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Smallpox Vaccination Update. Nancy Fasano 2003 Michigan Communicable Disease Conference The story in a few headlines…. Dec.13, 2002 : Smallpox: To vaccinate or not?

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smallpox vaccination update

Smallpox Vaccination Update

Nancy Fasano

2003 Michigan Communicable Disease Conference

the story in a few headlines
The story in a few headlines…
  • Dec.13, 2002: Smallpox: To vaccinate or not?
  • Dec. 16, 2002: The Smallpox Scenario-- Fears that Iraq may possess the virus have lately come to a head. What the U.S. is planning…
  • Dec 16, 2002:Half of second target group for smallpox shots may refuse them, officials estimate
  • February 24, 2003:Bush Smallpox Inoculation Plan Near Standstill Medical Professionals Cite Possible Side Effects, Uncertainty of Threat
  • April 11, 2003:Smallpox compensation deal reached
  • April 13, 2003:Officials: Smallpox plans squeezing services'It has forced trade-offs'
  • April 13, 2003: U.S. Smallpox Vaccine Program Lags

“According to Health and Human Services Secretary Tommy G. Thompson, vaccinating one-fifth of the number of people originally proposed will indicate success at this point.”

and finally
And finally…
  • April 29: Report Faults Federal Officials for Problems in Smallpox Program
  • May 1, 2003: Bush Signs Smallpox Vaccine Compensation Package, Allowing Affected People Up to $50,000 Per Year
what we expected in december
What we expected in December
  • 5,000-7,000 vaccinees in Michigan
    • Public Health Response Teams
    • Hospital-based health care response teams
  • A timely response from Congress to injury compensation issues
  • Vaccination beginning by mid to late January
what really happened
What really happened
  • The state vaccination clinic (ta-da!) on February 21, 2003
since february 21
Since February 21
  • Fewer than 1,000 vaccinated to date statewide
  • Some regions began vaccinating immediately after February 21
  • Other regions waited for resolution of compensation issue
the big picture
The Big Picture
  • 690 vaccinated against smallpox in Michigan as of May 13, 2003
    • Public Health Response Team Members: 249
    • Health Care Response Team members: 425
    • Other: 15
adverse events after vaccination michigan
Adverse Events after vaccination, Michigan
  • Expected reactions
  • No serious
  • 2 non-specific chest pain
  • 1 episode elevated blood pressure
  • 1 r/o encephalitis, unrelated hospitalization
civilian adverse events national as of 5 9 03
Civilian Adverse EventsNational – As of 5/9/03

36,217 vaccinees

  • 1 Generalized Vaccinia confirmed
  • 4 Inadvertent inoculation (self) confirmed
  • 2 Ocular Vaccinia confirmed

Source: MMWR, May 23, 2003

cardiac events
Cardiac events
  • Myocardial Infarction: 6 as of May 9
  • Myocarditis (inflammation of heart muscle tissue): 15 as of May 9
  • Pericarditis (inflammation of membrane surrounding heart): 6 as of May 9
  • Angina (chest pain due to insufficient blood flow to heart): 3 as of May 9
cardiac events smallpox vx
Cardiac events & smallpox vx
  • Myo- & peri-carditis previously described in European & Australian literature
  • May be causal association
  • Other cardiac events (MI, angina) not previously associated with smallpoxox vx
  • Coronary artery disease is common, hard to determine if event is causally associated or coincidental
changes to program
Changes to program
  • As of April 1, pre-vaccination screening includes assessing history of heart disease and presence of risk factors.
phase 2
Phase 2?
  • Not here, not yet
a little about han
A little about HAN
  • Internet-based software application that can alert public health partners by telephone, e-mail, text pager, and in limited instances fax
  • Over 50% of the 1,850 Phase 1 licenses will be LHD staff and their designees
  • HAN users must have access to a reliable, high-speed Internet connection
health alert network training
Health Alert Network Training
  • Training for system administrators, trainers, and some state and local staff will occur the week of June 9th in Lansing
  • Regional training for all local staff and their public health emergency response partners will occur in July at times and locations to be determined

What’s next?

(not “What next?!?”)