It’s time to make decisions about smallpox
As the reality of smallpox vaccine administration grows nearer, the main question you need to answer is: Who will be offered the vaccine? Phillip L. Coule, MD, director of emergency medical services and emergency care center at the Augusta-based Medical College of Georgia, says, "Not only does our state have a plan for how the vaccine will be rolled out, but our hospital has been working for some time on who we’re going to offer the vaccine to."
Emergency department (ED) managers at the Medical College of Georgia recently participated in a conference call regarding pre-event smallpox immunizations, with only an hour’s advance notice. "We were told there was a definite decision made for how and when Georgia would roll out the vaccine," Coule reports. At press time, the first phase of that state’s smallpox vaccination was to begin on or before Dec. 15.
Although vaccine programs also will be implemented shortly in other states, Georgia is somewhat "ahead of the game" due to excellent lines of communication with the public health department, which arranged the conference call, Coule notes.
Program to start in Atlanta
The vaccine program is slated to begin with the trauma centers that are in the Atlanta metropolitan area and then branch out to the other trauma centers in the state, Coule says. Trauma centers were chosen to receive the vaccine first, because they usually are located in larger metropolitan areas and have effective relationships with the state public health department, he explains. "There is a well-worn path of communication that is very easy to activate for this purpose," he says. "For example, the entire network of trauma centers were all asked to participate in a conference call within one hour, and I believe we had 100% attendance."
Here are some actions being taken:
• The vaccine will be offered to all the ED attending physicians. The plan at the Medical College of Georgia is to have a group of immunized physicians and nurses to care for any suspected patient, to minimize the exposure to staff who haven’t been immunized, Coule explains. "We occasionally will get a patient with an atypical rash that looks like it could be smallpox," he says. In this scenario, the nurse or physician would immediately leave the room, place the patient in isolation, and have an immunized attending physician go in and take care of the patient, in case it turns out to be an actual case, he says.
Vaccinating all attending physicians is the only way the smallpox vaccine program outlined by the Centers for Disease Control and Prevention could work in the ED, says Coule. "Otherwise, the person who is ultimately responsible for the patient is not one of those people going into the room of a suspected case," he says. "A case could come in at any time of the day or night on any shift."
• Not all ED staff will be offered the vaccine. Other ED staff would not be offered the vaccine at this stage, says Coule. "We know that we will not have enough vaccine available to us, at this stage, to offer it to anybody who wants it," he says.
• Staff are being briefed and surveyed. At Inova Health System in Falls Church, VA, a memo is being distributed to staff outlining the relevant issues, along with a one-page survey for all staff to review and complete, says Dan Hanfling, MD, FACEP, director of emergency management and disaster medicine. (See Memorandum and Smallpox Vaccine Screening Survey.) "The purpose of the survey will be to get staff thinking about possible contraindications to smallpox vaccine, and whether they would be eligible, or interested, to receive the vaccine," he says.
Hanfling’s facility will mirror the strategy used by the Jerusalem-based Israeli Ministry of Health by giving the vaccine preferentially to health care providers who have been immunized previously against smallpox. About 15,000 have received the vaccine with no serious side effects reported. "Needless to say, we are doing this in close consultation with our local public health departments, as the logistics for vaccine administration is likely to rest with them," he says.
Hanfling says he’s concerned that the liability issues of the vaccine have not been completely resolved. He notes that vaccine makers and those who administer the vaccine will be covered by the federal government. "But those who receive the vaccine on a voluntary basis are still not covered in the event of any adverse reaction," he says.
Sources
For more information on the smallpox vaccination plans, contact:
• Phillip L. Coule, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia, AF-2037, 1120 15th St., Augusta, GA 30912. Telephone: (706) 721-7144. E-mail: [email protected].
• Dan Hanfling, MD, FACEP, Director, Emergency Management and Disaster Medicine, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042. Telephone: (703) 698-3002. Fax: (703) 698-2893. E-mail: [email protected].
As the reality of smallpox vaccine administration grows nearer, the main question you need to answer is: Who will be offered the vaccine? Emergency department managers at the Medical College of Georgia recently participated in a conference call regarding pre-event smallpox immunizations.
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