Transcript LA Dept. of Health Services - Department of Public Health

Smallpox Preparedness
in LA County
Cristin Mondy, MSN/MPH, RN, PHN
Bioterrorism Epidemiology & Surveillance Unit
Acute Communicable Disease Control Program
Los Angeles County Department of Health Services
LA Dept. of Health Services
Outline
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The current threat
Brief history
Signs and symptoms of smallpox
Smallpox vaccine
LAC activities
LA Dept. of Health Services
Smallpox: Overview
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Smallpox is an acute, contagious, and
sometimes fatal disease caused by the
variola virus
Eradicated in the world in 1980
The use of smallpox as a biological
weapon is now a possibility
The US government is taking precautions
to deal with smallpox
LA Dept. of Health Services
Smallpox: Overview
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Person-to-person transmission
(respiratory droplets/contact)
Patient is contagious after rash appears
Death may occur in up to 30% of
unvaccinated cases
LA Dept. of Health Services
Smallpox: Overview
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Vaccination can prevent smallpox
No proven treatment at this time but
research is ongoing
Vaccination within 3 days of exposure will
prevent or significantly modify smallpox
Vaccination within 4-7 days after exposure
offers some protection or modify smallpox
LA Dept. of Health Services
Brief History
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1949: Last case of smallpox in U.S.
1972: Routine vaccination of the
American public stopped
1977: Last natural case occurred in
Somalia
1980: WHO announced eradication of
smallpox worldwide
LA Dept. of Health Services
Signs and Symptoms
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The first symptoms of smallpox usually
appear 7-17 days after exposure
Begins with high fever, head and body
aches, and sometimes vomiting (2-3
days)
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NOT contagious during this time
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LA Dept. of Health Services
Signs and Symptoms
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Rash follows
 Rash can start on the mouth, face,
hands, and forearms and then spread
to the legs and body.
 Rash becomes raised bumps that
crust, scab and fall off after about 3
weeks, leaving a pitted scar.
LA Dept. of Health Services
LA Dept. of Health Services
Smallpox
Rash:
 The same stage of
development
 Mostly concentrated
in face and
extremities (hands
and feet)
LA Dept. of Health Services
Transmission
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Spreads from contact with infected
persons
Direct and fairly prolonged face-to-face
contact is required to spread smallpox
(within 6 feet)
May also be spread with contact
through infected bodily fluids
LA Dept. of Health Services
Smallpox Vaccine
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Not available to the public at this time
If there is a smallpox outbreak, there is
enough vaccine for everyone who would
need it.
Vaccination within 3 days of exposure will
prevent or significantly modify smallpox
Vaccination within 4-7 days after exposure
offers some protection or modify smallpox
LA Dept. of Health Services
Smallpox Vaccine
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Made from a live virus “vaccinia”
The vaccine can not spread or cause
smallpox
Given with a bifurcated needle, not a
“shot” like other vaccinations
The needle is used to prick the skin 3 or
15 times in a few seconds
LA Dept. of Health Services
LA Dept. of Health Services
Who should NOT get the
vaccine?
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Pregnant women
People who have or have had skin conditions (especially
eczema and atopic dermatitis)
People with weakened immune systems
 Those who have received a transplant
 Those who are HIV positive
 Those receiving treatment for cancer
 Those taking medications (steroids) that suppresses the
immune system
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Anyone who is a household contact to any of the above
Anyone under the age of 18
LA Dept. of Health Services
Normal Vaccine Reactions
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A red and itchy bump develops at the site
in 3-4 days
In the first week after vaccination, the
bump becomes a large blister, fills with
pus, and begins to drain
During the second week, the blister
begins to dry and a scab forms
The scab falls of in the third week, leaving
a small scar.
LA Dept. of Health Services
LA Dept. of Health Services
Vaccine Reactions
 Reactions are less if revaccinated
 Mild to Moderate:
 Mild rash (lasts 2-4 days)
 Swelling and tenderness of armpit glands
(lasts 2-4 weeks)
 Fever of over 100oF (about 10% of adults)
 Blisters elsewhere on the body (about 1 per
1,900)
LA Dept. of Health Services
Vaccine Reactions
Moderate to Severe:
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Serious eye infection or loss of vision
(<6 per 10,000)
 Rash on entire body (1 per 4,000)
LA Dept. of Health Services
Vaccine Reactions
Potentially Life-Threatening:
Severe rash on people with eczema
(1 per 26,000)
 Severe brain reaction (encephalitis);
may lead to permanent brain damage
(1 per 83,000)
 Severe infection beginning at
vaccination site (1 per 667,000, mostly
those with weakened immune systems)
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LA Dept. of Health Services
Vaccine Reactions
 Treatment is available for serious vaccine
reactions
 VIG / Cidofivir
 Research for new treatment is ongoing
 14-52 people per million could have a lifethreatening reaction
 Death: 1-2 people per million
LA Dept. of Health Services
Los Angeles County
Activities
LA Dept. of Health Services
LA County
Smallpox Plan
Elements of the Plan
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Preparedness
Response
Recovery
LA Dept. of Health Services
Preparedness
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Vaccination: Phase 1, 2, and 3
Surveillance
Smallpox Response Teams
Laboratory
Communication
Training
Management of a Suspect Case of
Smallpox
LA Dept. of Health Services
Response
Criteria for Activation of the Response Plan
 Redeployment of LAC DHS Staff
 Activation of Emergency Contract and Mutual
Aid Personnel
 Use of the Standardized Emergency
Management System: ring and mass
vaccination, smallpox case management,
contact management, logistics, etc.
