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SMALLPOX QUESTIONS AND ANSWERS for 1/31/03


Q. Why does the New Jersey Department of Health and Senior Services plan to vaccinate volunteer hospital and public health workers for smallpox?

A. As part of a federal Homeland Security program, the Centers for Disease
Control and Prevention (CDC) asked all states to submit a plan to vaccinate volunteer first-line healthcare workers and public health workers against the smallpox virus to defend against the potential for a bioterrorism attack. New Jersey submitted its plan for this first stage to the CDC December 9, 2002 and it was approved in early January 2003. The plan for Stage 1 vaccinations in New Jersey is consistent with the New Jersey Department of Health and Senior Services (NJDHSS) Terrorism and Public Health Emergency Preparedness and Response Plan.

Q. According to the New Jersey Smallpox Vaccination Plan, who will be immunized first?

A. The first group of people who will be vaccinated are volunteer public health workers who, in turn, will be able to vaccinate other health care workers in the future. We also plan to vaccinate public health response team members and hospital health care response team members.

Q. Who are on the Public Health Response Teams?

A. The Public Health Response Teams will be comprised of, but not limited to, a physician team leader, epidemiologist, public health nurse/vaccinator, a lab worker, law enforcement agent, regional planner/coordinator, a LINCS (Local Information Network Communication System) planner/coordinator and an industrial hygienist.

Q. Who are on the Hospital Health Care Response Teams?

A. Hospital health care response teams will be comprised of, but not limited to, emergency physicians, infectious disease physicians, emergency department nurses and general nursing staff, infection control practitioners, and ancillary and security personnel.

Q. What will these teams do?

A. The Public Health Response Teams will be deployed to hospitals to investigate a high-risk or confirmed patient with smallpox, identify potential contacts, collect clinical specimens, and ensure safety precautions are maintained. The Hospital Health Care Response Teams will provide direct patient care and ensure that proper infection control procedures, personal protective equipment and security are available. In the event of a smallpox outbreak, these teams will help treat and contain the disease.

Q. How credible is the smallpox threat to New Jersey?

A. At this time, the worldwide threat is uncertain. However, the New Jersey Department of Health and Senior Services recognizes that it is prudent to acknowledge the possibility of the threat and prepare to protect New Jersey citizens in accordance with the federal plan. The Department will rely on receiving additional updated information from law enforcement and federal and state intelligence agencies.

Q. Where will vaccination clinics be located?

A. The Department has identified seven clinic sites. They will be in five regions (northeast, northwest, central east, central west, and south) and one in Newark, an MMRS site (Metropolitan Medical Response System). The southern region clinic will alternate between two locations. Department of Health and Senior Services staff will be assigned to each clinic location.

Q. How many people can be vaccinated in a day?

A. Initially, in the vaccination preparedness program, each clinic will be able to vaccinate up to 720 individuals per day. Each regional clinic will operate about one day a week for four weeks.

Q. How many doses of vaccine does New Jersey have now?

A. The Department of Health and Senior Services has received 5,000 doses of the 9,500 approved does of vaccine from the federal Centers for Disease Control and Prevention (CDC) for the Stage 1 preparedness program.

Q. Why is the number of vaccines less than the 15,000 New Jersey requested?

A. New Jersey presented an aggressive plan to the CDC to have treatment teams available in every acute care hospital plus investigation teams of public health workers. The CDC provided enough vaccine for New Jersey to begin its preparedness program. The number of volunteers allows for adequate treatment teams in the event of an outbreak.

Q. When will the smallpox vaccine be administered?

A. Vaccines for volunteers among public health and hospital workers began January 31, 2003 and will continue through the first week of March.

Q. Is there enough smallpox vaccine for everyone?

A. There is enough licensed vaccine available at this time to vaccinate volunteers in the Stage 1 vaccination preparedness program (i.e., public health and hospital response teams). The federal government does not recommend vaccination of the general public at this time.

According to the information received from CDC, there will be enough vaccine to inoculate the entire country within the next 12-16 months.

Q. Is there a cure for smallpox?

A. There are medications that can be used for supportive care (i.e., to treat the symptoms of smallpox). However, there is no "cure" for smallpox, and it cannot be treated with antibiotics.

Q. Are there side effects to the smallpox vaccine? How safe is the vaccine?

A. There are side effects and risks associated with the smallpox vaccine.
Some people experience normal, usually mild reactions that include a sore or swollen arm, fever, and body aches. However, other people experience reactions ranging from serious to life threatening.

Q. Who are most likely to have serious side effects from the vaccine?

A. Serious side effects are most likely to occur in people who have now or in the past have had, even once, skin conditions, especially eczema or atopic dermatitis, and people with weakened immune systems, such as those who have received a transplant, are HIV positive, are receiving treatment for cancer, or are currently taking medications (like steroids) that suppress the immune system. In addition, women who are breastfeeding or pregnant women should not get the vaccine at this time because of the potential risk it poses to the baby or unborn fetus. And people under 18 years of age and those allergic to the vaccine or any of its components should not receive the vaccine at this time.

Q. How many people get side effects after being vaccinated?

A. In the past, about 1,000 people for every 1 million people vaccinated for the first time experienced reactions that, while not life-threatening, were serious. These reactions included a toxic or allergic reaction at the site of the vaccination (erythema multiforme), spread of the vaccinia virus to other parts of the body and to other individuals (inadvertent inoculation), and spread of the vaccinia virus to other parts of the body through the blood (generalized vaccinia). These types of reactions may require medical attention. In the past, between 14 and 52 people out of every 1 million people vaccinated for the first time experienced potentially life-threatening reactions to the vaccine. Based on past experience, it is estimated that 1 or 2 people in 1 million who receive the vaccine may die as a result. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk do not receive the vaccine.

Q. How many people have been vaccinated so far?

A. Some laboratory technicians, the federal public health response team, and groups in clinical trials related to production of Vaccinia Immun Globulin (VIG-for treatment of severe side effects) have been vaccinated.

Q. Can I go to my doctor and get vaccinated against smallpox?

A. No. The federal government does not recommend vaccinations for the general public at this time. Vaccine will be distributed on a limited, secure basis to state health departments.

Q. Can a hospital or person be held liable for injuries to a volunteer who has a severe reaction to the vaccine?

A. Section 304 of the federal Homeland Security Act provides an exclusive remedy against the United States for injury or death attributable to smallpox vaccine, other substances used to treat or prevent smallpox, or vaccinia immune globulin ("smallpox countermeasures"). This means that no claim for liability for injury or death attributable to a smallpox countermeasure could be brought against entities or individuals who are covered by Section 304's protections. This volunteers who receive the vaccine, hospitals in which they work, and people who administer the vaccine.

Q. When do the provisions of Section 304 become effective?

A. The effective date, as established in the Homeland Security Act, was January 24, 2003.

Q. Are volunteers who suffer severe reactions to the smallpox vaccine entitled to worker's compensation?

A. Yes. NJDHSS will register volunteers for the preparedness program with the Office of Emergency Management and those people will be eligible for state workers compensation for prolonged reactions.
Those employed by institutions, such as hospitals, will be covered by their institution's worker's compensation carrier.

Except in rare circumstances, reactions to the vaccine are mild. Screening for contraindications will help prevent giving the vaccine to volunteers who may be at risk or who come in regular contact with someone who could be at risk.

 

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