaccination Clinic Guide
(www.bt.cdc.gov) - NPS Smallpox Distribution Plan (www.nchan.org)
- NC Smallpox Vaccination Plan (www.nchan.org)
- Executive Summary
- Press Release
- Slides from today
- Office of Public Health Preparedness Response
- (919) 733-3421
- (jim.kirkpatrick_at_ncmail.net)
39The North Carolina Division of Public Health
QUESTIONS?