Smallpox Vaccinee Evaluation and Follow-Up WVDHHR/BPH US Department of Health and Human Services Centers for Disease Control and Prevention December 2002 / January 2003

Smallpox Vaccinee Evaluation and Follow-Up Learning Objectives: Describe the “take” that can be expected after vaccination Describe the care of the vaccination site Describe the management of vaccinees after vaccination Describe the system for vaccinee follow-up in West Virginia

Progression of smallpox vaccination site in a non-immunized person

Normal Response to Vaccination – “Take” First (primary) Vaccination Vesicular or pustular lesion Area of definite palpable induration surrounding a center crust or ulcer Revaccination Less pronounced and more rapid progression Pustular lesion or induration surrounding a central crust or ulcer Take MUST be documented

Normal Variants Local satellite lesions Lymphangitis Local edema Viral cellulitis Swelling and tenderness of axillary lymph nodes, usually during 2nd week Fever and malaise common

Satellite Lesion

Lymphangitis

Edema

Viral Cellulitis

Equivocal Reaction All responses other than major reaction or ‘take’ Caused by partial immunity, insufficiently potent vaccine, vaccination technique failure Vaccination should be repeated ASAP, if possible

Vaccination Site Care Virus can be recovered at site from time of papule until scab separates Site should be kept dry and covered Normal bathing can occur if covered by a waterproof bandage Healthcare workers should keep site covered Use gauze or similar absorbent material Change gauze daily

Vaccination Site Care Cover this with semi-permeable dressing Hand hygiene immediately after handling dressing or contact with site CRITICAL to preventing spread Other infection control precautions to prevent contact with site Clothing over site

Vaccination Site Care Do NOT use semi-permeable dressing alone; could cause: maceration of vaccination site prolonged irritation and itching increases touching/scratching, thereby contaminating hands Designate staff to assess dressings daily

Administrative Leave Do not need to place healthcare workers on leave, unless: physically unable to work due to systemic signs and symptoms extensive skin lesions or vaccination site that cannot be covered healthcare workers do not adhere to infection control precautions and recommendations

Follow-up in West Virginia Vaccinee take-home information: List the number of the local vaccine safety monitor Vaccine safety monitor Monitor the vaccination site daily Refer to Hospital Assigned Physicians for serious adverse events / questions Support for HAPS / Vax Safety Monitor IDEP: 800-423-1271 CDC: contractor 800-###-#TBA

Twenty-one Day Diary Surveillance for mild adverse events Record PVN for vaccinee on the form Give to vaccinee at clinic Educate them to record symptoms daily until day 21 Collect when the scab falls off. Send to: IDEP ATTN: Neely Kaydos-Daniels, PhD

Telephone Survey Patient Medical History Form has check-off: ‘Will you participate in a survey?’ If checked ‘yes:’ notify Neely Kaydos-Daniels, PhD: Photocopy all forms immediately after vaccination clinic, OR List name, phone, PVN AND Fax: 304-558-6335, OR Mail: Room 125, 350 Capitol St / Charleston, WV 25301

Severe Vaccine Adverse Events If VIG / Cidofovir is needed Contact IDEP to initiate request IDEP / physician will contact CDC IDEP will work with physician to assure reporting Reporting Urgent IDEP will assist with filing the report

Before you start, you must have: Vaccine Safety Monitor Site care education plan Follow up plan Hospital Assigned Physicians: Infectious disease Allergy/immunology Neurology Dermatology Ophthalmology Primary care

For More Information Coming soon: IDEP: 800-423-1271 CDC satellite training MMWR IDEP conference calls IDEP: 800-423-1271 CDC Smallpox website www.cdc.gov/smallpox National Immunization Program website www.cdc.gov/nip