Smallpox Preparedness in LA County - PowerPoint PPT Presentation

About This Presentation
Title:

Smallpox Preparedness in LA County

Description:

Smallpox Preparedness in LA County Cristin Mondy, MSN/MPH, RN, PHN Bioterrorism Epidemiology & Surveillance Unit Acute Communicable Disease Control Program – PowerPoint PPT presentation

Number of Views:197
Avg rating:3.0/5.0
Slides: 44
Provided by: stud1792
Category:

less

Transcript and Presenter's Notes

Title: Smallpox Preparedness in LA County


1
Smallpox Preparednessin LA County
  • Cristin Mondy, MSN/MPH, RN, PHN
  • Bioterrorism Epidemiology Surveillance Unit
  • Acute Communicable Disease Control Program
  • Los Angeles County Department of Health Services

LA Dept. of Health Services
2
Outline
  • The current threat
  • Brief history
  • Signs and symptoms of smallpox
  • Smallpox vaccine
  • LAC activities

3
Smallpox Overview
  • Smallpox is an acute, contagious, and sometimes
    fatal disease caused by the variola virus
  • Eradicated in the world in 1980
  • The use of smallpox as a biological weapon is now
    a possibility
  • The US government is taking precautions to deal
    with smallpox

4
Smallpox Overview
  • Person-to-person transmission (respiratory
    droplets/contact)
  • Patient is contagious after rash appears
  • Death may occur in up to 30 of unvaccinated
    cases

5
Smallpox Overview
  • Vaccination can prevent smallpox
  • No proven treatment at this time but research is
    ongoing
  • Vaccination within 3 days of exposure will
    prevent or significantly modify smallpox
  • Vaccination within 4-7 days after exposure offers
    some protection or modify smallpox

6
Brief History
  • 1949 Last case of smallpox in U.S.
  • 1972 Routine vaccination of the American public
    stopped
  • 1977 Last natural case occurred in Somalia
  • 1980 WHO announced eradication of smallpox
    worldwide

7
Signs and Symptoms
  • The first symptoms of smallpox usually appear
    7-17 days after exposure
  • Begins with high fever, head and body aches, and
    sometimes vomiting (2-3 days)
  • NOT contagious during this time

8
Signs and Symptoms
  • Rash follows
  • Rash can start on the mouth, face, hands, and
    forearms and then spread to the legs and body.
  • Rash becomes raised bumps that crust, scab and
    fall off after about 3 weeks, leaving a pitted
    scar.

9
(No Transcript)
10
Smallpox
  • Rash
  • The same stage of development
  • Mostly concentrated in face and extremities
    (hands and feet)

11
Transmission
  • Spreads from contact with infected persons
  • Direct and fairly prolonged face-to-face contact
    is required to spread smallpox (within 6 feet)
  • May also be spread with contact through infected
    bodily fluids

12
Smallpox Vaccine
  • Not available to the public at this time
  • If there is a smallpox outbreak, there is enough
    vaccine for everyone who would need it.
  • Vaccination within 3 days of exposure will
    prevent or significantly modify smallpox
  • Vaccination within 4-7 days after exposure offers
    some protection or modify smallpox

13
Smallpox Vaccine
  • Made from a live virus vaccinia
  • The vaccine can not spread or cause smallpox
  • Given with a bifurcated needle, not a shot like
    other vaccinations
  • The needle is used to prick the skin 3 or 15
    times in a few seconds

14
(No Transcript)
15
Who should NOT get the vaccine?
  • Pregnant women
  • People who have or have had skin conditions
    (especially eczema and atopic dermatitis)
  • People with weakened immune systems
  • Those who have received a transplant
  • Those who are HIV positive
  • Those receiving treatment for cancer
  • Those taking medications (steroids) that
    suppresses the immune system
  • Anyone who is a household contact to any of the
    above
  • Anyone under the age of 18

16
Normal Vaccine Reactions
  • A red and itchy bump develops at the site in 3-4
    days
  • In the first week after vaccination, the bump
    becomes a large blister, fills with pus, and
    begins to drain
  • During the second week, the blister begins to dry
    and a scab forms
  • The scab falls of in the third week, leaving a
    small scar.

17
(No Transcript)
18
Vaccine Reactions
  • Reactions are less if revaccinated
  • Mild to Moderate
  • Mild rash (lasts 2-4 days)
  • Swelling and tenderness of armpit glands
    (lasts 2-4 weeks)
  • Fever of over 100oF (about 10 of adults)
  • Blisters elsewhere on the body (about 1 per 1,900)

19
Vaccine Reactions
  • Moderate to Severe
  • Serious eye infection or loss of vision
  • (lt6 per 10,000)
  • Rash on entire body (1 per 4,000)

20
Vaccine Reactions
Potentially Life-Threatening
  • Severe rash on people with eczema
  • (1 per 26,000)
  • Severe brain reaction (encephalitis) may lead
    to permanent brain damage
  • (1 per 83,000)
  • Severe infection beginning at vaccination site
    (1 per 667,000, mostly those with weakened
    immune systems)

21
Vaccine Reactions
  • Treatment is available for serious vaccine
    reactions
  • VIG / Cidofivir
  • Research for new treatment is ongoing
  • 14-52 people per million could have a
    life-threatening reaction
  • Death 1-2 people per million

22
Los Angeles CountyActivities
LA Dept. of Health Services
23
LA County Smallpox Plan
  • Elements of the Plan
  • Preparedness
  • Response
  • Recovery

24
Preparedness
  • Vaccination Phase 1, 2, and 3
  • Surveillance
  • Smallpox Response Teams
  • Laboratory
  • Communication
  • Training
  • Management of a Suspect Case of Smallpox

25
Response
  • Criteria for Activation of the Response Plan
  • Redeployment of LAC DHS Staff
  • Activation of Emergency Contract and Mutual Aid
    Personnel
  • Use of the Standardized Emergency Management
    System ring and mass vaccination, smallpox case
    management, contact management, logistics, etc.

