Bioterrorism Preparedness Program

Smallpox Preparedness

- Health Care Provider Alert -

SMALLPOX VACCINATION ADVISORY
25 January 2003

This alert is an update on information provided to you on December 13, 2001. The military has already begun vaccinating individuals at various sites around the country and locally a smallpox vaccine research project is underway at Memorial Hospital. Also in the very near future HEALTH will begin the voluntary smallpox vaccination of selected health care workers. Details of HEALTH's program will be broadcast later. It is expected that all vaccinated persons will have received instructions to contact the clinic site where they were vaccinated should they have questions, become ill, or need medical attention related to their vaccination. However, it is still possible that in the course of your practice you may encounter recently vaccinated individuals for issues related to their vaccination, or encounter them for other routine care. Physicians and health care facilities should know the following:

INFECTION CONTROL ISSUES:

• Smallpox vaccination produces a skin lesion which is infectious. Vaccinia virus in the skin lesion can be transferred to others if the skin lesion is touched directly or if the bandage is handled casually with ungloved hands. The vaccination site is infectious until the scab falls off, approximately 21 days after vaccination.
• Learn to recognize an active vaccination site. In the unlikely event that an injured and/or comatose person recently vaccinated for smallpox is seen by you, it is important that you know what to look for. There will be a bandage on the deltoid (usually but not always on the left). The bandage may be a transparent semi-occlusive dressing over gauze, gauze secured by paper tape or a bandaid. Images of these will be posted at: http://www.healthri.org/environment/biot
  /smallpoxprepare.htm#pub  If you render medical care to an individual vaccinated for smallpox within the previous 21days who is unable to give a history but who has a bandage as described above, do NOT remove the bandage or touch the vaccination site with ungloved hands.
• If you touch an active vaccination site or the bandage covering it with ungloved hands, wash your hands with soap and water, or with one of the alcohol-based handwash solutions. Bandages must be disposed of in biohazard waste bags.
• Once the scab has fallen off, the vaccination site is no longer infectious.

RESOURCES FOR CONSULTATION:

• If needed, HEALTH suggests consultation with an infectious disease expert or infection control practitioner at your institution for questions on individual patients, as you would for any other infectious disease issue. Patients may also be referred back to the clinic where they were vaccinated.
• If serious adverse events are suspected, report the case immediately to HEALTH at 401-222-2577 (day), or the on-call number 401-272-5952 (after hours). HEALTH can mobilize in-state and Federal specialty consultation, lab testing, and access to drugs as needed.

• It is important that practitioners learn the basics about smallpox vaccination, normal reactions and adverse events. Extensive training resources including images can be found at: www.bt.cdc.gov/training/smallpoxvaccine/
  reactions/default.htm