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MASS VACCINATION AND PROPHYLAXIS

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MASS VACCINATION AND PROPHYLAXIS

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    1. MASS VACCINATION AND PROPHYLAXIS History Planning Common Sense Practical Logistics

    3. Immunization-active immunity produced by a vaccine Vaccination- (L vacca-cow)-process of vaccine administration

    4. Vaccines are used to prevent disease before exposure in animals and humans

    5. Active vaccines Live, attenuated – often produce antibody with one dose (10-14 days) Inactivated – often require multiple doses over extended period of time to achieve antibody (>6 months) Passive Delivery of antibodies (Human,animal - RIG, VZIG,SIG,IG) Usually used after exposure, maybe used in conjunction with inactivated active agent, to prevent immediate disease and long-term

    6. Vaccination Utility in acute outbreaks to stop disease and transmission Depends on may variables Disease characteristics: communicability, natural pathogen, carriage, disease pattern Vaccine: live or inactivated, efficacy/dose, availability, side effect profile Ability to reach target populations in a specific time period or long-term strategy

    7. What is “mass vaccination” Delivery of vaccine to all people who need them Immediate need – imminent danger of disease in non-immunized population Sustained need – vaccine is used to control and eliminate disease

    8. On 21 January 2001, Rotary volunteers from Philadelphia, Pa., USA, Bakersfield, Calif., USA, Riverside, Calif., and Aomori, Japan, joined Rotary club members in India to administer the polio vaccine to more than 150 million children throughout the country in a single day.

    9. In the U.S. “Controlled, continuous mass vaccination” requirements (schools, military) recommendations, standards of practice, vaccination strategies are sophisticated and considered best accomplished in a medical home (primary care) “mass” vaccination clinics or “round-ups” are rarely used in the U.S. Influenza requires some controlled, limited round-up mass vaccination (health departments, drug stores, senior centers, drop-in availability)

    11. General public expectations The general public perceptions about vaccines from phone calls I get: something that is needed after a disaster, to get into school, exotic travel mass clinics will be readily available to protect them from a dangerous disease the government has a responsibility to protect them but does not tell them the whole story greatly influenced by media “and there working on a vaccine…”

    12. Bioterrorism Requires planning for the ability to respond and control diseases with vaccines Requires the ability to set-up and conduct mass prophylaxis and vaccination clinics Part of over all readiness

    13. Mass Vaccination Campaigns.. Through History Jenner described smallpox “inoculations” 1800-1970’s Smallpox was a dangerous threat; evidence of use as a military weapon “mass” smallpox vaccinations ~1852 compulsory vaccination in England, many dissenters, fears of vaccines, laws rescinded “routine” vaccine to develop population immunity (herd immunity) ~1900’s, post WWII major acceptance

    15. Next I would like to discuss what has been done to help evaluate public perceptions about vaccine safety. This part of the presentation will focus more on how parents perceive this issueNext I would like to discuss what has been done to help evaluate public perceptions about vaccine safety. This part of the presentation will focus more on how parents perceive this issue

    16. Mass Vaccination Campaigns…Through History Pasteur: Cholera, rabies, anthrax (animal) Not used in “mass” campaigns but used enough to get the public increasingly interested in vaccines and “inoculations” Development of animal vaccines was very significant

    17. Mass Vaccination Campaigns.. 1940’s Military – “Join the Army …See the world…Get vaccinated” Huge user of vaccines, mass vaccination of recruits Tetanus Immune Globulin (equine) WW I and WW II Tetanus toxoid – WW II military, targeted populations (types of mass vaccination) Routine civilian use of tetanus,diphtheria (Td) after WW II

    18. Influenza Vaccine developed in 1936 Evidence of protective efficacy – 1950’s Antigenic flu shift 1957, 1968 Lead to “mass” flu vaccine campaigns in 1950-1960’s based loosely on polio campaigns Last nationwide, government lead vaccine campaign was “swine flu”, 1974

    20. Notable Smallpox Campaign NYC 1947 Be sure, be safe, get vaccinated!" NYC Mass Vaccination Campaign Slogan Beginning of advertising mass vaccination Campaign of “urban legend”

    22. Polio “Mass” Vaccination Campaigns 1954-1965

    24. 1970-1990’s Some mass “catch-up” mass campaigns – measles, rubella Introduction of school laws – “mass” campaigns to get kids immunized to go to school Volunteering in developing countries to control disease with vaccines

    25. Mass Vaccinations – Developing Countries Charitable campaigns via well known organizations – Rotary, Kiwanis, Gates Foundation

    26. 2000’s A New Century Intentional bioterrorism “Project BioShield” New diseases and complex medical conditions New era of bioengineered vaccines and chemo prophylaxis Scientific advances New laws and personal protections

    28. 'The Government Must Plan for Mass Vaccinations' by Arlene Getz | Jul 10 '02 Newsweek Reality: There is no infrastructure for sustained mass vaccination in the U.S. Reality: Little recent practical experience with mass vaccination Rely on computer modeling, planning and exercises Reality: Mass vaccination is effective against very few diseases Few live vaccines, inactiviated vaccines take multiple doses, no real supply of passive agents.

    29. Sepkowitz KA. The 1947 smallpox vaccination campaign in New York City, revisited. Emerg Infect Dis 2004 May

    30. Five Components for MVC Organization and systems management Communication Coordination Competent work force Information and data management systems

    31. Organization and Systems Management Need a written, comprehensive, and practiced plan Command structure Logistics (vaccines, chemoprophylaxis, disease control strategies) Security Communication Data collection and follow-up Staffing

    32. Smallpox In 1947, millions of New Yorkers received smallpox vaccinations…. Although now mythologic, a review of the events of April 1947, from copies of The New York Times, tells of a more recognizably human response: pushing, jawing, deceit, shortages, surpluses, and perhaps a unusual way of counting vaccinees.

    33. Vaccines and Long Term Strategies Vaccines take long time to make Huge volumes of vaccine would be needed for “mass” campaigns, sustained campaigns Chemoprophylaxis accompanying vaccines (?) Staff and supplies to administer Personal health care responsibility

    35. What needs to be developed Simple, well developed mass vaccination plans National, state, LHD Sustained vaccine supplies and availability Drills and practice that encompass community, state

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