Smallpox Vaccine Use ACIPNVAC Smallpox Working Group - PowerPoint PPT Presentation
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Smallpox Vaccine Use ACIPNVAC Smallpox Working Group
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About 400 members from all states and territories ... and epidemiology of infectious diseases, chronic diseases and conditions, and ... – PowerPoint PPT presentation
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Title: Smallpox Vaccine Use ACIPNVAC Smallpox Working Group
1
Smallpox Vaccine UseACIP-NVAC Smallpox Working
Group
- Gianfranco Pezzino, MD, MPH
- Council of State and Territorial Epidemiologists
- Gpezzino_at_kdhe.state.ks.us
- 785, 296-6179
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CSTE Who we are
- Council of State and Territorial Epidemiologists
- Organized in early 50s
- Promotes the effective use of epidemiologic data
to guide public health practice - About 400 members from all states and
territories - Members engaged in practice of epidemiology at
the state level - Focus on surveillance and epidemiology of
infectious diseases, chronic diseases and
conditions, and environmental health
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Public Health Decision Process
How Common?
How Severe?
How Preventable?
_________________
Science
4
Public Health Decision Process
How Common?
Public Perception
External factors (e.g., economics, politics)
How Severe?
How Preventable?
Societal, ethical, and individual values
_________________
_________________
Science
Other Forces
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Public Health Decision Process
How Common?
Public Perception
External factors (e.g., economics, politics)
How Severe?
Societal, ethical, and individual values
How Preventable?
_________________
_________________
Science
Other Forces
Priorities, Policies
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The Science
- How common?
- Smallpox is the only disease on earth eradicated
from nature - Current risk is UNKNOWN!
- How serious?
- Very
- How preventable?
- Very preventable, BUT at a price
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The Other Forces
- Public fear may easily escalate
- Public perception
- Preferential treatment for privileged groups
- Trust What is the government hiding?
- Ethical issues
- Individual freedom versus the good of the whole
- Practical issues
- States want their own internal first response
capacity - Timing is essential (e.g., immediate interview of
index case while still conscious, immediate
contact tracing) - Unprotected first responders may not be available
when needed
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The Answers
- General Principles
- Any distribution of vaccine should be limited to
the minimum required to achieve the desired goals - Most CSTE members favor restrictive policies in
vaccine use before event - Epidemiologic data should ALWAYS be considered
when formulating vaccine policies - Public discussion and information are essential
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Question 1 Pre-event vaccination of the general
population
- Permissive use not recommended at this time
- Illness and deaths from side effects greater than
from disease - Availability for general population not
recommended until - Risk of disease is quantifiable and substantial
- Vaccine is available outside I.N.D.
- Vaccine availability is assured to control
outbreaks - VIG availability is assured to control vaccine
side effects
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Questions 2 - Should early responders be
vaccinated before an event?
- Most difficult and divisive of all the questions
- No to a mass vaccination of all first responders
- Consider a limited vaccination of people involved
in immediate first response likely to be in
contact with index case(s) - Eligible individuals identified in the context of
statewide smallpox response plan, e.g. - Some staff of Level C (containment) structure
- State/local public health rapid response teams
- Adequate screening for contraindications and
follow up must be assured - Practical challenge to define target population
- Apply uniform criteria
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Question 3 Is ring vaccination the control
strategy of choice?
- Yes, in the absence of evidence in favor of
alternative strategies - Doubts about feasibility and efficacy of ring
vaccination under a BT scenario remain - Extent of required activities
- Multiple foci intentionally spread in a
non-natural fashion - Quickly analyze epidemiologic data and modify
recommendations accordingly - Population-wide campaign at local, regional, or
national level may become necessary after cases
appear
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Additional Comments
- Need for broad discussion, consensus process
- Vaccine prepositioning should be considered
- Public Information is of paramount importance
- Regardless the option chosen, the public and
first responders must receive adequate
information and explanation - Issue must be revisited as assumptions change
- Any guidelines from ACIP should be considered as
preliminary and subject to change based on new
evidence - Is there a rapid mechanism for this?
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