Bioterrorism/smallpox information and resources

Bioterrorism/smallpox information and resources

Smallpox Information and Resources

On Dec. 13, 2002, President Bush announced a plan to better protect the American people against the threat of smallpox attack by hostile groups or governments. For several months, many groups in Connecticut have been involved in developing plans for the three-tier staging of smallpox vaccinations. Four health-care workers who had volunteered to receive the first round (first tier) were vaccinated against smallpox on January 24, 2003. The January date was the first day that the law providing liability protection for individuals giving the vaccinations took effect.

The first vaccinations were given to officials from Connecticut’s Department of Public Health and medical personnel from UConn Health Care Center. It is expected that personnel from the first tier group (Genesis), who are from the Department of Public Health and UConn Health Center, will travel to various state hospitals in mid-February, administering the vaccine to other doctors, nurses and nurse practitioners who volunteer for the program. For more Connecticut bioterrorism information:

Secretary Thompson Issues Declaration to Begin Smallpox Vaccination Program

As required by the Homeland Security Act, HHS Secretary Thompson signed a declaration to begin the smallpox vaccination program on Friday, January 24, 2003. The declaration outlines the reasons for the program and the specific actions to be taken. According to the HHS press release (available at, the Centers for Disease Control and Prevention delivered vaccine to Connecticut, Nebraska, Vermont and Los Angeles County. Below, please find the first five (5) sections of the declaration.




1) The attacks of September and,October 2001 have heightened concern that terrorists may have access to the smallpox virus and attempt to use it against the American public and U.S. government facilities abroad.

2) In light of these concerns, and in order to advance the public health and national security, the president announced the smallpox vaccination program on December 13, 2002.

3) Given the potential for a bioterrorist incident, administration of smallpox countermeasures is advisable within the terms of this declaration.

4) Smallpox vaccine is currently recommended domestically only for smallpox response teams, health-care workers and emergency response workers.

5) The U.S. government is making smallpox countermeasures available to personnel associated with certain U.S. facilities abroad and, administration of these countermeasures to such personnel is advisable within the terms of this declaration.

6) Liability protections for manufacturers and distributors of smallpox countermeasures and the hospitals, health care facilities, and health care workers who will receive them and treat potentially infected smallpox cases are integral to ensuring maximum participation in the vaccination program.

7) Section 304 of the Homeland Security Act (P.L. 107-296) is intended to alleviate liability concerns and therefore ensure that vaccine is available if necessary to protect the public health.

8) Administration of a countermeasure such as smallpox vaccine is necessarily more involved than the act of placing a drop of vaccine on a two-pronged needle and inoculating a person’s arm. Determining who is contraindicated; monitoring, management, and care of the countermeasure site; evaluation of countermeasure “takes”; and contact transmission of vaccinia, among other things, all arise out of and are directly related to and part of the administration of the countermeasure. All such acts also potentially give rise to legal liability that, without sufficient protections, may significantly discourage participation in the smallpox vaccination program.

9) Under current domestic planning, many health-care entities will designate individuals to receive countermeasures at a hospital or vaccination clinic determined by the state. To achieve a successful vaccination program and because it is impractical to have countermeasures administered at every health-care entity involved in the program, it is critical that health-care entities participate in this manner and that their personnel be protected while acting within their scope of employment.

10)It is important to the successful implementation of the vaccination program that those workers employed by health-care entities under whose auspices a countermeasure is administered be protected by Section 304 while acting within the scope of their employment.

11) Health-care entities use numerous staffing arrangements to carry out daily functions. Individuals designated to receive covered countermeasures and subsequently treat potential smallpox cases may fall into any of these arrangements. Liability protection for these individuals, to the extent described below, is necessary to encourage participation in the smallpox vaccination program.

12)Based upon scientific data from animal model studies examining Cidofivir’s effectiveness in treating lethal pox virus infections that are similar to smallpox, Cidofivir may be useful in treating smallpox in humans.


I, Tommy G. Thompson, Secretary of the Department of Health and Human Services, have concluded, in accordance with authority vested in me under section 224(p)(2)(A) of the Public Health Service Act, that a potential bioterrorist incident makes it advisable to administer, on a voluntary basis, covered countermeasures specified in this declaration for prevention or treatment of smallpox or control or treatment of adverse events related to smallpox vaccination, to categories of individuals named in this declaration. The countermeasures set forth below shall be considered to be administered pursuant to this declaration when used for prevention or treatment of smallpox, or to control or treat the adverse effects of smallpox vaccination.

This declaration may be amended as circumstances require.


