1 Preparing for Smallpox: Post-event Smallpox Response

2 Smallpox Viral infection Person to person spread 30% death rate 1949 – Last case in US 1972 – Stopped routine vaccination in US 1977 – Last naturally occurring case in world

3 Smallpox Vaccination is effective in preventing infection if given in advance or within 3 days of exposure

4 Smallpox Recent intelligence indicates four countries have stockpiles of the virus –Iraq –North Korea –France –Russia

5 Mass Vaccination Plan We must be prepared for the possibility of a terrorist attack in which smallpox is used as a biological weapon The Centers for Disease Control (CDC) has instructed state public health agencies to develop and be ready to implement plans to immunize the entire population of the state in a 10-day period if such an attack were to occur

6 Mass Vaccination Plan Clinic demographics –One clinic per 50,000 population, 117 clinics statewide –Each clinic serves 5000 patients per day –Each clinic operates 2 shifts per day, for 10 days straight –Each clinic staffed by over 200 people, over 100 per shift

7 Mass Vaccination Plan Where possible, the number of people identified to work in clinics should be increased by 20% with cross-trained personnel to allow for no-shows, breaks, surge needs and other contingencies

8 Clinic Volunteers 25,000-30,000 people needed to staff 117 clinics statewide Only 4,500 public health staff in the state In order to assure our ability to protect our families and communities, we need volunteers to work with public health staff to operate these clinics

9 KNOX COUNTY MASS VACCINATION PLAN 8 Clinics planned in Knox County –High school sites –Transportation, parking, security plan –Administration plan Two 8 hour shifts a day (16 hour days) Approximately 2, ,000 volunteers needed Volunteers would be vaccinated first, along with their family members

10 Mass Vaccination Plan –Clinic Flow Triage Forms Distribution Patient Education / Informed Consent Vaccination Exit Review Special Processes for Select Groups –Patients with symptoms of smallpox –Contacts to a case of smallpox –Individuals with possible contraindications to vaccination

11 Mass Vaccination Plan –Clinic Support Functions Interpreter services Ability of deal with medical emergencies Security and traffic control Vaccine preparation Supply management Transportation plan Waste disposal plan Media plan

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14 Clinic Flow and Staff Functions Triage –Screen out those individuals that may have smallpox (fever and rash) or contacts of a possible or confirmed case of smallpox and separate them from the mainstream clinic flow

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16 Clinic Flow and Staff Functions Ill Evaluation Area –Evaluate/examine triaged ill persons and provide back-up to Medical Screeners and/or Contact Evaluation Area and/or EMT –Possible cases of smallpox will be referred to hospital or other health care provider for diagnosis/treatment –Patients approved for vaccination will reenter mainstream clinic flow –Staff working in this area should be fitted for N-95 masks

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18 Clinic Flow and Staff Functions Contact Evaluation Area –One-stop shopping for the most at-risk population –Medical screening –Vaccination –Register for surveillance of symptoms –Identification of contacts –Education and special instructions –On-site data entry

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20 Clinic Flow and Staff Functions Forms Distribution –Put together and distribute patient forms and information packets –Direct patients to video area

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22 Clinic Flow and Staff Functions Video Areas –The same process takes place in staggered sessions in different locations where the patient: Views educational video Completes informed consent –Staff Run video Review informed consent forms Direct persons with all no checked boxes to vaccination area Direct persons with any yes or maybe checked box to either exit the clinic or to another area of the clinic for further evaluation

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24 Clinic Flow and Staff Functions Special Assistance Unit –Patients with special needs (disability, literacy problem, language barrier, etc) are referred here for the same processes that occur in the other video areas –Interpreter(s) will be available in this area

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26 Clinic Flow and Staff Functions Medical Screening and Counseling Area –Patients with self-identified potential contraindications to vaccination are sent to this area if they they still desire vaccination or need/want further counseling –Patients may either exit clinic from this area or proceed to vaccination area

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28 Clinic Flow and Staff Functions Vaccination Area –Multiple vaccination stations per shift –2 Trained vaccinators at each station Ideally, 1 of the vaccinators at each station is a nurse During any given time period, 1 vaccinator is vaccinating while the other is dealing with paperwork and serving as a witness. The two will trade off on a regular basis. –1 Non-vaccinator support person at each station to assist in the compilation of paperwork and distribution of vaccine site care supplies

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30 Clinic Flow and Staff Functions Exit Review –Staff answer any final questions about site care, adverse event symptoms, non-take reporting procedures, or other issues following vaccination –Assures patients exit with all information sheets and instructions

31 Other Clinic Support Staff Clinic Administration –Assure smooth clinic operation –Coordinate/communicate with regional public health office –Address problems as they arise Supply Area –Assure all clinic workstations have access to needed supplies –Oversee vaccine storage and preparation

32 Other Clinic Support Staff EMT to deal with medical emergencies Float nurse to oversee non-medical vaccinators Security / traffic control staff to maintain order

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34 Clinic Volunteers/Staff Should not have any contraindication to vaccination if they are going to work in the Illness Evaluation, Contact Evaluation or Vaccination Areas Volunteers and other members of their households will be the first to be offered vaccination in a post-event response

35 Thank you for volunteering! Your help will be vital to the health and safety of our community.