Smallpox Vaccination Update

Nancy Fasano

2003 Michigan Communicable Disease Conference

Fasanon@michigan.gov

The story in a few headlines…

• Dec.13, 2002: Smallpox: To vaccinate or not?

• Dec. 16, 2002: The Smallpox Scenario-- Fears that Iraq may possess the virus have lately come to a head. What the U.S. is planning…

And…

• Dec 16, 2002: Half of second target group for smallpox shots may refuse them, officials estimate

• February 24, 2003: Bush Smallpox Inoculation Plan Near Standstill Medical Professionals Cite Possible Side Effects, Uncertainty of Threat

And…

• April 11, 2003: Smallpox compensation deal reached

• April 13, 2003: Officials: Smallpox plans squeezing services 'It has forced trade-offs'

And…

• April 13, 2003: U.S. Smallpox Vaccine Program Lags

“According to Health and Human Services Secretary Tommy G. Thompson, vaccinating one-fifth of the number of people originally proposed will indicate success at this point.”

And finally…

• April 29: Report Faults Federal Officials for Problems in Smallpox Program

• May 1, 2003: Bush Signs Smallpox Vaccine Compensation Package, Allowing Affected People Up to $50,000 Per Year

What we expected in December

• 5,000-7,000 vaccinees in Michigan– Public Health Response Teams– Hospital-based health care response teams

• A timely response from Congress to injury compensation issues

• Vaccination beginning by mid to late January

What really happened

• The state vaccination clinic (ta-da!) on February 21, 2003

Since February 21

• Fewer than 1,000 vaccinated to date statewide

• Some regions began vaccinating immediately after February 21

• Other regions waited for resolution of compensation issue

Smallpox Vaccination Clinics

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The Big Picture

• 690 vaccinated against smallpox in Michigan as of May 13, 2003– Public Health Response Team Members: 249– Health Care Response Team members: 425– Other: 15

Adverse Events after vaccination, Michigan

• Expected reactions

• No serious

• 2 non-specific chest pain

• 1 episode elevated blood pressure

• 1 r/o encephalitis, unrelated hospitalization

Civilian Adverse EventsNational – As of 5/9/03

36,217 vaccinees• 1 Generalized Vaccinia confirmed

• 4 Inadvertent inoculation (self) confirmed

• 2 Ocular Vaccinia confirmed

Source: MMWR, May 23, 2003

Cardiac events

• Myocardial Infarction: 6 as of May 9

• Myocarditis (inflammation of heart muscle tissue): 15 as of May 9

• Pericarditis (inflammation of membrane surrounding heart): 6 as of May 9

• Angina (chest pain due to insufficient blood flow to heart): 3 as of May 9

Cardiac events & smallpox vx

• Myo- & peri-carditis previously described in European & Australian literature

• May be causal association

• Other cardiac events (MI, angina) not previously associated with smallpoxox vx

• Coronary artery disease is common, hard to determine if event is causally associated or coincidental

Changes to program

• As of April 1, pre-vaccination screening includes assessing history of heart disease and presence of risk factors.

Phase 2?

• Not here, not yet

A little about HAN

• Internet-based software application that can alert public health partners by telephone, e-mail, text pager, and in limited instances fax

• Over 50% of the 1,850 Phase 1 licenses will be LHD staff and their designees

• HAN users must have access to a reliable, high-speed Internet connection

Health Alert Network Training

• Training for system administrators, trainers, and some state and local staff will occur the week of June 9th in Lansing

• Regional training for all local staff and their public health emergency response partners will occur in July at times and locations to be determined

What’s next?(not “What next?!?”)