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LA Dept. of Health Services
Recovery
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Criteria for Declaring the End of the
Smallpox Emergency
Heightened Active Surveillance
Risk Communication
Evaluation and Analysis of Lessons
Learned
LA Dept. of Health Services
Smallpox Vaccination:
Phase 1
Given the recent concerns that
smallpox virus may be intentionally
used as a bioterrorism agent, Los
Angeles County has been directed to
begin planning for the implementation
of the Phase I Smallpox Preparedness
Vaccination Program
LA Dept. of Health Services
Phase I: Goal
To increase the LAC’s smallpox
preparedness capacity by offering
vaccination safely to:
– volunteer public health teams (including
vaccinators) who will conduct investigations
and outbreak control for the initial smallpox
case(s)
– volunteer health care workers who will treat
and manage the initial smallpox case(s)
LA Dept. of Health Services
Timeline
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Phase 1 plans were submitted on
December 9, 2002.
Approved by CDC on December 23
Immunization operations started on
January 29, 2003
LA Dept. of Health Services
Public Health
Smallpox Response Teams
In order to provide a pre-designated,
highly trained, interdisciplinary team of
public health personnel that will be
immediately available to respond to a
smallpox emergency, LAC DHS is
assembling teams for rapid, scaled
mobilization and deployment.
LA Dept. of Health Services
Public Health
Smallpox Response Teams
 Five (5) teams from LAC DHS
 40 persons, as needed, per team
 One team from Pasadena
 One team from Long Beach
 One team from LAX/LA Port Quarantine
LA Dept. of Health Services
Smallpox
Health Care Teams
To provide uninterrupted medical care
for smallpox patients in acute care
hospitals, a team of health care workers
will be vaccinated so they can provide
direct medical care for the initial
smallpox case(s) presenting in the ER
or requiring hospital admission
LA Dept. of Health Services
Hospital Team
Requirements
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Willingness to be vaccinated
Vaccination of all team members
Deliver medical care 24 / 7 for the first
7-10 days using 8-12 hour shifts
Experienced and competent staff
45-100 employees per hospital
LA Dept. of Health Services
Considerations
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If possible, start with previously
vaccinated individuals to decrease
incidence and severity of systemic
effects
Stagger same unit personnel to
minimize number simultaneously out
of work
Furlough not recommended by ACIP
LA Dept. of Health Services
Administrative Leave
Administrative leave is not routinely
recommended unless:
 Physically unable to work due to symptoms
of illness
 Extensive skin lesions which can not be
adequately covered
 Non-adherence to recommended infection
control precautions
LA Dept. of Health Services
Site care
Health care workers will need checks of
sites before each shift
 To prevent nosocomial transmission
 Ensure bandage clean and dry
 Reinforce importance of hand hygiene
 Follow up on reactions, adverse events
LA Dept. of Health Services
Training and Education
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4 to 8 hours of training covering the
smallpox vaccine, LAC’s response plan,
and the vaccination clinic operations will
be provided to all staff that will
participate in the vaccination program.
Core training for all staff
Task oriented training based on
responsibilities for each staff
LA Dept. of Health Services
Community Training
Training on recognizing and treating adverse
events after smallpox vaccination will be
developed and offered to community physicians
on an ongoing basis
 Comprehensive “train-the-trainer” program will
be developed to be implemented after Phase 1
to prepare for LAC’s future Phase 2 smallpox
preparedness vaccination program
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LA Dept. of Health Services
LAC Activities
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Reinstated Smallpox as a reportable
disease (May 2001)
Established the Smallpox Planning
Working Group (January 2002)
Developed the Draft Smallpox
Preparedness, Response, and Recovery
Plan (February 2002)
LA Dept. of Health Services
LAC Activities
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Developed smallpox posters and
disseminated to the medical community
(July 2002)
Assessed public health workforce
capacity (November 2002)
Developed a Plan for Phase I Smallpox
Preparedness Vaccination Program
(December 2002)
LA Dept. of Health Services
LAC Activities
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Trained licensed public health staff on
how to administer the smallpox vaccine
(January 2003)
Started the Smallpox Vaccination
Program (January 2003)
Trained select public health staff
[Speaker’s Bureau] to give
presentations to the community on
smallpox (January 2003)
LA Dept. of Health Services
LAC Activities
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Developed a Smallpox Public Health
Response Team
Developed and disseminated smallpox
FAQ sheets
Ongoing education and training
activities for public health employees
and the health care community
Ongoing updates in www.labt.org
LA Dept. of Health Services
Resources
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http://www.bt.cdc.gov/training/smallpox
vaccine/reactions/default.htm
www.labt.org
LA Dept. of Health Services