Kern County Smallpox Preparedness Plan Overview

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Kern County Smallpox Preparedness Plan Overview
Presented by Jessica Núñez, MD, MPH Kern County
Department of Public Health February 24, 2003
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• Essential Functions and Authorities
• Director, Office of Public Health Preparedness
• Deputy Public Health Officer, Kern County
  Department of Public Health

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Public Protection Goals

• To protect the publics health, including every
  resident of Kern County and especially our health
  care and first responder communities
• To prepare for any public health threat
• To respond to any public health threat
• To communicate all necessary emergency guidelines
  to the public

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What is an event?

• Outbreak of Smallpox due to a terrorist attack
• Preparations in advance of any attack are
  considered PRE-EVENT
• Response to any attack/outbreak is post-event

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Post-Event Smallpox Immunization Program

• Would require rapid mobilization and vaccination
  of exposed populations
• No contraindications to vaccine if person truly
  exposed to Smallpox

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Kern County Department of Public Health
Bioterrorism Program Plan Organization
Management Chart
Board of Supervisors
Kern County Public Health Preparedness Advisory
Committee County Administrative Officer Fire
Chief and Emergency Services Director Sheriff
Coroner Resource Management Agency
Director Public Health Officer Emergency Medical
Services Director Environmental Health Services
Director County Counsel Chairman, Board of
Supervisors CEO, Kern Medical Center Waste
Management Director Assistant C.A.O. for General
Services Emergency Services Manager Federal
Bureau of Investigation California Highway
Patrol Edwards Air Force Base Naval Air Weapons
Station, China Lake City Managers Association
Health Officer
MMRS
NPS
Law Enforcement
HAZMAT
Medical
Training
Local Government
Food Water Safety
Legend Focus Area A
Planning B Surveillance C Lab/Bio E
H.A.N. F Risk Communication G Training
Education KCDPH OPHP Kern County Department of
Public Health Office of Public Health
Preparedness MMRS Metropolitan Medical Response
System NPS National Pharmaceutical Stockpile
Kern County Preparedness, Response and Recovery
Plan for Bioterrorism
County of Kern Emergency Plan
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Bioterrorism Focus Areas

• A Preparedness planning and readiness
  assessment
• B Surveillance and epidemiology capacity
• C Laboratory capacity biological
• D Supplemental funding not available

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Bioterrorism Focus Areas

• E Health Alert Network/communication and
  information technology
• F (NEW) Communicating health risks and heath
  information dissemination
• G (NEW) Education and training

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• National Smallpox Vaccination Program (NSVP)
• Presidential Directive Important to National
  Security
• LOW RISK of threat
• Significant health consequences if no proactive
  measures
• VOLUNTARY

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Deaths During the 20th Century

• Due directly or indirectly to armed conflict
• 100,000,000
• Due to smallpox
• 300,000,000
• Conference in Bioterrorism and New and Emerging
  Infections
• per D.A. Henderson M.D., M.P.H., Davis,
  California - December 5, 2002

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Face of Smallpox
www.bt.cdc.gov/agent/smallpox/smallpox-images
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Susceptibility of US Population to Smallpox

• Isolation of patients and vaccination the only
  tools available to stop an epidemic
• Vaccination stopped in 1972
• No persons under 32 years old have been
  vaccinated, and make up 45 of the population
• Persons vaccinated once before 1972 with minimal
  immunity make up 35 of the population
• Conference in Bioterrorism and New and Emerging
  Infections
• per D.A. Henderson M.D., M.P.H., Davis,
  California - December 5, 2002

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Live Vaccinia Virus Vaccine

• This public health measure allowed for the
  eradication of naturally occurring smallpox from
  the planet
• Same vaccine used in 1972
• Administration of this vaccine will adhere to
  national standards, state and local requirements
• Does not contain Smallpox Virus
• Does contain trace amounts of antibiotics

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Vaccinia Vaccine
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Bifurcated Needle

• Live Vaccinia Virus Vaccine Administered with a
  Bifurcated Needle

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www.bt.cdc.gov/agent/smallpox/smallpox-images
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Adverse Reactions to Vaccine

• Mild - Fever, Sore Arm, Lymph Node Swelling,
  Redness/Itching at Inoculation Site, Fatigue,
  Headache, Muscle Ache
• Moderate Outbreak of Sores to Limited to One
  Area, Widespread Rash and/or an Allergic Rash a
  Secondary Bacterial Infection at Inoculation Site
• Serious Rash at Eczema or Atopic Dermatitis
  Site, Rash with Tissue Distruction, Inflammation
  of the Brain, Death (one in a million)

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NVSP Pre-Event VOLUNTARY Smallpox Immunization
Program Kern County

• Phase I Health Care Personnel (Vaccinators)
• Phase II Vaccinators First Responders
• Phase III General Public

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• Top Priorities Pre-Event Phase I
• Target Eligibles
• Educate
• Train
• Vaccinate

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Phase I Eligibility Requirements

• Workers Compensation for Adverse Reactions
• Kern County Employees Covered
• Prior Vaccination History (Kern County
  Requirement)
• National Eligibility Standards for Healthcare
  Workers and Household Contacts must be met

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Not Eligible

• Pregnant Volunteer
• HIV
• Immunocompromised
• History of Eczema or Atopic Dermatitis
• Household Contact under 1 year of age (State
  Requirement)
• Not Previously Vaccinated (Kern County
  Requirement)
• Allergy to Polymyxin B, Streptomycin,
  Tetracycline Neomycin
• Household Contact or Volunteer

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Phase I Pre-Event Preparations for Kern County

• Seven Pre-screening Orientations for Phase I
  Volunteers
• Three Train-the-Trainer Vaccinia Vaccine
  Administration Programs
• One Smallpox Training Overview for the Media
• Two Ad hoc Committee Meetings with members of the
  Emergency Management Council

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Phase I Pre-Event Preparations for Kern County

• Hosted Four Smallpox Satellite Broadcasts
• Development of Clinical Operating Procedures and
  Medical Standing Orders
• Collection of Information and Communication with
  the California Department of Health Services to
  Participate in the Program

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• Future Directions
• Use Pre-Event Planning Lessons Learned to inform
  Post Event Scenario Response Planning and to
  improve Emergency Response Communications and
  Functions

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• Contact Information
• Kern County Department of Public Health
• 1800 Mt. Vernon Avenue, 3rd Floor
• Bakersfield, CA 93306-3302
• Attn Jessica M. Núñez, MD, MPH, Director
• Office of Public Health Preparedness
• [phone], Fax [phone]
• E-mail nunezj_at_co.kern.ca.us
• www.co.kern.ca.us/health