26
Recovery
  • Criteria for Declaring the End of the Smallpox
    Emergency
  • Heightened Active Surveillance
  • Risk Communication
  • Evaluation and Analysis of Lessons Learned

27
Smallpox Vaccination Phase 1
  • Given the recent concerns that smallpox virus
    may be intentionally used as a bioterrorism
    agent, Los Angeles County has been directed to
    begin planning for the implementation of the
    Phase I Smallpox Preparedness Vaccination Program

28
Phase I Goal
  • To increase the LACs smallpox preparedness
    capacity by offering vaccination safely to
  • volunteer public health teams (including
    vaccinators) who will conduct investigations and
    outbreak control for the initial smallpox case(s)
  • volunteer health care workers who will treat and
    manage the initial smallpox case(s)

29
Timeline
  • Phase 1 plans were submitted on December 9, 2002.
  • Approved by CDC on December 23
  • Immunization operations started on January 29,
    2003

30
Public Health Smallpox Response Teams
  • In order to provide a pre-designated, highly
    trained, interdisciplinary team of public health
    personnel that will be immediately available to
    respond to a smallpox emergency, LAC DHS is
    assembling teams for rapid, scaled mobilization
    and deployment.

31
Public Health Smallpox Response Teams
  • Five (5) teams from LAC DHS
  • 40 persons, as needed, per team
  • One team from Pasadena
  • One team from Long Beach
  • One team from LAX/LA Port Quarantine

32
Smallpox Health Care Teams
  • To provide uninterrupted medical care for
    smallpox patients in acute care hospitals, a team
    of health care workers will be vaccinated so they
    can provide direct medical care for the initial
    smallpox case(s) presenting in the ER or
    requiring hospital admission

33
Hospital Team Requirements
  • Willingness to be vaccinated
  • Vaccination of all team members
  • Deliver medical care 24 / 7 for the first 7-10
    days using 8-12 hour shifts
  • Experienced and competent staff
  • 45-100 employees per hospital

34
Considerations
  • If possible, start with previously vaccinated
    individuals to decrease incidence and severity of
    systemic effects
  • Stagger same unit personnel to minimize number
    simultaneously out of work
  • Furlough not recommended by ACIP

35
Administrative Leave
  • Administrative leave is not routinely
    recommended unless
  • Physically unable to work due to symptoms of
    illness
  • Extensive skin lesions which can not be
    adequately covered
  • Non-adherence to recommended infection control
    precautions

36
Site care
  • Health care workers will need checks of sites
    before each shift
  • To prevent nosocomial transmission
  • Ensure bandage clean and dry
  • Reinforce importance of hand hygiene
  • Follow up on reactions, adverse events

37
Training and Education
  • 4 to 8 hours of training covering the smallpox
    vaccine, LACs response plan, and the vaccination
    clinic operations will be provided to all staff
    that will participate in the vaccination program.
  • Core training for all staff
  • Task oriented training based on responsibilities
    for each staff

38
Community Training
  • Training on recognizing and treating adverse
    events after smallpox vaccination will be
    developed and offered to community physicians on
    an ongoing basis
  • Comprehensive train-the-trainer program will be
    developed to be implemented after Phase 1 to
    prepare for LACs future Phase 2 smallpox
    preparedness vaccination program

39
LAC Activities
  • Reinstated Smallpox as a reportable disease (May
    2001)
  • Established the Smallpox Planning Working Group
    (January 2002)
  • Developed the Draft Smallpox Preparedness,
    Response, and Recovery Plan (February 2002)

40
LAC Activities
  • Developed smallpox posters and disseminated to
    the medical community (July 2002)
  • Assessed public health workforce capacity
    (November 2002)
  • Developed a Plan for Phase I Smallpox
    Preparedness Vaccination Program (December 2002)

41
LAC Activities
  • Trained licensed public health staff on how to
    administer the smallpox vaccine (January 2003)
  • Started the Smallpox Vaccination Program (January
    2003)
  • Trained select public health staff Speakers
    Bureau to give presentations to the community on
    smallpox (January 2003)

42
LAC Activities
  • Developed a Smallpox Public Health Response Team
  • Developed and disseminated smallpox FAQ sheets
  • Ongoing education and training activities for
    public health employees and the health care
    community
  • Ongoing updates in www.labt.org

43
Resources
  • http//www.bt.cdc.gov/training/smallpoxvaccine/rea
    ctions/default.htm
  • www.labt.org
Write a Comment
User Comments (0)
About PowerShow.com