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Smallpox Vaccine Use ACIP-NVAC Smallpox Working Group

Smallpox Vaccine Use ACIP-NVAC Smallpox Working Group. Gianfranco Pezzino, MD, MPH Council of State and Territorial Epidemiologists Gpezzino@kdhe.state.ks.us 785, 296-6179. CSTE – Who we are. Council of State and Territorial Epidemiologists Organized in early 50’s

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Smallpox Vaccine Use ACIP-NVAC Smallpox Working Group

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  1. Smallpox Vaccine UseACIP-NVAC Smallpox Working Group Gianfranco Pezzino, MD, MPH Council of State and Territorial Epidemiologists Gpezzino@kdhe.state.ks.us 785, 296-6179

  2. CSTE – Who we are • Council of State and Territorial Epidemiologists • Organized in early 50’s • Promotes the effective use of epidemiologic data to guide public health practice • About 400 members from all states and territories • Members engaged in practice of epidemiology at the state level • Focus on surveillance and epidemiology of infectious diseases, chronic diseases and conditions, and environmental health

  3. Public Health Decision Process How Common? + How Severe? + How Preventable? _________________ “Science”

  4. Public Health Decision Process How Common? Public Perception + + External factors (e.g., economics, politics) How Severe? + + How Preventable? Societal, ethical, and individual values _________________ _________________ “Science” “Other Forces”

  5. Public Health Decision Process How Common? Public Perception + + External factors (e.g., economics, politics) How Severe? + + Societal, ethical, and individual values How Preventable? _________________ _________________ “Science” “Other Forces” Priorities, Policies

  6. “The Science” • How common? • Smallpox is the only disease on earth eradicated from nature • Current risk is UNKNOWN! • How serious? • Very • How preventable? • Very preventable, BUT at a price

  7. “The Other Forces” • Public fear may easily escalate • Public perception: • Preferential treatment for privileged groups • Trust: “What is the government hiding?” • Ethical issues • Individual freedom versus the good of the whole • Practical issues: • States want their own internal first response capacity • Timing is essential (e.g., immediate interview of index case while still conscious, immediate contact tracing) • Unprotected first responders may not be available when needed

  8. The Answers • General Principles: • Any distribution of vaccine should be limited to the minimum required to achieve the desired goals • Most CSTE members favor restrictive policies in vaccine use before event • Epidemiologic data should ALWAYS be considered when formulating vaccine policies • Public discussion and information are essential

  9. Question 1 – Pre-event vaccination of the general population • Permissive use not recommended at this time • Illness and deaths from side effects greater than from disease • Availability for general population not recommended until: • Risk of disease is quantifiable and substantial • Vaccine is available outside I.N.D. • Vaccine availability is assured to control outbreaks • VIG availability is assured to control vaccine side effects

  10. Questions 2 - Should early responders be vaccinated before an event? • Most difficult and divisive of all the questions • No to a mass vaccination of all first responders • Consider a limited vaccination of people involved in immediate first response likely to be in contact with index case(s): • Eligible individuals identified in the context of statewide smallpox response plan, e.g.: • Some staff of Level C (containment) structure • State/local public health rapid response teams • Adequate screening for contraindications and follow up must be assured • Practical challenge to define target population • Apply uniform criteria

  11. Question 3 – Is ring vaccination the control strategy of choice? • Yes, in the absence of evidence in favor of alternative strategies • Doubts about feasibility and efficacy of ring vaccination under a BT scenario remain • Extent of required activities • Multiple foci intentionally spread in a non-natural fashion • Quickly analyze epidemiologic data and modify recommendations accordingly • Population-wide campaign at local, regional, or national level may become necessary after cases appear

  12. Additional Comments • Need for broad discussion, consensus process • Vaccine prepositioning should be considered • Public Information is of paramount importance • Regardless the option chosen, the public and first responders must receive adequate information and explanation • Issue must be revisited as assumptions change • Any guidelines from ACIP should be considered as preliminary and subject to change based on new evidence • Is there a rapid mechanism for this?

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