Though vaccinations lag, Connecticut forges ahead
Though vaccinations lag, Connecticut forges ahead
State leads in volunteer smallpox inoculations
Although the response to the Bush administration’s voluntary smallpox vaccination has been underwhelming, one northeastern state is moving ahead with its program undeterred.
Connecticut, which claims to have both the first civilian public health official to be vaccinated as well as the first state program initiated, has taken delivery of 6,000 doses of the smallpox vaccine and has begun implementation of its vaccination program with the inoculation of a core team of health care workers from the UCONN (University of Connecticut in Farmington) Health Center.
A genesis team of 15 health care workers received the initial doses, and then proceeded to inoculate others at the state’s 32 hospitals.
"By end of today [Feb. 14], we expect to have 90-plus people vaccinated," says William Gerrish, spokesman for the Connecticut Department of Public Health in Hartford. "We were the first in the nation to start the program, and we are very pleased with our progress to date."
The state’s goal is to establish core teams in acute care hospitals in the state, thus creating a core group ready to respond in case of a smallpox outbreak in the state.
Jim Hadler, MD, the state epidemiologist, has been identified as the first civilian public health official publicly vaccinated since the announcement of the government’s voluntary inoculation program.
"On both counts — from a personal perspective and in terms of the statewide program — I didn’t feel any reluctance to roll out the program and encourage hospitals to participate," says Hadler. "We wanted every hospital to at least offer the vaccinations. For me as an individual, I felt the risk I was taking was very, very small, and of course in my job, I have the potential to be exposed to smallpox so it was worth doing. But everyone must make the decision for themselves."
A detailed plan
Connecticut was particularly well positioned to respond to the call for voluntary vaccinations, because it had already been developing bioterrorism and smallpox response plans. Under its Stage I smallpox plan, the state will offer the vaccine
to designated health professionals identified by hospitals, local health departments, and the state Department of Public Health who have volunteered to make up the first-response teams. The plan was based on guidance from and ultimately approved by Atlanta-based Centers for Disease Control and Prevention (CDC).
"From our perspective, we know we don’t have a dedicated smallpox facility; a person could show up in any acute care facility, so we asked all acute care facilities to identify response teams and have protocols in place," Hadler explains. "Then the issue becomes this: We also want you to offer the vaccine to people who would be part of your smallpox response team."
The Stage I plan:
- involves approximately 6,000 health care and public health response workers;
- includes full involvement and support of the state’s 32 acute care hospitals;
- includes full involvement of the state’s 98 local health departments and districts;
- establishes 32 hospital-based smallpox medical care teams with a full contingent of inpatient and emergency room health care worker teams, including various clinical specialists, nurses, technicians, mental health professionals, and housekeeping staff. Each hospital-based team would include approximately 140 volunteers per hospital for a total of approximately 4,600 hospital-based volunteer statewide;
- establishes smallpox field response teams (1,400 volunteers) in the event Connecticut needs mass-vaccination clinics;
- The University of Connecticut Health Center serves as the genesis team to be the primary vaccinator of the smallpox medical care and field response teams.
One of the major reasons such a plan is needed for health care workers is because a smallpox outbreak "would be an occupational health problem, especially for people in emergency departments," says Hadler.
"That’s the common pathway," he explains. "It may take up to six days before someone can look like they may have smallpox. "It might take two days for the rash to develop and three or four more to positively identify smallpox. So by then it may be too late to vaccinate [health care workers]." That’s why, he notes, in addition to recommending vaccinations, specific additional protocols are required, such as masking all staff who care for patients with fevers and rash.
"In Europe in the ’50s and ’60s, there was no smallpox, but people would travel to India and return with the disease, and it would be transmitted to others," Hadler notes. "More than 50% of the transmissions were to health care workers. This argues in favor of having the vaccination, or at least, offering it to those who want it."
And to whom will it be offered? In general, the state is looking for response teams to include personnel in hospitals who might first come in contact with an infected patient, as well as those public health personnel who would be assigned to investigate cases, track contacts, vaccinate people, and institute measures to control the spread of disease.
"We are working with representatives sent from the hospitals," says Hadler. "With the basic team, there should be a fair degree of protection in the ED — all the doctors and at least one-third of the emergency technicians. On the inpatient side, you need people who can take care of patients in the ICU for seven days while the others get vaccinated. This can include ICU nurses and docs, infectious disease specialists and a smattering of other specialists. If you do this and follow the right infection control protocols, you should be well protected."
After putting out its guidance on response team composition to every hospital, the department then provided a three-hour statewide training session about smallpox for the teams members that had been selected. The topics included a wealth of information about smallpox and how to control it — all from an occupational health perspective. "For people in a certain type of work, this is an occupational disease, and it is preventable if you are vaccinated," Hadler asserts.
The Connecticut plan is ahead of schedule, according to Gerrish. "One factor in our success has been our collaborative approach — the team that has been working all along on bioterrorism
is now working on this initiative," he observes. "Plus, a very strong partnership has developed between Connecticut’s hospitals and their local health partners."
Details on the Connecticut plan may be found at: www.dph.state.ct.us.
[For more information, contact:
- Jim Hadler, MD, Connecticut State Epidemiologist, State Department of Public Health, 410 Capital Ave., MS#13CMN, P.O. Box 34038, Hartford, CT 01634-0308. Telephone: (860) 509-7995.]
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