Smallpox Preparedness Definition

1. National Smallpox VaccinationUpdateJoseph M. HendersonCenters for Disease Control and Prevention

2. Smallpox 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

3. Strategies 1. Surveillance and containment 2. Mass Vaccination 3. Cadre of workers to facilitate 1 and 2

4. The 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

5. Advisory Committee on Immunization Practices Supplemental Recommendations, 2002 • Definition of response teams (to follow) • Vaccination site care • Administrative leave for vaccinated health care workers (not necessary)

6. Advisory Committee on Immunization Practices Supplemental Recommendations, 2002 • Screening for contraindications - Atopic dermatitis, eczema: screening questions suggested - Pregnancy - Immune suppression, including HIV/AIDS

7. Why Vaccinate Health Care 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.

8. Why vaccinate Health Care 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

9. Smallpox Public Health Response 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

10. Smallpox Healthcare Response 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.

11. 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 staff Respiratory therapists Radiology techs Security Housekeeping Suggested Composition of Healthcare Response Team

12. Post-attack Program Guidance • Guidance issued October 29, 2002 • Plans due to CDC December 2, 2002 • Plans presently under review

13. Post-attack Program Guidance 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

14. Pre-attack Program Guidance • Guidance issued November 22 • Plans due to CDC December 9 • Supplements plans for smallpox post-attack control submitted December 2

15. Pre-attack Program Guidance Elements • Organization and Management • Identification of public health smallpox response teams • Identification of Healthcare Smallpox Response Teams • Selection of Clinic Sites and Vaccination Teams • Scheduling

16. Pre-attack Program Guidance Elements (continued) • Vaccine Logistics and Security • Clinic Operations and Management • Vaccine Safety Monitoring • Training and Education • Data Management • Communications

17. Declaration, Administration of Smallpox 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

18. Pre-attack vaccination plans status • 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)

19. Vaccine Safety Monitoring and Response 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

20. Pre-vaccination Materials • Cover letter • Vaccine Information Statement (VIS) • VIS supplements: - Reactions after vaccination - Vaccination site care - Skin conditions/contraindications - Weakened immune system - Pregnancy

21. Pre-vaccination Materials (continued) • Screening worksheet • Contacts’ information sheet • VIG information • Cidofovir information • 11 minute video • Medical history and consent form • Post-vaccination followup sheet

22. Training 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

23. To Be Determined • Process for vaccination of - traditional first responders - additional health care workers - general public

24. www.bt.cdc.gov/agent/smallpox