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Edward P. Sloan, MD, MPH Associate Professor Dept of Emergency Medicine

Smallpox Vaccination: Risk Assessment and Perspectives of the Health Care Provider, Institution, and State of Illinois. Edward P. Sloan, MD, MPH Associate Professor Dept of Emergency Medicine. University of Illinois College of Medicine Chicago, IL. Attending Physician Emergency Medicine.

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Edward P. Sloan, MD, MPH Associate Professor Dept of Emergency Medicine

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  1. Smallpox Vaccination:Risk Assessment and Perspectives of the Health Care Provider, Institution, and State of Illinois

  2. Edward P. Sloan, MD, MPHAssociate ProfessorDept of Emergency Medicine University of Illinois College of Medicine Chicago, IL

  3. Attending Physician Emergency Medicine University of Illinois Hospital Our Lady of the Resurrection Medical Center

  4. Some Considerations • The disease • The risk of an attack • The public health impact of an attack • The medical literature • Current recommendations • Questions for today

  5. The Disease • Easily spread: Most infectious disease • Significant morbidity and mortality • 500 million deaths in 20th century • 2 million deaths in 1967 • Real morbidity

  6. The Risk of an Attack • 1980: Soviet Union starts Smallpox weapons program • 1986: WHO recommends destruction of existing virus stocks • 1994: Alibek defects, former deputy director of Soviet bioweapons program

  7. The Risk of an Attack • USSR producing “tons of virus” • Successful weaponization of smallpox accomplished • Virus transferred to a facility in Siberia • Occurred concurrent with serious economic problems in Russia • Might other countries might acquire the technology and weapons?

  8. Public Health Implicationsof a Smallpox Attack • 1972: Yugoslavia • 1 case identified • 11 people infected • 138 people then infected • 10,000 people isolated • 20,000,000 people vaccinated

  9. The Medical Literature • NEJM • Early release of articles • Free distribution of materials • Six articles • Public, risk, vaccination, public health • Good information for framing discussion

  10. NEJM: Schraeder • Obligation to protect public health • Public health decisions • “Trust our heads and our hearts”

  11. NEJM: Blendon • Public knowledge unclear • Survey of 1006 adults • False smallpox vaccination beliefs • Need for public education

  12. NEJM: Bozzette • Scenarios of smallpox attacks • Stochastic model of outcomes • Risk of attack, risks of vaccination • No risk: no vaccination • Some risk: vaccinate HCWs • High risk: vaccinate public

  13. NEJM: Sepkowitz • How contagious is vaccinia? • 1907-1975: • 12 outbreaks • 85 secondary cases • 75%: young children, atopic dermatitis • Immunocompromise in HCWs • Risk of hospital vaccinia outbreak

  14. NEJM: Mack • Alternate view of minimizing risk • Vaccination & immunoglobulin best • High risk of attack: immunize • Otherwise, go for safer options • Facilitate rapid diagnosis • Use alternate medical facilities • Vaccinate and train 15,000 in US • Have vaccinia IgG for complications • Educate in a less inflammatory way

  15. NEJM: Hanrahan • Smallpox false alarm: case report • Papulovesicular rash, same stages • Centrifugal distribution • Prodrome with fever, N/V • CDC specimens: HSV positive • Hospital test for HSV, VZV, syphillis • Digital camera for email to CDC

  16. Current Recommendations • CDC Advisory Committee on Immunization Practices (ACIP) • June 2001: Initial recommendations • June 2002: “Smallpox Health Care Teams” • October 2002: 8 Specific Issues • Comment: CDC HICPAC, DHHS NVAC

  17. ACIP Recommendations • Smallpox health care teams • Smallpox vaccination site care • Phase in: no administrative leave • Screen: atopic dermatitis, pregnancy, HIV • Administer other vaccinations • Vaccinate the vaccinators

  18. Questions for Today • Knowns: • Risk of disease • Risk of vaccination • Unknowns: • Risk of attack • Effect in society with immunocompromise • Public health value of vaccination • Need for vaccination

  19. Questions for Today • What are the risks of attack in 2003? • What are the risks of vaccination? • Who should get vaccinated? • Who should get vaccinated first? • Does prior vaccination matter? • What happens after vaccination? • Who assumes liability of vaccination?

  20. Questions for Today • What does the state expect of us? • What are hospitals doing? Why? • What are the risks of vaccination? • What do we need to get it done? • What are our knowledge gaps • What comes next?

  21. Our Speakers • Patricia Lee, MD • Advocate IMMC • Smallpox and vaccination • Dino Rumoro, DO • Rush-Pres-St Luke • Hospital perspective • John Lumpkin, MD, MPH • Illinois Dept of Public Health • State public health perspective

  22. Format & Information • Three 20 minute lectures • Opportunity for questions • Videostreamed content • Slides and lectures on internet • www.FERNE.org • Link from www.ICEP.org

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