Countermeasures to be administered pursuant to this declaration are:

1) Vaccinia (Smallpox) Vaccines, including the Dryvax vaccine;

2) Cidofivir and derivatives thereof;

3) Vaccinia Immune Globulin (VIG).

IV. INDIVIDUALS COVERED BY THIS DECLARATION: Individuals to whom it is advisable to administer the covered countermeasures specified above are:

1) Health-care workers who may be called upon to monitor or treat any persons who are either (a) covered by this declaration or (b) are deemed to be individuals to whom a covered countermeasure was administered by a qualified person, whether domestically or abroad, pursuant to section 224(p)(2)(C) of the Public Health Service Act;

2) Any person who is a member of a smallpox response team or teams identified by state[s] or local government entities or the United States Department of Health and Human Services;

3) Public safety personnel, including, but not limited to, law enforcement officers, firefighters, security, and emergency medical personnel who may be called upon to assist smallpox response teams specified in paragraph IV(2) above; and

4) Personnel associated with certain U.S. Government facilities abroad.

V. EFFECTIVE DATES: The declaration is effective January 24, 2003 until and including January 23, 2004. The effective period may be extended or shortened by subsequent amendment to this declaration.

Institute of Medicine report on Smallpox

In January the Institute of Medicine (IOM) released its report, Review of the Centers for Disease Control and Prevention’s Smallpox Vaccination Program Implementation, Letter Report #1. This report includes 23 substantive recommendations with regard to the current implementation plans for smallpox vaccination. The document is available at html/smallp vac/Itr report.pdf.

ANA has prepared a PDF-formatted document that reviews the IOM recommendations and speaks to ANA’s policy recommendations that are in concert with the IOM. ANA’s review is posted on NursingWorld at news/disaster/smallpox.htm. Connecticut Nurses’ Association has been involved with discussions with regard to implementation of the smallpox vaccination and has used these recommendations.

States report variance, drop in smallpox vaccine plans

The Los Angeles Times reported in January that its own telephone survey of public health officials in 20 states indicates the number of frontline health-care workers expected to volunteer to be inoculated against smallpox has shrunk dramatically and some states are still months away from launching their vaccination campaigns. The officials cited several reasons, including what they said was a lack of additional liability protections for hospitals, the absence of guaranteed compensation for vaccinated health care workers who lose time on the job, a growing sense that a smallpox attack is not imminent, and a deeper understanding of the vaccine’s risks.

Results from Bioterrorism and Smallpox Survey

The Robert Wood Johnson Foundation has released the report “Americans Speak Out on Bioterrorism and U.S. Preparedness to Address Risk” that summarizes the results from a bioterrorism and smallpox survey. Go to: http://

Connecticut Nurses’ Association receives official CDC Health Updates through Health Alert Network

Official CDC Health Update Distributed via Health Alert Network

When a potential public health emergency occurs, the Centers for Disease Control and Prevention Web site ( http://www.cdc. gov) can be your source for timely, accurate and scientifically precise information to help prepare you as situations develop. Facts, resources, guidelines, plans and frequently asked questions are available about plague, ricin, smallpox, radiological emergencies, anthrax, mass trauma, biological agents, chemical agents and the national pharmaceutical stockpile.

Many Nurses Lack Understanding of Smallpox, Poll Says

According to a nationwide survey released on January 22, 2003 by the National Network for Immunization Information (NNii), few nurses have a good understanding of the smallpox disease or the vaccine.

Of 2,661 nurses polled, about 1 in 5 is aware that immunization given within a few days of exposure to the deadly virus will prevent the disease. More than half the nurses surveyed also mistakenly thought smallpox could be spread to someone a few feet away.

Twenty-two democratic senators, led by Edward M. Kennedy (Mass.), sent a letter to President Bush pressing for a federal fund that would pay for treatment and lost work time of anyone with serious complications from direct vaccination or inadvertent spreading of the live vaccine.

Louis Sullivan, co-chairman of the immunization network and former secretary of Health and Human Services, said the survey highlights the need for extensive education of a medical workforce that is largely too young to have encountered smallpox-or even the vaccine. “They need to be sure they are comfortable with their level of knowledge” before they can be vaccinated or begin vaccinating others, he said.

* For more information, see the press release on this study pressroom/release.cfm?ID=16

* ANA has issued a statement in response to the press release. Please visit http://www.

* The study “Nurses’ Perceptions and Intentions Regarding Smallpox Vaccine: A National Survey,” can be accessed online at index.cfm?ID=511

Copyright Connecticut Nurses’ Association Mar-May 2003

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