Education and quarantine management suggested
[Editor’s note: This is the first of a two-part series on how home health agencies should address the threat of bioterrorist events. This month, we look at the most recent information from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) in relation to vaccination for smallpox and first-response teams. Next month, we’ll look at how home health agencies should incorporate bioterrorism into their emergency response plans.)
Although the ACIP recommendations for the use of smallpox vaccine don’t specifically mention the use of home health personnel, it is a logical assumption that home health will play a key role in the event of a smallpox outbreak, according to Steven Christianson, DO, MM, medical director of the Visiting Nurse Service of New York in New York City.
"Home health is one of the only groups of health professionals that practice in all areas of our communities," says Christianson, who testified at the May meeting of ACIP as the recommendations were being developed.
The recommendations that were released for comment in June, but not approved at press time, call for vaccination of response teams and health care professionals that will come into contact with infected people.
"The current CDC plan calls for quarantine of people exposed to but not symptomatic of smallpox in their homes," he says.
These people would need to be evaluated on a regular basis for signs of fever or rash throughout the 15-day incubation period, he adds. "Home care personnel could handle this task with minimal changes to their regular routine to meet CDC criteria."
Christianson proposed the use of home care personnel in four areas:
- public health education;
- community surveillance and reporting;
- quarantine management;
- vaccination health screening and vaccinations.
Although ACIP recommends vaccination of health and law enforcement personnel who would come into contact with infected people in case of a bioterrorism event, the recommendations do not call for vaccination of members of the general public with no known exposure. "More people died from the vaccination rather than smallpox in the 1947 New York City public initiative that immunized 6.7 million persons against smallpox," Christianson says.
According to the ACIP report, "The live smallpox vaccine virus can be transmitted from person to person. In addition to sometimes causing adverse reactions in vaccinated persons, the vaccine virus can cause adverse reactions in the contacts of vaccinated persons." Because of the known risk of adverse effects, ACIP does not recommend vaccination of the general population.
Although the risk of a bioterrorist attack with smallpox is considered small, Christianson points out that home health agencies should take a look at their emergency preparedness plans now to make sure they address bioterrorist attacks of any type.
"Even if your agency has addressed how to handle quarantine issues, vaccinations, and reporting of outbreaks, do other public health and safety organizations in your community have their plans in place? If so, do your plans mesh with their plans?" he asks.
[For more information on smallpox and how home health is affected, contact:
• Steven Christianson, DO, MM, Medical Director, Visiting Nurse Service of New York, 107 E. 70th St., New York, NY 10021. Telephone: (212) 290-4802. E-mail: [email protected].]
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