Transcript Hospital Issues and Smallpox Vaccine

Hospital Issues and Smallpox
Vaccine
Lisa G. Kaplowitz, M.D., M.S.H.A.
Deputy Commissioner
Emergency Preparedness and Response
Virginia Department of Health
VDH Emergency Preparedness
and Response (EP&R)
All hazards approach to emergency
preparedness
Responsible for CDC grant to enhance
public health infrastructure and ability to
respond to public health emergencies
Partnership with VHHA for HRSA grant to
enhance hospital emergency
preparedness
VDH EP&R Programs
National Pharmaceutical Stockpile (NPS)
distribution and management –
– Close collaboration with Virginia Department of
Emergency Management (DEM)
Pre and post event smallpox vaccination
plans
State, regional and local plans
District health departments (35) responsible
for development and implementation of plans
at local level
Smallpox vaccination
Dec, 2002: President Bush announced
plan to vaccinate civilian response teams
and military personnel
Pre-event smallpox vaccination
– Stage 1: Hospital and public health response
teams
– Stage 2: Other health care providers, first
responders
– Stage 3: Offer to general public when enough
licensed vaccine available
Hospital Participation in Smallpox
Vaccination Plan
Voluntary for both hospitals and individuals
Pre-event vaccination of team to provide
care to smallpox patients in first 7-10 days of
a smallpox event
Assure that a certain number of health care
providers will be comfortable providing care
for persons with smallpox until others are
vaccinated
Suggested Hospital Team Members
Physicians – ER,ICU, general medical,
specialists (ID, dermatology, others)
Nurses - ER, ICU, medical
Infection Control Practitioners (ICPs)
Respiratory therapists
Transportation
Laboratory technicians
Housekeeping
Smallpox Vaccine Issues
Live virus vaccine – vaccinia
Contraindications pre-event
– Immunosuppression: disease or medications
– Eczema or history of eczema
– Family member with immunosuppression or
eczema
– Pregnancy
– Breastfeeding
– Allergy: any vaccine components
Complication Rates of Vaccination
Rates (per million vaccinations) Following Smallpox Vaccination – U.S., 1968
(ten state survey)
Primary
Vaccination
Revaccination
Inadvertent
Autoinoculation
Generalized
Vaccinia
Eczema Vaccinatum
529
42
242
9
39
3
Progressive
Vaccinia
Postvaccinal
Encephalitis
1.5
3
12
2
Total
1254
108
Complication
Pre-Clinic Screening of Vaccination
Candidates
Health care workers volunteering for vaccination
will be identified
Volunteers will be given a packet of information
to review at home prior to vaccination day
–
–
–
–
Contraindications
Complications
Precautions
Information about HIV, pregnancy testing
Volunteers will be allowed to withdraw without
stating a specific reason
Screening for HIV Infection
Vaccine should NOT be administered to those
with HIV infection or AIDS
Educate staff regarding risk of vaccine for those
with HIV/AIDS
Mandatory HIV testing not required
HIV testing recommended for persons who have
history of risk factor and do not know status
Anyone wishing HIV testing can be referred to
health department for free confidential or
anonymous testing
Screening for Pregnancy
In pre-event setting, should NOT be given to:
– pregnant women
– women trying to become pregnant
Educate women of child-bearing age about fetal
vaccinia
Advise avoidance of pregnancy for 4 weeks
following vaccination
If concerned, administer home test for pregnancy
Smallpox Vaccination
Health Department Responsibilities
Education and training, including providing
education materials
– Contraindications
– Complications
– Vaccine site management
Responsible for vaccine and vaccine
administration
Collect information and report on adverse
vaccine events
Adverse Events
Notify health department
Clinical assessment by patient’s provider, with
assistance by appropriate specialists (ID,
dermatology)
VIG in limited supply, management of many
severe complications
– Only available from CDC, through health
department
Cidofovir not licensed for vaccinia complications
Hospital Responsibilities After
Vaccination
Daily assessment of vaccine site for
anyone involved in direct patient care
Vaccine site coverage for anyone involved
in patient care: gauze, dressing, clothing
Dressing change as necessary, with
appropriate disposal of dressings
Assessment of vaccine take at 7 days
Hospital Issues
Do not need to place HCWs on leave, unless:
– Physically unable to work due to systemic signs
and symptoms
– Extensive skin lesions or vaccination site that
can not be covered
– HCWs do not adhere to infection control
precautions and recommendations
No requirement for staff reassignment after
vaccination
Vaccination Site Care
Virus can be recovered at site from
time of papule until scab separates
Site should be kept dry
Normal bathing can occur if covered
by waterproof bandage
Contact precautions most important –
vaccinia virus IS NOT aerosolized
Vaccination Site Care
HCWs should keep site covered
Use gauze or similar absorbent material
Cover this with semi-permeable dressing
Wear long sleeves to further limit contact
with vaccine site
Other Post Vaccine Issues
Defer blood donation for 21 days after scab
falls off
Appropriate care with dressing change
– Handwashing
– Disposal of dressings in ziplock bag
– Disposal of dressing in red bag in hospital, trash at
home