National Smallpox VaccinationNational Smallpox VaccinationUpdateUpdate

Joseph M. HendersonJoseph M. Henderson

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

Smallpox Preparedness DefinitionSmallpox 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

StrategiesStrategies

1. Surveillance and containment

2. Mass Vaccination

3. Cadre of workers to facilitate 1 and 2

The Federal PlanThe 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

Advisory Committee on Immunization Practices Advisory Committee on Immunization Practices Supplemental Recommendations, 2002Supplemental Recommendations, 2002

Definition of response teams (to follow)

Vaccination site care

Administrative leave for vaccinated health care workers (not necessary)

Advisory Committee on Immunization Practices Advisory Committee on Immunization Practices Supplemental Recommendations, 2002Supplemental Recommendations, 2002

Screening for contraindications

- Atopic dermatitis, eczema: screening

questions suggested

- Pregnancy

- Immune suppression, including HIV/AIDS

Why Vaccinate Health Care Why Vaccinate Health Care Workers?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 1972;125:161-9.

Why vaccinate Health Care Why vaccinate Health Care Workers?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 2001;414:748-51

Smallpox Public Health Smallpox Public Health Response TeamsResponse 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

Smallpox Healthcare Smallpox Healthcare Response TeamsResponse 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.

SuggestedSuggested Composition of Composition of Healthcare Response TeamHealthcare 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 staffRespiratory therapists

Radiology techsSecurityHousekeeping

Post-attack Program Post-attack Program GuidanceGuidance

Guidance issued October 29, 2002

Plans due to CDC December 2, 2002

Plans presently under review

Post-attack Program Post-attack Program Guidance ElementsGuidance 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

Pre-attack Program GuidancePre-attack Program Guidance Guidance issued November 22

Plans due to CDC December 9

Supplements plans for smallpox post-attack control submitted December 2

Pre-attack Program Guidance Pre-attack Program Guidance ElementsElements

Organization and Management

Identification of public health smallpox response teams

Identification of Healthcare Smallpox Response Teams

Selection of Clinic Sites and Vaccination Teams

Scheduling

Pre-attack Program Guidance Pre-attack Program Guidance Elements (continued)Elements (continued)

Vaccine Logistics and Security

Clinic Operations and Management

Vaccine Safety Monitoring

Training and Education

Data Management

Communications

Declaration, Administration of Declaration, Administration of Smallpox Countermeasures, 1/24/03Smallpox Countermeasures, 1/24/03 From Secretary, HHS: reiterated President’s

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

Pre-attack vaccination plans Pre-attack vaccination plans statusstatus

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)

Vaccine Safety Monitoring and Vaccine Safety Monitoring and Response SystemResponse 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

Pre-vaccination MaterialsPre-vaccination MaterialsCover letterVaccine Information Statement (VIS)VIS supplements:

- Reactions after vaccination

- Vaccination site care

- Skin conditions/contraindications

- Weakened immune system

- Pregnancy

Pre-vaccination Materials Pre-vaccination Materials (continued)(continued)

Screening worksheetContacts’ information sheetVIG informationCidofovir information11 minute videoMedical history and consent formPost-vaccination followup sheet

Training and EducationTraining 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

To Be DeterminedTo Be Determined

Process for vaccination of

- traditional first responders

- additional health care workers

- general public

www.bt.cdc.gov/agent/smallpox